Pediatrics – Respiratory: Ventilator Weaning SECTION: 20.33

Strength of Evidence Level: 3__RN__LPN/LVN__HHA

PURPOSE:

To transition the patient from ventilator support to completely spontaneous breathing, during which time the patient assumes the responsibility for effective gas exchange.

CONSIDERATIONS:

  1. Detailed physician order for weaning patient from ventilator.
  2. Determine patient’s status prior to weaning trial. This includes: respiratory status, vital signs, patient’s color, oxygen saturation, nutritional status and alertness:
  1. Must be alert and pleasant.
  2. The patient is able to ventilate.
  3. The patient is able to oxygenate.
  4. The patient is able to protect his/her airway.
  5. Patient must have an accurate oxygen saturation > 94-95% on room air.
  6. No gastrointestinal upset, irritability or change in level of consciousness.
  7. Stable vital signs.
  1. Registered nurse must oversee and train the LPN during the weaning process.
  2. To provide care it is recommended that nurses successfully complete a ventilator weaning competency.
  3. The nurse must be at the patient’s bedside at all times during the weaning process.
  4. Ventilator, oxygen and suction equipment must be checked and functioning properly.
  5. Emergency backup portable vent, oxygen and suction equipment must be readily available.

EQUIPMENT:

Patient’s chart with physician weaning order

Gloves

Ambu/Resuscitation Bag

Back-up portable ventilator

Suction machine and suctioning supplies

Pulse oximeter

Oxygen tank and oxygen supplies

Tracheostomy tray at bedside that includes: one size smaller tracheostomy

Trach with obturator, scissors, suction catheter, gloves, trach collar and ties.

PROCEDURE:

  1. Adhere to Standard Precautions.
  2. Explain procedure to caregiver and patient.
  3. Administer physician-ordered pulmonary toilet 30 minutes prior to start of weaning trial.
  4. Deflate cuff.
  5. Remove from ventilator for physician-ordered length of time and patient tolerance. Place vent on the standby mode.
  6. Apply Passy Muir Valve or Artificial Nose.
  7. Observe for signs and symptoms of respiratory distress which include:
  8. Decrease level of consciousness.
  9. Decreased oxygen saturations.
  10. Cyanosis.
  11. Retracting.
  12. Nasal Flaring.
  13. Tachypnea.
  14. Increased heart rate >140.
  15. Decreased heart rat <60.
  16. If patient develops any signs of respiratorydistress,immediately place patient back on vent. The DOPE pneumonic may be utilized for potential causes of respiratory distress:

D isplaced Tube.

O bstruction.

P neumothorax.

E quipment Failure.

  1. Once weaning trial is complete, place patient back on vent at previous ventilator settings.
  1. Reinflate cuff.
  1. Observe for patent airway.
  2. Observe for signs and symptoms of respiratory distress.
  3. Auscultate lung sounds and monitor respiratory rate.
  4. Complete ventilator flow sheet/check.

AFTER CARE:

  1. Document patient’s response to trial.
  2. Document patient’s current respiratory status.
  3. Continue to monitor patient throughout shift.
  4. Document instructions given to caregiver.