Care Fusion 3100B Pocket Manual
  1. Manuals
  2. Brands
  3. Care Fusion Manuals
  4. Medical Equipment
  5. 3100B
  6. Pocket manual

Care Fusion 3100B Pocket Manual

High frequency oscillatory ventilator
Hide thumbs Also See for 3100B:
Table of Contents

Advertisement

Quick Links

Pocket guide
3100B high frequency
oscillatory ventilator

Advertisement

Table of Contents
loading

Related Manuals for Care Fusion 3100B

Summary of Contents for Care Fusion 3100B

  • Page 1 Pocket guide 3100B high frequency oscillatory ventilator...
  • Page 2 Use this document as a guideline for initiating and managing the patient on HFOV. Management of a patient on the 3100B HFOV must be altered based on the patient’s individual clinical needs. This document is not intended to be used as a...

  • Page 3: Table Of Contents

    Contents Indications and contraindications ..................1 Things to consider before placing the patient on HFOV ...........4 Pre-use checklist ........................6 Patient circuit calibration ....................8 Ventilator performance check ...................10 Initial settings and management ..................12 Managing oxygenation and ventilation ................16 Assessment of the patient on HFOV .................18 Documentation of oscillator settings ................21 Weaning HFOV and transitioning to conventional ventilation ........22 Transitioning to conventional ventilation ................23...

  • Page 4: Indications And Contraindications

    Indications and contraindications Indications The 3100B High Frequency Oscillatory Ventilator is indicated for use in the ventilatory support and treatment of selected patients weighing 35 kilograms and greater with acute respiratory failure. Contraindications The 3100B High Frequency Oscillatory Ventilator has no specific contraindications.
  • Page 5 Identifying patients for high-frequency oscillatory ventilation Patients with ALI or ARDS, weighing 35 kilograms or greater, who are currently failing on conventional ventilation with a protective lung strategy, will benefit from HFOV. The following criteria are generally used for determining the feasibility of using HFOV.
  • Page 6 The Multicenter Oscillatory Ventilation for Acute Respiratory Distress Syndrome Trial (MOAT2) excluded severe COPD and asthma patients from the RCT trial of the 3100B HFOV. High frequency oscillatory ventilation is recognized as less effective in diseases with increased airway resistance and using it in such cases may potentially result in air...

  • Page 7: Things To Consider Before Placing The Patient On Hfov

    Things to consider before placing the patient on HFOV • Hemodynamic status: – The patient should be hemodynamically stable with a mean arterial pressure of at least 75 mmHg – If mean arterial pressure is less than 75 mmHg, consider fluids and/or vasopressors to optimize the hemodynamic status before starting the oscillator •...
  • Page 8 • Ensure the patient has had a recent chest x-ray • Consider the type of mattress the patient is on—you should have the ability to firm up the mattress if needed • Verify whether the patient requires an off-unit procedure such as a CT scan or MRI;...

  • Page 9: Pre-Use Checklist

    Pre-use checklist 1. Connect the source gases to system. 2. Connect the power to system. 3. Check that the patient circuit support is installed on the system. 4. Connect the patient circuit and the humidifier to the system. 5. Connect the patient circuit control and pressure sense lines to the system. 6.
  • Page 10 13. Preset the flow, frequency, % inspiratory time, power and running mean airway pressure. 14. Set the Max P and Min P switches. 15. Set the blender and humidifier controls for the desired operation. 16. Remove the stopper from the patient circuit and connect it to the patient’s ET tube.

  • Page 11: Patient Circuit Calibration

    Each circuit that is used on the oscillator must be calibrated. The circuit calibration procedure verifies the circuit is leak-free and will hold pressure. Perform this procedure before placing a patient on the 3100B HFOV and anytime a circuit component is changed.
  • Page 12 6. Observe the mean pressure display and adjust the patient circuit calibration screw for a reading of 39 to 43 cmH a. Before adjusting the calibration screw, confirm there are no leaks, the bias flow is at 20 LPM and the circuit is set up correctly. See the troubleshooting guide for more information.

  • Page 13: Ventilator Performance Check

    Ventilator performance check The ventilator performance check ensures the 3100B HFOV is functioning properly. Perform this procedure before placing a patient on the 3100B HFOV. Insert the stopper in the patient circuit wye and turn on both gas sources. 1. Turn the Adjust control to the 12 o’clock position.
  • Page 14 Verify the following parameters according to the altitude of your hospital. Altitude (feet) mPAW (cmH P (cmH 0 to 2,000 26 to 34 113 to 135 2,000 to 4,000 26 to 34 104 to 125 4,000 to 6,000 26 to 34 99 to 115 6,000 to 8,000 26 to 34...

