Ventilators were once a specialized piece of equipment that trained medical professionals must operate. However, in recent years, patients who require long-term ventilation have had the option to go home. The only problem is that you’ll need to know how to assemble and set up your ventilator.
Here are the steps needed to assemble a ventilator:
- Read the instruction manual.
- Check you’ve got all the parts and pieces.
- Connect the ventilator to a power source.
- Connect ventilation tubing and wiring.
- Test the functions.
- Select the correct settings and modes.
- Connect to patient.
Continue reading for the complete guide on assembling and connecting your ventilator at home. I’ll go through some of the terminology and settings you’ll need to know and some common concerns and pitfalls people face when using a ventilator at home.
1. Read the Instruction Manual
You must read the entire instruction manual with your ventilator. Not every ventilator is the same, and while they operate using similar parts and principles, some ventilators have different connections and setups.
As a result, you’ll need to consult your ventilator’s instructions to ensure you’re following the proper procedure. A small mistake could cause the ventilator to malfunction, triggering alarms and adding to the stress of bringing someone home to care for them on a ventilator.
Ventilators keep the person alive and breathing. Therefore you must take the time to read the instructions to ensure you make no mistakes. A mistake in assembling a ventilator could put your loved ones’ life at risk.
2. Check You’ve Got All the Parts and Pieces
After reading the instruction manual thoroughly, it’s time to assemble all of the pieces you’ll need to construct the device. This means all the plugs, tubes, connections, and monitors. It’s essential to check that you’ve got everything before starting to ensure you’re doing it right.
Here’s a list of parts and pieces typically used in a ventilator setup:
- Flexible tubing
- High-pressure tubing
- Wall plugs
- Oxygen regulator
- ET tube
- Power Source
- Safety Features
- Oxygen Supply
Double-check your instruction manual for a list of parts, as some ventilators have additional connections or adaptors.
Once you are sure that you’ve got all of the pieces you need for the assembling, it’s time to get started.
3. Connect the Ventilator to a Power Source
The next step in setting up your ventilator is to connect the monitor to a power source. Ventilators in the United States all operate on a 120V supply. As a result, you can plug the ventilators directly into the main power supply.
Connect the ventilator to a power supply in a room away from open flames or fire. Ventilators operate using oxygen which can cause flammable objects to combust quickly, setting your home ablaze in a short time.
Another point to consider when choosing where to plug in the ventilator is the source’s reliability. If the socket is faulty, it could result in system failures which will result in an emergency. You can get the power supply inspected by an electrician before installing the ventilator for added safety.
The electrician may suggest that some wiring be changed or a new socket to ensure that you have a safe and reliable power source for the ventilator. An unreliable power source is not safe for a ventilator as, in many cases, it’s keeping the patient alive.
Alternatively, you can use a battery or generator that runs the ventilator. This option stops backups from interfering with the ventilator’s functionality and ensures that the patient in your home remains safe.
4. Connect Ventilation Tubing and Wiring
Reading the instructions, sorting the pieces you need, and plugging in the ventilator are straightforward steps. Now it’s time to connect the wires and tubing so the ventilator can function as it should. This may seem like a daunting task, but following these instructions will save you time and hassle.
Connect the Tubing on the Ventilator
The first step in connecting the tubing on the ventilator is to take out the humidity chamber. Remove the protective covering from the humidity chamber and attach the device to the top of the ventilator. The humidity chamber must be kept clean.
There will be a heated plate underneath the humidity chamber to offer warm air to the patient in some ventilators.
Attach Inspiratory and Expiratory Tubing
Next, you’ll need to attach the inspiratory tubing to the humidity chamber inspiratory outlet. The other end of this flexible tube connects directly to the ventilator. In some cases, doctors will prescribe a filter to be fitted to the inspiratory tube.
This filter will regulate humidity and keep harmful bacteria out of the patient’s lungs. However, this is not always required.
Then you’ll need to find the angled elbow joint and connect one side to the ventilator and the other to the expiratory port. Next, attach the expiratory tubing to the expiratory port. Doctors may also request that you attach a filter to the expiratory tubing to prevent bacteria buildup.
You will be informed by the doctors if you need to attach a filter and how to attach them.
Attach the Wiring
After you’ve connected the tubing, you’ll need to attach the wiring. Connect the temperature probe leads to the jack socket on the ventilator. The jack socket is typically on the side of the monitor.
The other end of this lead connects to the central chamber outlet on the humidification chamber. It would help if you joined the temperature probes to the angled elbow connectors on the inspiratory and expiratory limbs.
If your ventilator has heated air, you will need to connect the heater sites to the heat plate. You may also attach this to the inspiratory or expiratory tubing, depending on the connection.
Ensure that all of the wirings are connected correctly and that all seals are tight. This will prevent air from escaping, which could cause contamination, loss of air pressure, or damage to the ventilator, all of which may put the patient at risk.
