1 VENTILATOR AND SCI TRAINING 2 Payment of Expenses Please note that to claim for any travel...
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Transcript of 1 VENTILATOR AND SCI TRAINING 2 Payment of Expenses Please note that to claim for any travel...
1
VENTILATOR AND SCI
TRAINING
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Payment of ExpensesPlease note that to claim for any travel expenses you must: • Please make sure that you sign in. This sheet triggers your
certificate and is also verification of your attendance for your payment for today, as well as your intention to claim expenses.
• Please list today's training on your time sheet as “Ventilator and SCI Training in the community” and state where this training took place.
• Send in with your time sheet a completed expenses sheet (provided here today) with a valid receipt.
• Failure to do both of these may result in a delay in your payment or not receiving payment at all.
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What is mechanical ventilation?• Short term or long term • Invasive (trachy) or non-invasive (face mask)?• Used by those with neuro-muscular diseases, spinal
injury (C4), polio, emphysema or chronic bronchitis• Sometimes used just overnight• Often first used in ICU.• Ventilators in the community are often smaller, light
weight and portable with an external battery.• A ventilator can take over the act of breathing
completely or make breathing easier by assisting weakened respiratory muscles.
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Daily Checks of Ventilator
• Check :
• Tidal Volume
• Rate of breath given per minute
• Setting of low pressure alarm
• Setting of high pressure alarm
• I/E Ratio (Airway Pressure)
• Power source
Spinal Cord Injury - Causes
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Spinalcolumn
anatomy
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TRACHEOSTOMY CARE1. What is a Tracheostomy?2. Different types of Trachy tubes3. Essential safety Equipment.4. Changing the inner tube.5. Changing the tape and dressing.6. Infection and action.7. Changing the whole
tracheostomy.
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What is a Tracheostomy?
It is a surgical opening in the windpipe between the 3rd and 4th tracheal rings into which a tube is inserted.
Different Types of Trachy tubes1. Plastic tube
2. Metal tube
3.Silicone Tube
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4. Fenestrated tube (helps with speech)
5. Cuffed tube, to initially keep in place
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Essential Safety Equipment
• Ambu Bag• 2x tracheostomy tubes. 1 same,
1one size smaller.• spare inner (if used)• Dressing• Tube holder• Lubricant gel• Syringe (if cuffed)• Gloves• Hand gel• Suction catheters• Extension lead• Supra pubic catheter and equipment
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Changing the inner tube• One person.• Is the emergency equipment checked and
nearby?• Disconnect ventilator, rest on clean gauze.• Wear gloves, hold the flange of the trachy
firmly while removing the inner tube.• If clean reinsert, if soiled insert new inner.• Immediately reconnect ventilator.• Clean soiled inner and store in clean dry
container.• Dispose of all waste appropriately (is the
inner tube to be kept as a spare)
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Changing the whole tracheostomy
• Prepare equipment, clean site• One clean, one dirty nurse• Take client off the ventilator• Dirty nurse removes old trachy • Clean nurse inserts new trachy• Clean nurse removes guiding tube • Clean nurse inserts inner tube• Put client back on ventilator• Redo collar
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Changing the holder and dressing
• Two people, one person should hold the tube and observe the client.
• Prepare all equipment before you start• Is the emergency equipment checked and nearby?• Wear gloves, remove the old dressing and holder.• Change gloves, clean the site, replace dressing and
holder.• Dispose of all waste appropriately.
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SIGNS of INFECTIONat the trachy site
• Redness• Wet appearance• Odour from site or
dressing• Soreness• Skin breakdown• Temperature• Pain
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Tracheostomy Site Infected
ACTION• Swab if available and
know how.• Change dressing
as/when becomes soiled.
• Any other signs?• Document.• Communicate.• If persists – contact
GP
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Suctioning – WHY and WHEN?
• To keep the airway clear of secretions.
