Trouble shooting alarm in icu PRESENTATION.pptx

Trouble shooting

1. TROUBLE SHOOTING ALARM IN ICU BY Keerthana Priya.V critical care therapist

2. OUTLINE VENTILTOR ALARM -PRESSURE ALARM -LOW AND HIGH PRESSURE -VOLUME ALARM -HIGH AND LOW MINUTE VOLUME -TIDAL VOLUME PEEP ALARM PRECAUTIONS SERVCING AND TESTING HEMODYNAMIC TROUBLE SHOOTING BIPAP TROUBLESHOOTING HFNC TROUBLESHOOTING

3. INTRODUCTION Troubleshooting and monitoring is an important part of ventilator handling. One needs to be alert and aware of the various alarms as it guides to the proper alarms are there in the ventilator and can be divided into the following types: 1. Pressure alarms 2. Volume alarms 3. Respiratory rate alarms 4. Positive end-expiratory (PEEP) alarms 5. Oxygenation

4. VENTILATOR ALARM CHECKLIST PRESSURE ALARMS High-Pressure Alarm Increased secretions are in the airway. Wheezing or bronchospasm causes decreased airway size. The endotracheal tube is displaced. The ventilator tube is obstructed because of water or a kink in the. tubing. Patient coughs, gags, or bites on the oral endotracheal tube. Patient is anxious or fights the ventilator. Low-Pressure Alarm Disconnection or leak in the ventilator or in the Patient’s air-way cuff occurs. client stops spontaneous breathing.

5. APNEA ALARM An  apnea alarm  in mechanical ventilation is triggered whenever the breathing frequency falls below a preset low frequency limit. This alarm ensures that the patient receives a minimum number breaths . Troubleshooting Check for leaks or disconnections in the circuit. Inspect for leaks or disconnections in the artificial airway. Increase the amount of ventilator support to assist the patient’s breathing efforts. Adjust the sensitivity setting to ensure the ventilator responds appropriately to the patient’s breathing attempts.

6. VOLUME ALARAMS - Low expired minute volume alarm − Loss of system pressure - Power failure - Source gas failure - Air compressor failure. − Loss of circuit volume - Circuit disconnection - Loose circuit connection - Loose humidifier connection - Leak around ET tube. − Inappropriate ventilator settings - Low minute volume limit set too high - Inappropriate sensitivity settings.

7. RESPIRATORY RATE ALARMS High respiratory rate alarm - Patient experienced tachypnea—need to increase ventilation - Inappropriate sensitivity settings—increase trigger sensitivity. Apnea alarm - Set to insure a minimum number of breaths to be delivered - Disconnection of ventilator circuit from ET tube - Respiratory depression - Respiratory muscle fatigue . - Use of muscle paralyzing agents . - Some ventilators switch to back up ventilation

8. Positive end-expiratory (PEEP) Alarms Auto PEEP (Intrinsic PEEP, inadvertent PEEP) − Causes - Significant airway obstruction with air trapping - Rapid respiratory rates - Small expiratory time. Auto PEEP increases work of breathing - Ventilator initiates breath when the positive pressure reaches the sensitivity setting - lf auto PEEP present, the work of breathing is increased because the level of auto PEEP must first be overcome before the sensitivity setting is to be reached. − Strategies to reduce auto PEEP - Improve ventilation and reduce air trapping by bronchodilators - Decrease the respiratory rate and prolong the expiratory time. − Using PEEP to reduce the effects of auto PEEP - Increase PEEP to 85% of the measured auto PEEP level

9. OXYGENATION ALARM Low FiO2 alarm - Oxygen source failure - Oxygen sensor failure - Faulty oxygen blender. High FiO2 alarm - Air source failure - Faulty oxygen blender

10. General Troubleshooting Tips Assess the Patient First:  Before adjusting ventilator settings, always assess the patient’s clinical status and ensure their airway is clear and secure. Check Ventilator Settings:  Verify that the ventilator settings are appropriate for the patient’s current condition. Inspect the Equipment:  Regularly inspect the ventilator and its accessories for any signs of malfunction or disconnection. Educate the Staff:  Ensure that all staff members are familiar with the ventilator’s alarms and know the initial steps for troubleshooting.

