Ven= tilator Operations (LTV 1200)

Policy:

A transport ventilator may be required du= ring the prehospital treatment / transportation of a patient. If a transport ventilator is neede= d, Catawba County Emergency Medical Services System will provide a LTV 1200 Ventilator System. When requi= red, this system will be operated by appropriately trained personnel following t= he procedure listed below.

Purpose:

The purpose of this policy is to assure that all patients who need ventilator support receive safe and effective care.

Procedure:

1. Prior to utilizing the transp= ort ventilator, the attending Paramedic must successfully complete a training course and skill evaluation conducted by the Catawba County Emergency Medic= al Services System.

2. The ventilation system will o= nly be utilized during interfacility transports on patients 1 year and older, unle= ss prior approval of the administrative staff has been obtained.

3. Upon receiving a call that wi= ll require using the ventilation system, the appropriate crew will respond to a predetermined location and obtain the ventilator and necessary supplies. A minimum of the following must be obtained:

LTV 1200 Ventilator System
AC/ DC power supply for the system along with 1 external battery.
High pressure tubing and quick connect adapters when patient is on FIO2 hi= gher than 21%.
2 - disposable adult ventilator circuits/ 1 disposable pediatric ventil= ator circuit

4. The crew will then respond to= the transferring facility and obtain the following information from the staff:<= o:p>

General transfer information (demographics, diagnosis, lab values, x-rays, etc…)
Patient’s weight
Patient’s vital signs (level of consciousness, blood pressure, respirator rate = [if spontaneous], heart rate, ECG rhythm, SPO₂, CO₂, blood gas values, etc…)
Ventilator settings (ventilation mode, ventilation rate, inspiration time, tidal volume, FIO₂, high and low pressure alarm settings, pressu= re support, low minute volume and PEEP setting)

5. On the rare occasion when ventilator settings are unavailable use the following to determine your ini= tial settings:

ADULT

Perform a circuit leak test

o Ventilation mode - SIMV/CPAP

Ventilation rate - 12 breaths / minute
Set the inspiration time– 1.0
Tidal volume – 6-8cc / kg
Set the pressure support – 6-10 cc
FIO₂ – 100%
PEEP setting - 5 mmHg
Low Minute Volume – 3.0
High and low pressure alarm settings - high =3D 15 mmHg above the peak = / low =3D 3 below PEEP

Pediatric<= /p>

Perform a circuit leak test
Ventilation mode - SIMV/CPAP
Ventilation rate - 15 breaths / minute
Set the inspiration time– 1.0

o Tidal volume – 6-8 cc / kg

Pressure support – 6-10 cc<= o:p>
FIO₂ – 100%
PEEP setting - 5 mmHg
Low Minute Volume – 1.0
High and low pressure alarm settings - high =3D 15 mmHg above peak / lo= w =3D 3 below PEEP

Infant

Perform a circuit leak test
Ventilation mode - SIMV/CPAP
Ventilation rate - 20 breaths / minute
Set the inspiration time– 0.4
Tidal volume – 6 cc / kg
Pressure support – 3-5 cc<= /o:p>
FIO₂ – 100%
PEEP setting - 4 mmHg
Low Minute Volume – 1.0
High and low pressure alarm settings - high =3D 15 mmHg above peak / lo= w =3D 3 below PEEP

These settings may be adjusted to the patient’s comfort and hemodynamic stability

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6. The attending Paramedic will = then set-up the ventilator by completing the following steps:<= /p>

Do a circuit leak test to ensure safety of ventilation=
Set the mode (Assist Control or SIMV/CPAP)

o Set the rate

Set the inspiration time in seconds
Set the tidal volume
Set the pressure support if indicated by facility ventilator
Set the FIO₂
Set the PEEP
Set the low minute volume
Attach the end-tidal carbon dioxide detector to the endotracheal tube or tracheotomy tube
Determine the peak airway pressure
Set the high pressure alarm to 15 mmHg above the peak airway pressure
Set the low pressure alarm to 3 mmHg below the PEEP level

These settings may be adjusted to the patient’s comfort and hemodynamic stability.

8. The crew will then transport = the patient per standard operating procedure.

9. During transport the patient = should be reassessed at least every 15 minutes for stable patients and every 5 min= utes for unstable patients.

10. The end-tidal carbon dioxide level = and oxygen saturation must be monitored continuously.