Connect the water to the water inlet once the wiring and tubing are connected. This will allow clean water into the humidification chamber, which prevents the patient’s lungs from drying out. Finally, connect the air to the air connector and switch on the monitor.
5. Test the Functions
After you’ve attached the wiring and tubing to the ventilator, you’ll need to run a functional test on the device before you can use it. This test happens automatically on some ventilators, while on others, you need to push a button and consult a manual to learn how your model works.
The functional testing ensures that every aspect of the device is connected correctly and operating. The ventilator will not work until it has passed the functional testing. Once the functional test is complete, you’ll need to select the correct modes and settings for the ventilator.
6. Select the Correct Settings and Modes
Ventilators can be set up in a few different ways and under other parameters.
Here are the five primary modes of ventilation:
- Volume Assist / Control
- Pressure Assist / Control
- Pressure Support Ventilation
- Volume Synchronized Intermittent Mandatory Ventilation (SIMV)
- Pressure-Volume Synchronized Intermittent Mandatory Ventilation
I’ll explain the different modes of ventilation in detail below.
Volume Assist / Control
Volume assist ventilation is one of the most common ventilation modes, especially for patients in the ICU. This mode works by sending a fixed air volume at set intervals into the patient’s airway. This setting may also assist the person connected to breathe as they initiate a breath.
This model ensures that the patient receives sufficient oxygen into their body through the ventilator.
Pressure Assist / Control
The next mode you may need to know about is pressure assist/ control. This mode offers assisted pressure control ventilation at a mandatory rate. This regulates the pressure inside the patient’s lungs and keeps it at a constant rate. However, the volume varies to allow for breathing.
Since the pressure of the air flowing into and out of the patient does not vary in this mode, the lungs should not come under too much pressure. Changes in lung pressure can cause damage, a common side effect of ventilation. However, this mode minimizes lasting damage to the lungs.
Pressure Support Ventilation
Pressure support ventilation is a mode of mechanical ventilation where the patient initiates each breath and is assisted by positive air pressure from the ventilator. The positive air pressure helps the person inflate their lungs and get enough breath.
Pressure support ventilation can work via an intubated tube that goes into the patient’s throat or with a face mask. If the patient’s case calls for a face mask covering to supply oxygen, they will be saved a lot of the discomfort associated with intubated ventilation.
Pressure support ventilation is for patients with weak breathing. Some patients on pressure support ventilation may only require ventilation for a few hours per day and will not rely as heavily as others on a ventilator for breath.
Volume Synchronized Intermittent Mandatory Ventilation (SIMV)
SIMV is a mode of ventilation that manages volume control. This setting delivers a set amount of breaths at a fixed volume while simultaneously allowing for spontaneous breaths. As a result, this model offers partial breathing assistance to the patient.
This setting delivers a fixed amount of air to ensure that the patient breathes. However, when the patient wishes to breathe independently, this mode will allow the patient to breathe in as much as they like without forcing more air into their lungs.
PSV works similarly to SIMV; however, SIMV works as a stand-alone form of mechanical ventilation that does not require effort from the patient.
Pressure-Volume Synchronized Intermittent Mandatory Ventilation
The last mode of mechanical ventilation that will be covered today is pressure-volume synchronized intermittent mandatory ventilation or PSIMV, which is similar to SIMV. The critical difference between the two is this mode also manages the air pressure in the patient’s lungs and volume control.
This mode can allow patients to breathe independently while gaining assistance to ensure that they have enough air pressure and volume in their lungs. At the same time, this mode also delivers set amounts of air at a constant pressure to the patient’s lungs, minimizing long-term damage associated with ventilation.
Another setting that you’ll need to manage is the oxygenation levels of the patient attached to the ventilator. This is known as oxygen control. If the oxygen level is set to 21%, this is also referred to as room air, as it has the same composition as the air we breathe under ordinary circumstances.
However, in many cases, patients will require oxygen therapy. This is where the oxygen levels are elevated to supply additional oxygen to the patient. This helps them to get enough oxygen to breathe.
In most cases, patients on a ventilator require an oxygenation level between 92% and 98%. However, in specific circumstances, doctors may order lower oxygen levels. Doctors will typically order a patient to have reduced oxygen levels in the case of severe lung damage or chronic long conditions.
Before the person who needs the ventilator is released home, the doctor will clearly state what settings and parameters are required. Please take note of the correct settings and ensure that you follow them precisely to ensure that the ventilator works correctly and the person attached can continue to breathe.
Selecting the wrong settings could have severe consequences for the person attached to the device. Not every patient on a ventilator requires the same oxygen content or other parameters, and selecting the wrong settings could cause further damage to the person’s ability to breathe.
7. Connect to Patient
The next step is attaching the tubing to the patient. This is typically done in one of two ways; via a face mask or an intubation tube. See below for how to attach each of these:
How To Attach the Face Mask
Attach the face mask to the tubes connected to the humidification chamber. Cover the patient’s face and nose with the face mask. Secure the straps or elastic around the back of the patient’s head. Ensure that the mask forms an airtight seal on the patient’s face and that air is flowing.