  • Page 15: Initial Settings And Management

    Initial settings and management 1. Set bias flow between 25 to 40 LPM. Patients with severe air-leak syndrome or cuff leak may require higher set Bias Flow to achieve the desired mP 2. Set the initial mean airway pressure (mP ) at 5 cmH O pressure above the conventional ventilator mP...
  • Page 16 c. Check a chest-x-ray within one to four hours of initiating HFOV to assess lung volume. 3. Set the power at 4.0 and rapidly increase it to achieve chest wiggle (a visual vibration from shoulders to mid-thigh area). a. Transcutaneous monitoring for CO (TcCO ) should be considered.
  • Page 17 4. Set Hz at a range of 5 to 6 initially. a. You may decrease the Hz if you cannot control the PaCO with amplitude of approximately 90 cmH b. Decrease the Hz by 1 Hz at a time every 30 minutes until you reach a level of 3 Hz. 5.
  • Page 18 7. Initial FiO at transition to HFOV should be set to 1.0. Alternatively, increase current FiO by 10%. 8. As oxygenation improves, gradually wean FiO to 0.40, and then slowly reduce mP 2 to 3 cmH O every four to six hours until mP is in a 22 to 24 O range.

  • Page 19: Managing Oxygenation And Ventilation

    Managing oxygenation and ventilation If h PaO 1. Wean FiO slowly (5%) to < 0.60. Re-check the x-ray for lung volume assessment. If lung volume is adequate, continue to wean FiO to 0.40. If lung volume is approaching a hyperinflation state, consider weaning mP by 1 to 2 cmH O and continue to wean FiO...
  • Page 20 If h pH i Power, maintaining adequate chest wiggle factor. h Hz. i % I-time to 33% if at 50%. If i pH h Power, obtaining or maintaining adequate chest wiggle factor. i Hz (minimum of 3.0). Generate ETT leak. h % I-time to 50% if at 33%.

  • Page 21: Assessment Of The Patient On Hfov

    Assessment of the patient on HFOV • Sixty minutes post initiation of HFOV • ABG frequency based on clinical status • Within one hour of any major settings change or as clinically indicated • Within one to four hours post initiation of HFOV •...
  • Page 22 Patient assessment Patient assessment should be done every two hours and should include the following: 1. Chest wiggle factor (CWF): Visible vibration noted from the shoulder to mid thigh and bilateral. This check ensures movement of air through the airway structure and lung.
  • Page 23 PaCO , a decrease in oxygen saturation and a visible decrease in chest wiggle. 10. If a cuff leak is used, monitor it closely during position changes. You may see changes in amplitude and mP reflected on the 3100B HFOV.

  • Page 24: Documentation Of Oscillator Settings

    Documentation of oscillator settings • Verify and record the ventilator settings (frequency, bias flow, % inspiratory time, power, Max P and Min P ) and measurements (mP and amplitude). Note: If mP or amplitude measurements change independent of changing a setting, assess for clinical changes, circuit issues or airway issues before dialing for a given measurement.

  • Page 25: Weaning Hfov And Transitioning To Conventional Ventilation

    Weaning HFOV and transitioning to conventional ventilation When the goals below are met (but no sooner than 24 hours) switch to PCV. • is weaned to 0.40 • is 22 to 24 cmH • > 88% (or as ordered) The patient should be stable on the above settings and able to tolerate suctioning and brief disconnects.

  • Page 26: Transitioning To Conventional Ventilation

    Transitioning to conventional ventilation 1. Use a mode most conducive to the patient; usually PCV/APRV. 2. Set the mean airway pressure to be the same in CMV as on HFOV. 3. Adjust inspiratory pressure to achieve Vt 6 to 10 mL/kg of ideal body weight. 4.

  • Page 27: Troubleshooting

    Troubleshooting Troubleshooting clinical issues These clinical troubleshooting guidelines are to help orient you to a possible cause for a clinical change. These only address common problems and are by no means all inclusive.
  • Page 28 Problem: The patient experiences an abrupt deterioration (with a rapid rise in PaCO while being mechanically ventilated with the high frequency oscillator. Consider the following: • Acute airway obstruction (mucous plug) • Pneumothorax • Bronchospasm • Right mainstem intubation or extubation Responses under these circumstances: •...
  • Page 29 Problem: The patient experiences an abrupt deterioration with a drop in oxygen saturation. Consider the following: • Airway patency • Changes in mean arterial pressure • Disconnection from the HFOV device with loss of lung volume • Possible pneumothorax Responses under these circumstances: •...
  • Page 30 Problem: Hypotension. Increased intrathoracic pressure from the elevated mP may cause decreased blood flow resulting in reduced right ventricular preload. Consider the following: • Fluid bolus • Pharmacologic support • Reduce mP...
  • Page 31 Troubleshooting equipment issues Circuit does not pass patient circuit calibration • Visually check for leaks, cracks and open ports on the circuit • Check cap/diaphragms • Check the water trap stopcock (may be open or missing) • Ensure the circuit set up is correctly •...
  • Page 32 Ventilator does not pass the performance check • Low amplitude: – Bypass the humidifier – Check the power knob (0.0 to 10.0) • Low mP (with or without low amplitude): – Crimp the airway pressure line (mP should read 130 to 140 cmH –...
  • Page 33 Fluctuating mP • The Auto-Limit feature is activated • Check the high-pressure setting • Check for spontaneous breathing Low Source Gas is illuminated • This condition indicates an input pressure of less than 30 psi from either the blender or the cooling air; check the input gas lines •...
  • Page 34 High Pressure alarms (alarm setting or > 60 cmH • Spontaneously breathing: Consider the clinical status of the patient, assess the sedation level or insufficient bias flow rate; re-adjust mP using a higher flow • Obstruction in the expiratory limb or in the pressure sense line: Replace the patient circuit •...
  • Page 35 • Leak in the humidifier or patient circuit: Fix the leak or replace the patient circuit • Cap diaphragm leak: Replace the cap diaphragm • The water trap stopcock is open: Close the water trap stopcock • Interference from a radio transmitter: Remove the source of interference Oscillator stopped with no other alarm occurring The power setting is too low and the amplitude is ≤...
  • Page 36 • Changes in amplitude are normal as the patient’s pulmonary status changes; assess patient changes in status and adjust ventilator settings if deemed appropriate General guidelines • Ventilator circuits should never be reused: Washing and sterilizing will reduce their overall performance and increase the risk of malfunction •...

