If someone you know requires a ventilator for assisted breathing, I don’t have to accentuate how vital the device is. Hospital ventilators can tip the scale between a patient’s life and death, and a critical part of the ventilator circuit is the breathing tube. How often should this tube be changed?
You should change ventilator tubing when it appears soiled or damaged. The rule of thumb used to be that ventilator tubing should be changed every 48 hours. However, changing the ventilator tubing when it’s damaged is safer for the patient and can save hospitals millions of dollars per year.
The rest of this article will examine the ventilator, its function, and the different types of ventilators. I’ll also go over how to know when it’s time to change the tubing, tips on preventing pneumonia, the effects location has on ventilator tubing, and additional preventative maintenance.
What Does a Ventilator Do?
Merriam-Webster’s generic definition of ventilation is a system or means of providing fresh air. That fits quite neatly with the purpose of ventilators in the medical field.
A ventilator provides people who suffer from breathing difficulties a clean, safe source of oxygen—and, in some cases, assistance with breathing itself. Additionally, different kinds of ventilators accommodate different needs, depending on what the patient requires.
The different kinds of ventilators include:
- Non-invasive ventilators, or face mask ventilators. These are typically used on patients who have difficulty breathing but can still carry it off. They are often used at home for people living with asthma or sensitive allergies.
- Mechanical ventilators. These do most, if not all, of the breathing for a patient. The tubing may be inserted down the throat or via a tracheostomy. Mechanical ventilators are used for patients who cannot breathe on their own.
- Resuscitator bags. These are ventilators that do not require electricity to run. These kinds of ventilators come with bulbs or bladders that, when squeezed, provide oxygen. They are used in situations where power is not available.
Each of these ventilators uses tubing that, while designed to live a long life, does not last forever. As for when it needs to be changed, the guidelines have “changed” over the years.
When to Change the Ventilator Circuit
The once rigid rule of changing a ventilator circuit (air source, valves, filters, humidifier, and tubing) every 48 hours has faded. There are three main reasons for this:
- The risk of VAP (ventilator-associated pneumonia) is decreased for patients.
- Modern ventilators no longer need such frequent upkeep.
- Hospitals can save millions of dollars per year on medical supplies.
The 48-hour “guideline” for changing ventilator tubing existed until 2003. Still, up to that point, doctors and nurses believed extended usage of ventilator circuits placed their patients at higher risk for hospital-acquired pneumonia.
The CDC (Centers for Disease Control and Prevention) once stated that patients contracted VAP through the inhalation of ventilator tube condensation. In turn, the CDC recommended changing the circuit every two days.
Modern science has since tipped this belief on its head. More contemporary CDC studies have revealed that frequent changes to ventilator circuits can increase a patient’s risk of VAP and other complications. The CDC now contends that these changes more often expose the equipment to pathogens entering the patient’s body.
Additionally, today’s ventilators simply don’t require as much maintenance. Most mechanical ventilators are not only fully computerized (monitoring inhalations, oxygen content, and lung pressure) but also come with mobile trolleys. They look sort of like the 2-1B droids from Star Wars, though without the ability to attach a bionic hand.
And yes, hospitals do stand to save a lot of money by not changing ventilator circuits so often. Longer-lasting equipment means more miles per dollar.
Today the CDC is content to let individual hospitals decide when to change ventilator tubing (or, indeed, the entire circuit). “Check and see” seems to be their new policy.
Therefore, the frequency of ventilator tubing exchange will vary from patient to patient and ailment to ailment.
Who Is Qualified To Change Ventilator Tubing?
In most cases, when it’s time to change the tubing, it’s time to change the entire circuit of a ventilating system. Swapping out a component here and a component there results in more downtime for the unit and, ultimately, more discomfort for the patient. So, who is allowed to change the ventilator circuit?
Only a respiratory therapist or knowledgeable nurse is qualified to change ventilator tubing. The nurse should know as much about ventilators as a respiratory therapist to be qualified. Therefore, it’s ideal that only respiratory therapists change the ventilator tubing.
Today, many hospitals wait two weeks to change ventilator tubing and/or the entire circuit. Others adhere to a one-week policy, while some have found that a whole month without changing is okay. Again, as permitted by the CDC, it’s genuinely a judgment call.
Only in an emergency will doctors and nurses change the circuit or adjust respirator settings. Otherwise, a respiratory therapist is needed for this task.
There are good reasons for this. Ventilators—especially the mechanical ones—are complex machines requiring proper use training.
The following may result in harm to the patient in changing ventilator tubing:
- Improper settings
- Mistimed alarms
- Changes made sans communication with other personnel
It could even result in the rather dreadful euphemism: Negative Patient Care Outcome.
Other strategies for safe ventilator use exist. Knowing when to change the ventilator tubing (and when not to) has been proven to reduce VAP risk. But when we say “change the tubing as needed,” what indicators should we be looking for? I will examine these in the following section.
How To Know It’s Time To Change the Ventilator Tubing
Because the guidelines about changing the tubing have gotten so vague over the years, it’s not always easy to know when to pull the trigger on a ventilator circuit and when to leave it alone. Hence the joy of having a respiratory therapist around.
