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Taking NIV further Philips Respironics V60 ventilator pocket guide 2296264441.i

Taking NIV further Philips Respironics V60 ventilator pocket guide 2296264441.indd 1 8/4/2010 10:52:54 AM Introduction Noninvasive ventilation (NIV) has been shown to significantly reduce many of the complications associated with conventional mechanical ventilation, including the incidence of ventilator-acquired pneumonia, [1] while at the same time reducing the overall cost of care by shortening lengths of stay. [2, 3] This pocket guide was designed to familiarize clinicians with the V60 ventilator setup and application. It provides step-by- step explanations of how to use the V60 ventilator from initial setup to making mask and port settings to changing modes. This guide also includes suggestions for increasing tank life during transport. The Philips Respironics V60 ventilator is a microprocessor- controlled, bi-level positive airway pressure ventilatory assist system that provides noninvasive and invasive ventilatory support for adult and pediatric patients (> 20 kg). References 1 Hill NS, Brennan J, Garpestad E, Nava S. Noninvasive ventilation in acute respiratory failure. Crit Care Med. 2007 Oct;35(10):2402-7. 2 Keenan SP, Gregor J, Sibbald WJ, Cook D, Gafni A. Noninvasive positive pressure ventilation in the setting of severe, acute exacerbations of chronic obstructive pulmonary disease: more effective and less expensive. Crit Care Med. 2000 Jun;28(6):2094-102. 3 Hubble MW, Richards ME, Wilfong DA. Estimates of cost effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema. Prehosp Emerg Care. 2008 Jul-Sep;12(3):277-85. 2296264441.indd 2 8/4/2010 10:52:54 AM 1 Introduction Device overview 2 Front 2 Back 2 Side 3 Air inlet filter 3 Patient circuits General operation 4 Mask and port settings 4 Setting changes 5 Mode changes 6 Batch changes 6 Alarm message navigation 7 Low rate 8 Menu tab 8 Screen lock 9 Patient data and waveforms 10 Standby 10 Help button 11 Mask leak symbols 12 Exhalation port settings 12 Exhalation port test New modes and options 13 Ramp 13 C-Flex 14 Pressure control ventilation 14 AVAPS (average volume-assured pressure support) 16 Patient transport Contents 2296264441.indd 1 8/4/2010 10:52:54 AM 2 Device overview Front Back Side 2296264441.indd 2 8/4/2010 10:52:55 AM 3 Air inlet filter To change the air inlet filter 1. Power down the V60 ventilator and disconnect it from AC power. 2. Turn the D-ring fastener (bottom of side panel) counter- clockwise one-quarter turn and release. 3. Remove the side panel. 4. Remove the air inlet filter by pinching it out of the recess in the bracket. 5. Install the new air filter by tucking it in the recessed area. 6. Replace the side panel, and then push in the D-ring fastener turn one-quarter rotation, or until it locks. Patient circuits Assemble the patient circuit, including bacterial filter, proximal line and humidifier (if desired). Standard patient circuit includes main flow filter, and proximal pressure line. Not for use with a humidifier. The standard humidifier patient circuit includes a main flow filter, a short tube, water trap, pressure sensor, and elbow. 2296264441.indd 3 8/4/2010 10:52:56 AM 4 General operation Once the circuit and filter are attached, press the ON/ Shutdown button. An informational message is displayed on the screen indicating which mask and leak port were last used. If the current mask and port match the displayed data, continue to Mode settings. Otherwise follow the instructional steps to change the mask/port settings. Mask and port settings 1. Press the Menu setting tab. 2. Press the Mask/Port button. 3. Press desired patient interface type (see Mask leak symbols for more information) and press Accept to apply. 4. Press the desired exhalation port (see Exhalation port settings for more information) and press Accept to apply. 5. Run the exhalation port test only if required. Setting changes 1. In the settings window, touch the setting to be changed. 2. Adjust the setting by either using the arrow keys or the navigation ring. 3. Once the correct value has been chosen, press Accept. 2296264441.indd 4 8/4/2010 10:52:56 AM 5 Mode changes The active ventilation mode is displayed in the upper left corner of the screen. To set or change a mode, do the following: 1. Select the Modes setting tab. 2. Select the desired mode (active mode will be displayed in blue). 3. Adjust settings as desired. Newly adjusted setting values will be displayed in yellow. 4. Select Activate Mode to apply. 2296264441.indd 5 8/4/2010 10:52:56 AM 6 General operation Batch changes Batch changes are available in only the active mode. Batch changes allow you to activate multiple ventilation setting changes simultaneously. To make batch changes follow these steps: 1. Press the Modes setting tab. 2. Press the active mode (it will state “Batch” and be displayed in blue). 