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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:

  • Arterial Blood Gas levels
  • pulse rate
  • breath sounds
  • spontaneous tidal volume
  • minute ventilation
  • and negative inspiratory force

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:

  • restlessness
  • dyspnea
  • accessory muscle use
  • altered skin color
  • altered level of consciousness
  • tachycardia
  • ECG changes
  • altered ABG Values

notify the doctor if patient's

  • RR exceeds 30 rpm
  • pulse would rise more than 20 bpm
  • if systolic rises or falls 15 mm Hg
  • depressed ST Segment
  • or 6 extrasystolic beats/min
  • "DRAW AN ABG SAMPLE AND RECONNECT TO VENTILATOR"

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 VERY MUCH

THANK YOU!!!

majority of the expired air goes to the atmosphere, reducing rebreathing CO2

To ensure successful weaning...

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