11. Power: ➢ Plug into a grounded AC power. ➢Secure the power cord properly. Battery Back up: ➢ Check the battery level before connecting. ➢ Charging should be carried out regularly. ➢ Remember it is for short term use. Precautions that would reduce troubles

12. SERVICING AND TESTING Qualified personnel should undertake servicing. ➢Ventilator housing should not be opened while it is still connected with power. ➢Follow the specifications mentioned in the service manual. ➢Use replacement parts supplied by the manufacturer only.

13. POINTS TO REMEMBER Never ignore an alarm. ➢Never mute the alarm on regular basis. ➢Find out for yourself what alarm is on. ➢Check the patient. ➢Silence the alarm.

14. DO NOT BE LIKE THIS!!!

15. HEMODYNAMIC TROUBLESHOOTING

16. ARTERIAL LINE PROBLEM SOLUTION Unable to aspirate cannula when undertaking blood sampling. Check arterial cannula for any kinks/incorrect position of the 3-way tap. Apply gentle traction to the cannula. Gently try to flush. Inform medical staff if unable to flush. Arterial cannula may need to be replaced. Loss of waveform Abnormal waveform. Dampened waveform Arterial catheter may be kinked: dressing may need to be removed to allow inspection at the insertion site. Sensor cable: check sensor cable has a secure connection to the transducer base. Pressure infusor may have lost it inflation pressure: check inflation pressure and maintain inflation at 300mmHg.

17. PROBLEM SOLUTION Difficulty with zeroing. Check all equipment and connections between patient and monitor. Check that the sensor cable is securely connected to the transducer base. Ensure all roller clamps are open and 3-way taps are in correct position. Check system for air bubbles and clots. Perform recalibration/zeroing procedure.

18. BIPAP TROUBLESHOOTING PROBLEM SUGGESTIONS Persistent Apnea Alarm Check patient, is the patient breathing? Is the patient conscious? Check circuit connected. Check mask fitting and leak. Check trigger settings. Check backup rate Mask Leaks Small leaks (20-35L/min) are normal and acceptable but larger leaks (>50L/min) may cause inefficient ventilation, eye irritation, noise, dry mouth and nasal symptoms. Leaks Asynchrony between patient and ventilator Check correct tubing is used in the circuit. If the patient’s respiratory effort is inadequate the machine may not sense inspiration. An increase in EPAP may help. If the patient is tachypnea increasing the IPAP may help. Changing the TRIGGER setting may improve asynchrony (making the machine MORE or LESS sensitive to the patient’s flow), seek senior support for changes to trigger setting.

19. PROBLEM SUGGESTION Hypercapnia / alkalosis Minute ventilation is too high. Reduce IPAP to reduce Tidal Volumes. IPAP not achieved If the measured IPAP is lower than the set IPAP by >0.5cmH2O (e.g. IPAP set at 18 but measured IPAP is showing as 17.4) consider changing the Rise Time to a lower setting. E.g. reducing from 3 to 2. Allowing a faster flow during inspiration. Low tidal volume alarm Low estimated tidal volume, check alarm settings Check leak – adjust mask if >40L/min. Consider increasing IPAP Patients with OSA may tolerate higher IPAP. High tidal volume alarm High estimated tidal volume, check alarm settings, aim tidal volume 360-480ml (or approx. 400-500ml). Consider decreasing IPAP (requires senior review)

20. HFNC TROUBLE SHOOTING ALARM ICON CAUSE ACTION Water out Sterile water empty, or obstructed inlet tube. Replace water bag or straighten inlet tube. Restart unit. If alarm persists, disconnect patient from therapy General fault and in flow (flashing) Internal component failure or insufficient gas pressure Check gas supply. If not corrected, disconnect patient. Unplug AC power, press and hold Run/Standby button for 3 seconds to clear the alarm, send for service. Temperature numeric display flashes User enters set point much lower than previous temperature. Very low water temperature after bag replacement. Silence alarm and wait for temperature to drop. Silence alarm and wait for temperature to rise.