• Reduce the risk of airway blockage.• Reduce the risk of infection.• Dependent on need• Client ability to cough.• Amount and consistency of
secretions
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Suctioning – How
Equipment• Suction unit- set at 120-150mmHg• Correct size catheters (-2x2)• Gloves• Water to rinse tubing.• Yankeur.• Closed-circuit
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Suctioning - How• Open catheter enough to attach to tubing remove some plastic covering• Switch on machine (listen)• Wear gloves• Use one hand to hold suction catheter, do not let it touch anything• Use other hand to access the trachy• Pass the catheter to approx 1/3rd length/ feel resistance. Pull back 1cm.• Apply suction and slowly remove (no more than 15secs) unless client can
breathe• Reconnect ventilator (ask client, remove catheter mount and listen)• Watch for signs of respiratory distress• Observe colour/amount/consistency of sputum. (plugs)• Document, report any changes
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Suctioning- Complications
• Damage to delicate lining of trachea and lungs. (check for blood)
• Lack of oxygen.
• Infection.
• Bronchial spasm.
• Increased secretions.
• Consider assisted cough
Alternative to Suctioning – Assisted Cough
If your cough is weak you can have an assisted cough:• Place the heel of one hand on your client’s abdomen just above the navel.• Place the second hand on top of the first hand with straight elbows.• The client takes a deep breath.• Push upwards and under the client’s ribs at the same time the client attempts to cough.
Make sure:
1.If client is in wheelchair, the brakes are on.
2.Client is not pregnant.
3.Client has not recently eaten.
Day 1 Finish 20
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Humidification
• Tracheostomy bypasses the nose which warms and moistens air breathed in.
• Cold dry air causes lung damage and dries secretions which then become sticky and thick. This can cause tube blockage (plugs).
• HME (heat and moisture exchanger) filter in ventilator circuit.
• ‘Wet’ system, water is warmed by a machine and humidified air fed into the ventilator circuit.
Why?
How?
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ALARMS- know what to do.
• Alarms are there to warn you of a problem• Do not silence them unless you are doing something to
rectify the problem.• By understanding how the ventilator is supporting the
client you can take the right action if an alarm sounds.• If there is a continuing problem, report immediately.• Alarm setting should be reviewed by the medical team
when the client goes for a review. Check to see if they have been changed.
• The humidifier also has alarms it will show where problem is
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Ventilator Alarms
• Power disconnect.• High pressure- usually
means some obstruction. Tube kinked/trapped. Trachy blocked. Check tubing for kinks, check trachy not blocked.
• Low pressure. Usually means break in the circuit. Check all tubing for connections.
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Manual Inflation (Bagging)
• Used to inflate the lungs temporarily whilst the ventilator is disconnected.
1) If ventilator fails.
2) When changing over the tubing.
3) When it is not safe/practical to use ventilator (eg in the shower).
• Used to over inflate the lungs to help to move thick sputum. (imitates cough).
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Problems with Bagging
• Over inflating lungs can cause damage.
• Under inflation causes lower oxygen levels and build up of carbon dioxide.
• Too fast and you can remove too much carbon dioxide.
• Too slow and you can reduce oxygen levels.
• DO NOT force air, there maybe a blockage which needs clearing.
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Tips for Bagging
To aid secretion removal
• Large in breath.• Release quickly to
mimic cough.• 10 maximum then
reconnect ventilator and suction.
Whilst disconnected from ventilator
• Match rate with usual ventilator setting [in time with your own breathing rate]
• Smooth in breath.• Allow time to breath out.• Keep time bagging to a
minimum.
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Safety-Precautions for ventilator
• Spare ventilator- battery charged and checked.
• Spare battery.• Know your alarms and
how to solve problems.• Know the engineer
number, check when service is due.
• Shift/daily checks.• Always report and
document problems.
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Spinal Cord Injury• Skin Management• Causes of Skin breakdown;• Lack of movement• Loss of sensation (poor blood circulation)• Psychological well being• Poor handling • Clothing too tight• Incorrect cushion or mattress
Four Stages of Pressure Sores
Stage What to Look For
1. Your skin looks lighter than usual.
2. Area of skin looks redder all the time, feels warm, maybe swollen.
3. Blister develops, bluish tinge, blister might open up.
4. Centre of blister turns black/brown, may be discharge.
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Four Stages of Pressure SoresStage What to Do/Other Information
1. Stay off, pressure is stopping your blood supply e.g. if you hold a glass tightly fingertips go lighter.
2. Stay off the area, DO NOT RUB, make sure redness goes after 30 minutes without pressure.
3. Stay off, SEE DOCTOR ASAP, there may be more damage to the skin than you can actually see.
4. Stay off, COVER WITH STERILE DRESSING, see Doctor, eat food with protein, damage has gone very deep, skin infected, discharge means body is losing protein.
