Face Mask Ventilation

1
Face Mask Ventilation

• Education Pack 9
• Liz Herd

2
Ventilation
What do you
know about
?
ventilation
3
Do you have any concerns

• about caring for a child who requires ventilation?

4
Ground rules

• We value the young people we care for we would
  never put them or you at risk
• Always ask any questions when they occur to you,
  weve all asked questions that may seem
  silly-there is no such thing as a silly question!
• Stop me if you dont understand- the chances are
  others dont either
• Tell me if you need a break

5
110

• The children and young people rely on the
  assessors to ensure we deliver high standards of
  care-the assessors take this responsibility very
  seriously
• These high standards protect you as well as the
  young people
• We are incredibly privileged to be part of their
  lives we owe them 110

6
Parent Experts

• All parents know their child/young person best
  They care for them daily
• Listen to them-act on what they say!!
• As a resource they are second to none Use
  Them-get to know the child as the parent does

7
Patient dignity

• Always ask child/young person for consent when
  considering interventions
• Ask how they would like care to be given
• In the majority of cases you will be caring for
  the young person while they are asleep how can
  you help preserve their dignity?
• Treat children/young people as you would like to
  be treated, respecting their beliefs and values

8
Patient Privacy

• This procedure invades privacy!!!
• Think of ways to try and support child/young
  person through this
• Privacy means that the family including the child
  may not be discussed with people who do not need
  to know or with whom you have no consent to share
  information.

9
Hand hygiene

• As with all care hand hygiene is extremely
  important
• Please follow the 8 point plan and repeat steps 5
  times
• Wash hands as required through out the procedure

10
Definition of long Term ventilation

• Any child/young person who, when medically stable
  ,continues to require a mechanical aid for
  breathing, after an acknowledged failure to wean
  or a slow wean, three months after the
  institution of ventilation

11
Why ventilation at home?

• A child is a child first, last and always they
  just happen to need ventilation!
• Integration into the community offers a much
  improved quality of life for child and family
  (NSF Every Child Matters etc)

12
Normal respiration

• Is negative ventilation we pull air into the
  lungs by the diaphragm contracting
• It is more gentle than positive ventilation
• It is controlled by need e.g. if running you
  breathe harder if resting you breathe slower it
  is therefore more responsive than it is possible
  to do with most ventilators

13
Advantages of Face mask ventilation

• Easy to apply face mask can commence immediately
  in most cases
• No operation required so no anaesthetic risk or
  pain
• Uses the bodies natural airways so no risk of
  accidental de-cannulation
• Facilitates natural defences to carry on working
  against infection

14
More advantages

• Much less risk of infection
• No disruption to speech
• ??No disfiguration more positive body image
• Its a non invasive procedure
• No concerns re blockage of tube so less
  intervention is required when child is not being
  ventilated when child/young person is not being
  ventilated

15
Disadvantages of Face mask ventilation

• Cumbersome and can be uncomfortable of face
• More easily dislodged than tracheostomy
  connections
• More prone to leaks so optimum ventilation may
  not be attained
• May lead to facial deformity and flattening of
  airways

16
More disadvantages

• Tissue viability problems around mask site
• Face can get hot and itchy round mask site
  disturbing the childs sleep Movement in bed may
  be restricted

17
Even More disadvantages

• Machine can and will blow air not only into the
  lungs but into the stomach as well this will
  cause bloating and stomach ache
• Children and young people who are ventilated via
  face mask with dry air or oxygen may develop dry
  sore/uncomfortable mouths

18
Levels of ventilation

• In order to apportion care in an equitable way we
  need to look at the level of need the child/young
  person has. We have tried to do this by using 3
  levels of ventilation.
• This is also affected by the other areas in which
  the child/young person requires support such as
  enthral feeding, catheterisation and most
  commonly tracheostomy care

19
Level 1

• Supportive Ventilation
• This is ventilation whilst asleep will improve
  the quality of the child/young persons life but
  if it were disconnected or fails the child/young
  person will only have very minor side effects
  that may not even be noticeable.
• The child/young person will survive

20
Level 2

• Necessary Ventilation
• The child/young person will breathe in a sub
  optimal manner this will have some detrimental
  effect on the child and the parents need to be
  alerted to the situation
• The chid will feel unwell after the event and may
  need some medical support after the event

21
Level 3

• Essential ventilation
• If the ventilator disconnects of fails there is a
  high risk of respiratory arrest and death
• What level of ventilation is the child/young
  person you care for ?
• How does this affect the care you give?