  • Page 37: Recruitment Maneuvers For Adult Patients On Hfov

    Recruitment maneuvers for adult patients on HFOV A recruitment maneuver is a technique employed by attempting to recruit the alveoli and increase lung volume by using a sustained inflation accomplished by a set mP of 40 cmH O pressure for 40 seconds with the piston in a stopped position. This technique, when combined with HFOV, is thought to provide further improvements in oxygenation and lung recruitment.
  • Page 38 Recruitment maneuver guidelines • Perform a recruitment maneuver after any circuit disconnect • Perform a recruitment maneuver before an increase in mP • A recruitment maneuver may be repeated up to three times to see improvements in oxygenation with the ability to reduce FiO Caution! Do not perform a recruitment maneuver under either of the following conditions:...

  • Page 39: Cuff Leak Procedure

    Cuff leak procedure The cuff leak procedure was identified as a technique that may be employed with HFOV to assist with clearing tracheal dead space of CO and assist with maintaining an adequate pH. Decreasing cuff pressure allows gas (PaCO ) to escape around the ET tube and to be excreted through the mouth.
  • Page 40 Indications Power/amplitude and mP have been optimized with no net improvement in PaCO Frequency has been lowered to four Hz or less with no improvement in PaCO Inspiratory Time % has been increased with no improvement in PaCO Procedure 1. With a syringe attached to the endotracheal tube pilot balloon, withdraw air. 2.
  • Page 41 Caution! Before producing a cuff leak consider the following: • The patient has been suctioned • A bronchoscopy, if possible, was performed to clear airway of any obstruction • A recent chest x-ray shows appropriate lung volume. Note that the distal mP will be less with cuff deflated even though the monitored mP is the same...
  • Page 42 Table 1: PaO / FiO ratio < 200 ARDS < 300 ALI < 400 Abnormal > 400 WNL...
  • Page 43 Table 1: PaO / FiO ratio (continued) < 200 ARDS < 300 ALI < 400 Abnormal > 400 WNL...

  • Page 44: Outcome Assessment Form

    Outcome assessment form The use of this form is not intended to encourage or deny the use of high frequency oscillation. The following below is only a portion of the form. You can find the Outcome Assessment Form to print and use on the CareFusion site at carefusion.com/hfov/.

  • Page 45: Useful Information

    800.268.7916.) 3100B HFOV rental program The 3100B HFOV rental program is designed to assist customers who own the 3100B HFOV and need additional units or customers trained on the 3100B HFOV and approved to rent the device as a short term solution to bridge to a purchase. Delivery will be within 24 hours or less in most cases.
  • Page 46 3100B HFOV intervention program The 3100B HFOV intervention program is designed to allow access to the device for centers that do not have trained personnel or have not maintained competency of the 3100B HFOV. The 3100B HFOV intervention program provides an onsite clinical consultant for education and clinical support.
  • Page 47 References 1 Derdak S., Mehta S., et al. High Frequency Oscillatory Ventilation for Acute Respiratory Distress Syndrome in Adults: A Randomized, Controlled Trial. Am J Respiratory Critical Care Medicine, 2002; 166:801-808. 2 Ferguson N., Chiche J., et al. Combining High-Frequency Oscillatory Ventilation and Recruitment Maneuvers in Adults with Early Acute Respiratory Distress Syndrome.
  • Page 48 CareFusion CareFusion Germany 234 GmbH 22745 Savi Ranch Parkway Leibnizstrasse 7 Yorba Linda, CA 92887 97204 Hoechberg Germany 800.231.2466 toll-free 714.283.2228 tel +49 931 4972-0 tel 714.283.8493 fax +49 931 4972-423 fax CareFusion Yorba Linda, CA carefusion.com © 2011 CareFusion Corporation or one of its subsidiaries. All rights reserved.

Table of Contents