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Spinal Cord Injury
• Prevention of skin problems• Observation/recording• Pressure relief• Equipment• Hygiene• Diet/Nutrition• Clothing [seams on trousers]• checking groin area for men
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Spinal Cord InjuryBladder Management
• No sensation• No voluntary void• Risk of kidney problems, stones• Risk of infection• Types of bladder management• Supra Pubic• Intermittent catheters• Urethral Indwelling• Conveen
Risks
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Changing the suprapubic catheter
• two people, (although one in emergency) one removing old catheter the other inserting new one. Firstly both glove up.
• Remove water from catheter’s balloon (up to 10 mls) using a syringe.
• Remove suprapubic catheter• Replace suprapubic catheter (check date)• Refill balloon with water from a syringe.• Attach leg bag, check draining properly.
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Spinal cord injury• Autonomic dysreflexia• An emergency situation that arises due to an
exaggerated sympathetic response to a noxious (painful) stimulus.
• This only occurs in injuries above T6• Signs• Pounding headache• Flushed or blotchy skin above level of injury• Nasal congestion• Blurred vision• Anxiety/Panic
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Spinal Cord Injury
• Autonomic Dysreflexia• Causes• PAIN/IRRITATION• Distended bladder• Distended bowel• Infection• Trauma• Ingrowing toe nail
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Spinal Cord Injury
• Action• Sit upright• Identify cause• Bladder• Bowels• General check• Nifedipine?• 999
Muscle Spasms• After a SCI, nerve cells below the level
of injury become disconnected from the brain.
• In an able-bodied person the brain stops most natural reflex actions.
• When there is no connection these actions cannot be stopped.
• Factors which make spasms worse –• Bladder infection• Kidney infection• Skin breakdown• Drugs used to combat spasms• Baclofen (pump), Valium and Dantrium
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Wheelchair Safety
• Checks brakes are on or if electric, power is off• If pushing wheelchair beware of going up slope of
1:12 as wheelchair may overbalance backward• If pushing wheelchair you may find it easier to
reverse down curbs (Occupant may slide out of chair)
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Wheelchair Etiquette• When talking for more than a few moments to
someone in a wheelchair try to put yourself at their eye level to avoid stiff necks. Try not to talk over the person in a wheelchair.
• if going to a venue check, suitable parking, entrance, toilets, lifts
• Scout ahead to see if they can Get to where get get to where they want to go
Do not lean on the wheelchair.
treat them as a person
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Complications for people with spinal cord injuries
• Reduce temperature control
• Possible skin conditions
• Pressure sores
• Blood pressure problems
• Diabetes
• Phantom pain
• Autonomic dysreflexia
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Ventilator and SCI Training
• Bowel Management• What is the bowel and what does it do?• The bowel is the last portion of your digestive tract (the
large intestine or colon)• The function is to take food into the body and to get rid of
waste.• The bowel is where the waste products of eating are
stored until they are emptied from the body in the form of a bowel movement (stool, faeces).
• A bowel movement happens when the rectum becomes full and the muscle around the anus opens.
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Bowel Management
• What stops normal bowel function?
Spinal Cord Injury Higher Breaks
Brain Injury
Physical Illness (MND, MS)
Immobility
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Bowel Management• Methods for emptying the bowel:
• Manual Removal
• Digital Stimulation
• Suppository
• Mini-Enema
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Bowel Management
• Factors that can affect success
Previous bowel history
Timing
Privacy and Comfort
Emotional Stress
Positioning
Fluids
Food
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Bowel Management
What to avoidUsing more than one finger
Bending finger
Rushing
More than Four Digital Stimulations at a Time
Long fingernails
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Manual handling back problems Some Statistics
• On any one working day, there are over 90,000 people off work with back problems.
• 5.5 million working days are lost in Britain ever year as a result of a manual handling back injury.