22
Common causes of long term ventilation

• Neuromuscular disease
• Central congenital hypoventilation syndrome
• Spinal injury
• Bronchopulmonary dysplasia
• craniofacial abnormalities

23
Psychological implications for 1,2,3

• On a flip chart (or paper) look at the
  implications for all ventilated families
• Then look at specific problems for all three
  levels
• Then look at the problems that you think are most
  relevant to the families you are involved with

24
Common terms associated with ventilation

• BiPap-means bi-phasic ventilation 1 phase to
  inflate the lung the other phase to allow the
  lungs to deflate
• CPAP continuous pressure on the airways makes it
  easier to breathe

• O2 oxygen
• Co2 carbon di-oxide
• SATS abbreviated term for oxygen saturation
  monitoring one way we assess good ventilation is
  taking place

25
Setting labels on the ventilators

• Pressures how hard the air is blown into the
  lungs
• Rate how often air is blown into the lungs in
  one minute
• Inspiration time How long the machine pushes
  air into the lungs
• NB All vents vary spend time getting to know the
  machine you are responsible for

26
Ventilator breathing patterns

• Plateau This is a pattern of respiration. Normal
  breaths follow the pattern across and best
  respiration takes place at the peak of the curve
• This plateau ensures best respiration for longer

• Normal breath patterns

• Plateau breath patterns

27
How do we know good ventilation is taking place

• Know the child/young person recognise what is
  normal for them

Look
Listen
and feel!
28
Look for-

• Chest movement good/poor
• Look at patient colour in conjunction with oxygen
  saturation levels
• Look at child young person are they restless? If
  so why?
• What is the child/young persons heart rate?

29
Listen to-

• Breath sounds
• Signs of restlessness
• Noises the ventilator is making
• Leaks from the circuit
• Leaks from the mask
• Listen to the child/young person they may need to
  go to the loo!

30
Feel for-

• Is child young person too hot/too cold?
• Feel back for chest movement
• Drafts coming from leaks in the circuit or mask
• Feel machine to ensure it is not over heating

31
Recognising poor ventilation

• Poor chest movement
• Patient restless
• Colour pate possibly fingers and toes blue
• Oxygen levels lower than normal
• NB not necessarily at alarm levels

• Heart rate rising
• Different noises from ventilator
• Pco2 monitoring (if in use) rising

32
Troubleshooting to improve ventilation

• Change child/young persons position to improve
  airway
• Look at child/young person for other factors i.e.
  too hot/cold/itchy/bad dreams/generally unwell
• Ensure nose is not blocked
• Ensure mask is correctly positioned

33
More trouble shooting

• Ensure oxygen probe is correctly attached and
  giving accurate readings
• Ensure that all ventilator readings are correct
• NB there have been incidences in the past of
  ventilator settings moving

34
Important points to remember when mask ventilating

• Mask must be as loose as possible but still have
  a good seal
• Masks may slip and occlude nostrils
• If mask rests on the bridge of the nose there is
  a danger of tissue viability problems
• Patient position will affect ventilation
• The dead space is longer in a mask vented
  patient than a tracheostomy patient

35
Any questions??

• We recognise that there are some very scary facts
  in this presentation
• We will ensure that you are comfortable caring
  for the child/young person long before you are
  left on your own-with on call support
• There are always parents to call on use them
• We would not put you or the children at risk

36
References

• Jardine E Wallis C 1998. Care guidelines for the
  discharge care of the child on long term assisted
  ventilation in the United Kingdom Thorax, 53,
  762-767 (Sept)
• Jardine E, OToole M, Paton JY Wallis C, 1998
• Current Status of long term ventilation of
  children in the United kingdom questionnaire
  summary BMJ, 18295-299 (30th January)
• Edwards E A, OToole M, Wallis C 2004, sending
  children home on tracheostomy, dependant
  ventilation pitfalls and outcomes. Archives of
  Disease in childhood 2004 89251-255.
• Sidney A , Widdas D 2nd 2005 Textbook of
  Community Childrens Nursing Elsevier Edinburgh.
• Pictures from google images