3. Adjust settings as desired so that newly adjusted values are displayed in yellow. 4. Press Activate Batch Change to apply all changes at once. Alarm message navigation To hide alarms or informational messages in the Alarms or Messages list, press the alarm button (flashing if high priority) or the informational messages button when up arrows are present. To display messages, touch the informational messages button when the down arrows are present. For a list of alarms, see the Respironics V60 Ventilator User Manual. 2296264441.indd 6 8/4/2010 10:52:56 AM 7 Changing an alarm setting 1. Press the Alarm Settings tab. 2. Press and change the appropriate alarm value. 3. Press Accept. Low rate On the V60 ventilator, the low rate alarm may also serve as an apnea alarm. The low rate alarm value should always be programmed above the set (backup) rate. If the low rate alarm value is lower than the set rate, the low rate alarm cannot be triggered, and the alarm is essentially disabled. A text warning will appear on the left side of the settings screen if the user sets the low rate at or below the set (backup) rate. 2296264441.indd 7 8/4/2010 10:52:57 AM 8 Menu tab From the Menu window, user preferences can be adjusted. There is a Brightness setting button for day or night view. There is a Loudness setting button to adjust the volume of alarms and audible feedback click. There is a Mask/Port menu button to choose various mask leak values and to choose the correct port (see Mask leak symbols). There is a Vent Info menu button, which displays the software version and other information specific to the ventilator, and the Screen Lock button. Screen lock Screen lock deactivates all buttons and tabs on the touchscreen except Alarm Silence, Alarm Reset, the alarm message button, and help icon. The tabs will be grayed out. To unlock the screen, press the accept button (√) in the center of the navigation ring. General operation 2296264441.indd 8 8/4/2010 10:52:57 AM 9 Patient data and waveforms The data screen displays alarms and patient data, which include rate, estimated tidal volume, estimated minute ventilation, peak inspiratory pressure, patient trigger %, TI/TTOT %, and leak. There is also a breath phase/trigger indicator that displays what triggered the breath (spontaneous or timed) and when the expiratory phase has begun. Pt. Trig – Patient-triggered breaths as a percentage of total breaths over the last 15 minutes. Rate – Total breath rate (Spont and Timed), a moving average over the last 6 breaths or 15 seconds. TI/TTOT – Inspiratory time divided by the total cycle time over the last 8 breaths. Pt. or Tot.Leak – Estimated unintentional leak (Pt. Leak) or total of intentional plus unintentional leak (Tot.Leak). 2296264441.indd 9 8/4/2010 10:52:57 AM 10 Standby Standby suspends ventilation and retains current settings when the clinician wants to temporarily disconnect the patient from the ventilator. You can also change ventilator settings and most menu functions during standby. To activate Standby 1. Press the Standby tab. The Entering Standby window appears. 2. Disconnect the patient from the ventilator. The ventilator will not enter standby until the patient is disconnected. It continues ventilation while waiting for the patient to be disconnected. The standby mode gives the clinician up to 60 seconds to disconnect the patient from the ventilator. If after 60 seconds no disconnection is detected, the standby mode cancels. Help button Press the help icon (?) to display additional information. Touch the screen anywhere to return to normal operation. General operation 2296264441.indd 10 8/4/2010 10:52:57 AM 11 Mask leak symbols Leak symbol (printed on mask) Patient interface Leak 1 PerfomaTrak oro-nasal mask PerformaTrak nasal mask Image3 oro-nasal mask Viny nasal mask Contour Deluxe nasal mask AF811 oro-nasal mask Leak 2 PerforMax full face mask Leak 3 Respironics AP111 nasal cradle Leak 4 Respironics Total face mask The leak symbol represents the intentional leak characteristics of the mask, and the proper V60 mask/ port settings will ensure the greatest accuracy and optimum performance. If the leak symbol does not appear on a Respironics patient interface, use the chart above to determine the proper V60 setting. When using an interface other than a Respironics mask, choose the leak setting Other. This selection causes Total Leak, not Patient Leak, to be displayed on the patient data screen. Leak 1 symbol on mask 2296264441.indd 11 8/4/2010 10:52:58 AM 12 Exhalation port settings After uploads/Sante/ v60-pocket-guide.pdf