• Absence from work due to back pain costs the UK £365 million per year.
• 30% of all back injuries in the workplace are caused by, or related to, lifting, handling or load carrying.
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WEIGHT GUIDANCE FOR LIFTING
• Moving and Handling regulations state:
• Male = 25kg
• Female = 16kg
• HOWEVER PERSON HANDLING!!??
• No Weight is safe
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BIOMECHANICS
• Keep the load close to your body.
• Use your leg muscles to lift not your back muscles.
• Keep your back straight and your legs/knees bent.
• Point your feet in the direction you want to travel.
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Principles of Safer Handling
COMMUNICATION:Try to obtain clients consent. (dependent on clients cognitive ability)
Good communication between carers and client.
Timing of the move, give clear instructions. The count of 1---2--- 3 should not be used.
Better to use READY STEADY MOVE.
Decide who will be the lift leader,
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Principles of Safer Handling
DYNAMIC STABLE BASE;• Think Triangle! Can not be pushed over easily.
• Weight is evenly distributed.
• Will allow you to transfer weight between your feet.
• Avoid putting your nose
over your toes!
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Principles of Safer Handling
KEEPING THE LOAD CLOSE TO YOURBODY:• Keep your elbows close to your body as possible.
• This helps stabilise your shoulders, which will also help you transfer your weight through your legs
• You will use the POWER MUSCLES, this will also reduce twisting movements.
• Load is closer to your body giving you more control of the load.
• Keep your chin up, good for your neck
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The LOAD is the person you are moving.• Have they been hoisted before?
• Do they know why they need to move?
• Have you got consent
• Can they weight bear?
• What happens when you get them on their feet?
• RISK ASSESSMENT
• AVOID
• ASSESS
• REDUCE
• REVIEW
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EXISTING CONTROLMEASURES
• Overhead track hoists.
• Mobile hoists.
• Profiling beds.
• Wheelchairs.
• Slide sheets.
• Transfer boards and turntables.• Using equipment will not save you time but it will save your
back!!!!
• It is your responsibility not to take on any task that you think may harm you or your client!!!!
• SAVE YOUR BACK YOU ONLY GET ONE!!!
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Administering Medicine Legal Requirement
The Medicines Act (1968)
• This was the first comprehensive legislation on medicines in the UK. It provides the legal framework for the manufacture, licensing, prescription, supply and administration of medicines.
The Medicines Act (1998)
• “In the United Kingdom, anyone can legally administer prescribed medicine to another person. This includes prescription only medication (POM) and controlled drugs (CD). The administration must only be in accordance with the prescriber’s directions (except in the case of injections)” (The Medicines Act 1998) (UKHCA (2006), Social Care inspection (2005),
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Providing Support With Medication
• Staff should only provide assistance with medication when it is within their competence to do so and they have received any necessary specialist training.
• Assistance should only be provided with the informed consent of the client or their relatives if they have a legal standing to do so, or through litigation, friend(s).
• If it is clearly requested on the care plan by a named assessor.
• It is with the agreement of the carer or support worker’s line manager and is not contrary to the company policy.
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Side Effects of the MostCommonly Used Medicines
What is a side effect?• A side effect is an unwanted reaction of the body to the
toxicity of the medicine.
• Some side effects diminish after a period of time
• It is important to recognise side-effects in order that your client may receive appropriate intervention/reassurance
Antibiotics:-Diarrhoea ConstipationAbdominal CrampsRashesUnusual tastesUrine colour
Analgesics:-ConstipationLiver damage foroverdoseHeadachesDry mouth
Antidepressants:-EuphoriaAgitationAbdominaldiscomfortDry mouthNausea
Sedatives:-Blurred visionLethargyDrowsinessTremorSlower heart
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Administration of MedicinesFive Rights of Administration
• Right - Patient/Client
• Right - Time
• Right - Route
• Right - Medicine
• Right - Dose
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Administration of Medicine
• Ensure the five rights are adhered to.
• Check medicine not been given.
• Ensure client condition is conducive to receiving the medication.
• Ensure labels are clear on medicine bottles.
• Check medicine is in date
• Hygiene
• Water
• Ensure medicine taken
• Sign
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Do you have any questions?
• finish