But if your therapist is on vacation or even just out to lunch, here are some signs to look for:
- Age discolored tubing
- Tubing that appears condensed (moisture in the line)
- Changes in the patient’s breathing sound or pattern
- A beeping ventilator alarm
The thing to remember about changing ventilator tubing is not to make it routine. Frequent dismantling of the system will only make recovery harder for the patient. It also raises the patient’s risk of contracting VAP, which occurs—or can happen—when germs get into the circuit and are then inhaled into the lungs.
Also, remember that if you intend to change a patient’s ventilator circuit, you should know at least as much about ventilators as a respiratory therapist. It’s not wise to fiddle with ventilators while not being 100% sure about what you’re doing.
If you’re caring for a patient at home, consider that the more tubing you unnecessarily discard, the more you have to buy. Ventilator tubing will not need changing for at least 48 hours under regular use. The settings on a mechanical ventilator should be checked every 1-2 hours by a qualified professional.
Preventing Ventilator-Associated Pneumonia
In this section, we will look at other ways to prevent or reduce VAP risk. I include it because occurrences of the condition are, frankly, all too common among those dependent upon mechanical ventilators. Ways to stop VAP before it happens include:
- Keep the mattress head elevated to 30 degrees or no more than 45 degrees. This will reduce the chance of patient aspiration.
- Maintain good communication with the patient. Ask how they are feeling.
- Extubate the patient as soon as they are ready. The sooner the patient can breathe without assistance, the better.
Specialists calculate that up to 10% of mechanically ventilated patients suffer a ventilator-associated event. Yet, the danger need not loom so large with a bit of safekeeping. Proper training on operating—and maintaining—a ventilator can go a long way toward your patient’s quick recovery.
Not all patients can be “unplugged” from their ventilator cold turkey. In many cases, it’s necessary to wean them off assisted breathing. This is when communication once more becomes essential. Once the limit of your patient’s comfort zone is reached (off the ventilator), be sure they tell you immediately.
The patient may even know better than you when it’s time to change the ventilator circuit. The patient is the one breathing through it, after all. Each time you check the ventilator, ask the patient how things are going.
Effects of Location on Ventilator Tubing
Where your patient’s care facility is located will impact how long ventilator tubing lasts. It’s to varying degrees and may be dependent upon things such as:
- The air quality of the environment
- The age of the facility
- The facility’s surroundings
Of the three, environmental air quality has the most potent effect. In high-density hospitals, the spread of pathogens becomes more prevalent. This is exacerbated even further during ventilator circuit changes.
Newer hospitals that feature private rooms and bathrooms are significantly safer for patients. Even something so simple as locating an alcohol hand rub near the ventilator can lessen the chance of infectious aspiration after a tubing change.
Changing Specific Kinds of Ventilator Circuits
Three main kinds of ventilator circuits are used in assisted or mandatory breathing. These are:
- The double-limb respiratory circuit
- The single-limb non-vented respiratory circuit
- The single-limb vented respiratory circuit
The CDC rule of thumb for changing ventilator tubing remains the same for the three main kinds of ventilator circuits: Change the tubing and the entire ventilator circuit only as needed.
It would be best for home caregivers to become familiar with the different types of circuits. Qualified professionals best handle connections, settings, and circuit change-outs. For patients using ventilators at home, caregivers can be trained to use any ventilator system properly.
Ventilator Preventive Maintenance
The respiratory ventilator is a complex device that, while dependable, requires a bit of care from time to time. As mentioned, some of these ventilators are considered life support machines. Their failure is simply not an option.
Besides changing the ventilator circuit, other things to keep an eye on include:
- The batteries
- The filters
- Overall cleanliness of the machine
Ventilator batteries will usually last for an entire year. This being said, it’s best not to place your bets on how much time they have left. Therefore, keep ventilator systems running on an AC line as often as possible.
Filters are a part of the ventilator circuit and, like tubing, have different change guidelines depending on the patient’s condition and the ventilator system itself. Some filters last for two or more weeks, whereas others need to be checked by caregivers every 24 hours. To determine how often filters need changing, consult your ventilator system guidelines.
Lastly, keep the ventilator disinfected at all times. This means the entire unit, including the collector vials. Ventilator disinfection should be done at least once per day or when the unit is used on a new patient.
Regular maintenance on your patient’s ventilator is critical. If you happen to be caring for someone at home, you may at times forget its importance. Don’t let things slide; keep your ventilator clean.
So when is it time to change the ventilator tubing? Is there a guideline to follow?
Since the early 90s, the CDC is no longer comfortable with respiratory therapists following a routine. It found that too much exposure to the open air can increase the chance of pathogens entering the tubing, infecting the patient’s lungs.
Therefore, the CDC decided to play things a little more safe and recommend changing ventilator circuits only when the need becomes apparent.
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- Merriam-Webster: Definition of ventilation
- ReliasMedia: CDC Halts Frequent Ventilator Breathing Circuit Changes
- The Conversation: ICU Ventilators: what they are, how they work, and why it’s hard to make more
- The National Center for Biotechnology Information: Ventilator Safety
- National Library of Medicine: Effect of ventilator circuit changes on ventilator-associated pneumonia: a systematic review and meta-analysis
- Agency for Healthcare Research and Quality: Getting Patients Off the Ventilator Faster
- Agency for Healthcare Research and Quality: The Physical Environment: An Often Unconsidered Patient Safety Tool
- ERS Publications: Choosing a ventilator for home mechanical ventilation
- Open Critical Care: Oxygen FAQ