Double-check that the straps are secure and won’t allow the mask to move quickly or come out of place.
How To Attach the Endotracheal Intubation Tube
Intubation tubes are inserted into the patient’s mouth, beyond the vocal cords, and directly into the trachea. A stiff tool is used to guide the intubation tube into the patient’s throat. Once the tube is in place, the rigid device can be removed. The tube is then secured to the outside of the patient’s mouth to hold it in place. A special tape is used to do this. The following video from Mayo Clinic illustrates how this is done:
In some instances, a small balloon filled with air is attached to the end of the intubation tube. This balloon holds the tubing in place and prevents blockages in the airway.
Doctors or nurses typically attach these tubes with specialized equipment. Doctors also use lights and torches to see down the patient’s throat before attaching the intubation tubing.
Concerns and Pitfalls
When you first take someone home on a ventilator, it can be a challenging and stressful time. Getting your home ready for the new equipment and assembling the ventilators are just part of the stress. Next, you’ll have to deal with several issues or situations that are bound to arise.
One concern that patients often have is discomfort. Unfortunately, a ventilator is not going to be comfortable. It involves a tube pushing air into your lungs, through your mouth and throat. As a result, people often complain of throat pains and discomfort.
Consult a doctor if your patient is experiencing severe discomfort from the ventilator. Doctors may prescribe medication that can help the patient relax and reduce the pain caused by intubation.
Not all people who require a ventilator need to use it for the same amount of time. Your doctor will inform you how long you’ll need to use the machine and when it’s okay to take a break. It’s essential to pay attention to how you need to use the machinery, as utilizing the ventilator more often than is needed is unnecessarily harsh on the patient.
People attached to ventilators often experience trauma due to the time that they are attached to the apparatus and having a tube inserted in their throat. As a result, it makes sense that you don’t use the ventilator more than your doctor recommends, as you risk causing mental harm.
Ventilators keep people’s lungs functioning with mechanical assistance. However, ventilators also cause harm to people’s lungs, especially after prolonged exposure. Some modes of mechanical ventilation cause more damage than others. Consult your doctor for the best form of mechanical ventilation that causes the least long-term harm.
Ventilators are equipped with various sensors to set off alarms when something is not working right. These alarms will indicate an issue that you will urgently need to address. In most cases, alarms go off on ventilators for one of four reasons:
- Dislodged tubes
- Obstructions in the patient’s airways
- Equipment failure
When your ventilator’s alarms are going off, it’s likely due to one of these issues.
Important Things To Remember
While ventilators are relatively simple as far as medical equipment goes, there are still lots that can go wrong. When something goes wrong with a ventilator, and you’re not a trained medical professional, panic can quickly set in. However, most issues you can resolve yourself, and if there’s anything you’re unsure of, contact emergency services as soon as possible.
It’s probably best that you contact the emergency services in your area before the person comes home with the ventilator. This allows emergency services to contact you in case of emergencies or to know what to expect if they get a call to your house.
You should also invest in a high-quality battery capable of running the ventilator for hours on its own. This allows you to keep the ventilator running in the case of a power outage. Alternatively, you can invest in a generator that will kick in when the main supply gets cut off.
Another essential thing to remember when taking someone home on a ventilator is breath bags. Breath bags can be used to manually pump air into the person on the ventilator in the case of a system or equipment failure. If the equipment falls, immediately contact emergency services, even if you can use the breath bag until a medical professional arrives.
Finally, it would be best to never place the ventilator in a room where there is an open flame. Therefore any room with a gas cooker, open fire, or where people regularly smoke is not a suitable place for the ventilator.
Ventilators use oxygen tanks to supply air to patients. While oxygen itself is not explosive, oxygen facilitates fire. As a result, a small leak from the oxygen tanks in a room could result in a fast-spreading and severe fire. Therefore, it’s integral that the ventilator is kept away from any flame or ignition source.
Another vital point to remember is that these instructions are for setting up a ventilator for an adult at home. Not for setting up a ventilator for a child.
Assembling a ventilator is a daunting task without the proper knowledge. However, this guide will help you make sense of the process and ensure that your ventilator is appropriately set up. Ensuring that you’ve got all the pieces and thoroughly reading the instruction manual is the best way to start.
You’re nearly ready to go once you’ve connected the wiring, tubing, air, and water supply. Remember to secure all connections tightly and select the correct modes and settings to match your doctor’s orders. Following all of these tips will help you successfully set up your ventilator.
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- Web MD: Intubation Explained
- National Library of Medicine: Pressure Support Ventilation
- European Respiratory Journal: Different modes of assisted ventilation in patients with acute respiratory failure
- National Library of Medicine: Synchronized Intermittent Mandatory Ventilation
- London Health Sciences Centre: Mechanical Ventilation
- YouTube: Mayo Clinic: Securing and Endotracheal Tube with Twill Tape and a Rolling Hitch