Cardiopulmonary Services Weaning/Lung Mechanics Proc9.6


PURPOSE: POLICY: To assess patient's ability to breathe on his own and protect his/her airway, prior to and following extubation and/or discontinuance of ventilatory support. I. Establishing of Weaning 1. Weaning parameters shall be obtained as ordered by physician. 2. Ventilatory weaning shall be instituted by physician order only and maintained by physician established criteria. 3. Patients must be observed during weaning for signs of respiratory distress or fatigue. 4. Arterial blood gas analysis shall be obtained on physician order or if a patient's status deteriorates. Discontinuing Ventilatory Support 1. Extubation or discontinuance of ventilatory support may be done only after physician assessment and with written order of physician. 2. Physician must be present for extubation and should remain for at least fifteen minutes post extubation. 3. Cardiopulmonary Services staff and or nursing staff shall have available a functional ambu bag/mask and oxygen delivery system. 4. Cardiopulmonary Services Staff, with assistance of nursing staff, shall insure that appropriate reintubation equipment for physician is available. a. Laryngoscope, blade, and functional light source. b. Suction catheter, vacuum system, and tonsil-tip suction. c. Appropriate sized airway device. d. Stylet (for adults). e. Lubricant for nasal intubations. f. Syringe for cuffed airways. g. Securement device. Extubation Procedures 1. Obtain necessary oxygen delivery device ordered by physician for post-extubation usage and assemble. 2. Explain procedure to patient. 3. Note heart rate, blood pressure, and respiratory rate. 4. Physician orders are followed for extubation procedure. Suggested guidelines for extubation procedures: a. Apply appropriate personal protective equipment after washing hands. Roll head of bed up if possible. b. Oxygenate patient with 100% oxygen and suction artificial airway of secretions. Hyperinflation should also be incorporated for more adequate removal of secretions. c. Suction oropharyngeal and/or nasotracheal secretions. d. Attach syringe to pilot balloon cuff, if present. e. Remove securement devices from the artificial airway. f. If possible, instruct the patient to take a deep breath in and deflate the cuff, and quickly remove artificial airway. g. If possible, instruct patient to cough. h. Assist Patient with secretion removal 5. Place oxygen delivery device, as ordered by physician, on patient. 6. Obtain arterial blood gas, other lab work or monitor pulse oximetry post extubation as related to services post extubation. 7. Discard personal protective equipment and wash hands.



Cardiopulmonary Services Weaning/Lung Mechanics Proc9.6 IV. Post Extubation or Discontinuance of Ventilatory Support Care 1. Assess patient's ability to remove secretions. 2. If patient needs cough and deep breathing instruction, instruct and assist patient with maneuvers as ordered by physician. 3. If patient has rhonchi, crackles, wheezes, or stridor, appropriate respiratory therapeutic interventions, bronchodilators or racemic epinephrine or chest physiotherapy or combination of both should be administered as ordered by physician. V. Documentation 1. Toleration of extubation procedure, physician in attendance, lab work, pulse oximetry, oxygen delivery device, therapeutic interventions (if applicable). 2. Verify written physician order for extubation, lab work, oxygen delivery device, or any additional therapeutic measures, if applicable. REFERENCES: 1. AARC Clinical Practice Guidelines, 1993. Written: August 1986 Revised: April 1988 Revised: April 1989 Reviewed: January 1992 Revised: 1993, 1994 Reviewed: May 1998 Reviewed: August 2000 Reviewed: March 2003



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