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Mechanical Ventilator Weaning: T-Piece
PaCO2 level under 50 mmhg or whatever is normal to the patient
an FiO2 of 40% and below with a PaO2
of 60 mm Hg or more
a vital capacity of 10 ml/kg of body wieght
a negative inspiratory force greater than 20 cm H2O
minute ventilation of less than 10L/min with a tidal volume equal to 5 ml/ kg of body weight
an ability to double his resting minute ventilation
a spontaneous respiratory effort
a successful ceasation of neuromascular blockers
absence of:
infection
acid base or electrolyte imbalance
hyperglycemia
fever
arrhythmias
anemia
renal failure
shock
excessive fatigue
are used for patients who still require oxygen or humidified gas, but does not need the positive pressure that a CPAP provides. Although there oxygen need is less, patients with T Pieces and Tracheostomy Collars still cannot obtain adequate O2 from room air...
T piece and trach collars are usually
the final stage of weaning
T piece: refers to the cross or T shaped connector...
that allows air to flow from an
air source to a patient...
air then blows at the side of the connector...
providing a continous source of fresh air which can be humidified as needed...
Problems encountered:
Accumulation of fluids in the tubings and the T Piece
which can lead to aspiration especially during postion changes if not drained periodically
the weight of the t piece or its manipulation
may pull on the tracheostomy tube which
may cause the patient to cough and experience discomfort
NURSING CARE:
obtain baseline:
connect a T piece or a Tracheostomy Collar
to a separate humidified oxygen system and
adjust the flow rate or concentration.
Deflate the cuff for a T piece trial unless its
needed to prevent aspiration of saliva and stomach contents...
if possible place the patient in semi-fowlers
position, give broncho dilators as ordered, and suction 15 minutes before disconnecting the patient from the ventilator...
turn on the oxygen source, detach the patient from the ventilator and connect his tubes to the oxygen source fro 5 - 10 min per hour at the start gradually increasing 5 - 15 min per hour...
use pulse oximetry to continously monitor oxygen saturation...
Watch closely for signs of hypoxia:
notify the doctor if patient's
obtain ABG samples, as ordered while the patient
is breathing spontaneously, compare results from baseline levels and report changes...
When weaning time has elapsed return patient to ventilator, increase weaning time as tolerated... Night weaning is attmepted last to promote rest
THANK YOU!!!
majority of the expired air goes to the atmosphere, reducing rebreathing CO2