HFO Training Manual

Optimizing
Respiratory
Therapy
Services
A Continuum of Care from
Hospital to Home
A Training Manual for
Paediatrics & Adults
Healthcare Professionals and Caregivers
June 2010
Project Team Acknowledgements
Mary Bayliss The College of Respiratory Therapists of Ontario
Carole Hamp (CRTO) gratefully acknowledges the Ministry of
Dianne Johnson Health and Long Term Care’s Health Force Ontario
branch for funding this collaborative initiative
Rosanne Leddy
entitled “Optimizing Respiratory Therapy Services:
Mika Nonoyama A Continuum of Care from Hospital to Home”.
Christine Robinson
Miriam Turnbull We would also like to thank the Toronto Central Local
Health Integration Network (LHIN) for its support of
this initiative.
Partners We would like to recognize the participation of our
partners is this initiative.
Central Community Care Access Centre
Professional Respiratory Home Care Services
Respiratory Therapy Society of Ontario
West Park Healthcare Centre
We also acknowledge the valuable contribution of
the following organizations in the development of
this teaching package.
Funding Hamilton Health Sciences
Kingston General Hospital
Support for the development of this London Health Sciences Centre
training manual was provided through St Michael’s Hospital, Toronto
HealthForceOntario’s Optimizing Use of Sick Kids, Toronto
Health Providers Competencies Fund. The Ottawa Rehabilitation Centre
Ventilator Equipment Pool, Kingston
We acknowledge the following Respiratory Therapists
for their dedication and tireless commitment to this
project.
Carlos Bautista Gail Lang
Melva Bellefountaine Adrienne Leach
Rob Bryan Karen Martindale
Noreen Chan Raymond Milton
Janet Fraser Ginny Myles
Terri Haney Patrick Nellis
A copy of this Training Manual Chris Harris Margaret Oddi
is available from Melissa Heletea Regina Pizzuti
College of Respiratory Therapists of Ontario Dave Jones Faiza Syed
180 Dundas Street West, Suite 2103 Jeannie Kelso Renata Vaughan
Toronto, Ontario M5G 1Z8
Tel: 416-591-7800 Special thanks to the ProResp Clinical Team.
Fax: 416-591-7890
Toll free: 1-800-261-0528 Our thanks to all of the patients/clients, families and
Email: [email protected] “hands on” caregivers without whom this project
Web site: www.crto.on.ca would not have succeeded.
Optimizing
Respiratory
Therapy
Services
A Continuum of Care from
Hospital to Home
A Training Manual for

Paediatrics & Adults
Healthcare Professionals and Caregivers
June 2010
Disclaimer
Information published by The College of Respiratory Therapists (CRTO) is provided for
educational purposes only and is intended for Ontario residents.
This educational material does not provide medical advice. Information provided is not
designed or intended to constitute medical advice or to be used for diagnosis of an individual
patient’s condition. Due to unique needs and medical history, patients are advised to consult
their own healthcare professional(s) who will be able to determine the appropriateness of the
information for their specific situation, and will assist them in making any decisions regarding
treatment and/or medication.
Specific products, processes or services. Reference to, or mention of, specific products, processes
or services does not constitute or imply a recommendation or endorsement by CRTO and/or its
contributors.
Links to other sites are provided as a reference to assist you in identifying and locating other
Internet resources that may be of interest. Please remember that Internet resources are no
substitute for the advice of a qualified healthcare practitioner. We do not assume responsibility for
the accuracy or appropriateness of the information contained in other sites, nor do we endorse
the viewpoints expressed in other sites.
Use of this educational material is encouraged, all we ask is that you give credit to the CRTO
and this project*.
Should you identify any areas that require revisions or updates please let us know.
* Support for the development of this training manual was provided through HealthForceOntario’s Optimizing
Use of Health Providers Competencies Fund. Please refer to the back cover of this educational package to view a
complete list of the project partners.
Glossary of Terms
Introduction &
Section #1: Introduction & Glossary of Terms
Introduction to Manual
Introduction to the CD Resources
Glossary of Terms
Section #2: Healthcare Professionals
Professionals
Healthcare
Discharge Identification & Preparation
Identification and Preparation Tool
Discharge Checklists
Preparation for ICU Discharge
Preparation for Hospital Discharge
Section #3: Patients/Clients & Caregivers

Ventilation & Tracheostomy Care Education Checklists
Home Ventilation & Routine Tasks
Tracheostomy Care (for Adults) My Education Checklist and Learning Log
Patients/Clients
& Caregivers
Non-Invasive Positive Pressure Oximeter Teaching Checklist
Ventilation (for Adults)
Home Ventilation & Troubleshooting
Tracheostomy Care (for Paediatrics) Troubleshooting Guide
Pulmonary Clearance Techniques Emergency Contacts and Planning

Useful Web Resources
Emergency Preparedness Guide for
People with Disabilities/Special Needs
Section #4: Appendices

Appendix A
Appendices
Assistive Devices Program

Equipment/Supply Authorization Form (Sample)
Appendix B
Quick Reference Guide to LTV® 1200/1150 Series Ventilators
Appendix C
Quick Reference Guide to LTV® 900, 950 & 1000 Series Ventilators
Glossary of Terms
Introduction &
Section #1: Introduction & Glossary of Terms

Glossary of Terms

Professionals
Healthcare


Ventilation & Tracheostomy Care Education Checklists
Home Ventilation & Routine Tasks
Tracheostomy Care (for Adults) My Education Checklist and Learning Log
Patients/Clients
& Caregivers
Non-Invasive Positive Pressure Oximeter Teaching Checklist

Home Ventilation & Troubleshooting
Tracheostomy Care (for Paediatrics) Troubleshooting Guide


Appendix A
Appendices

Appendix B
Appendix C
Glossary of Terms
Introduction &
Section #1: Introduction &
Glossary of Terms
Glossary of Terms
Professionals
Healthcare
Patients/Clients
& Caregivers
Appendices
Glossary of Terms
Introduction &
Section #1: Introduction &

Glossary of Terms
Glossary of Terms
Professionals
Healthcare
Patients/Clients
& Caregivers
Appendices
Introduction Introduction & Glossary of Terms
Introduction to the Manual

Mechanical ventilation was first developed during the polio
epidemic in the 1950s when patients were placed in an iron
lung. Today we use positive pressure ventilation with an
endotracheal tube or a tracheostomy tube. For the majority of
patients, ventilation is usually short term and is discontinued
after the respiratory or ventilatory failure has resolved. Most
patients are weaned off the ventilator with no problems.
However, for some patients weaning is a challenge.
If a patient cannot be weaned off the ventilator they are

deemed ‘ventilator-dependent’. Chronic ventilated patients can
be found in acute-care hospitals, ventilator step-down units,
long term care facilities, and at home. It is ideal and safe to
transition stable, chronically ventilated patients to their homes.
A stable, ventilator dependent patient can be transitioned successfully from the ICU to home, or a
long term care facility. This shift from acute care to home care has resulted in improved quality of
life, decreased morbidity and mortality, and reduced care costs. Patients and families report that
they are happier at home and have a better quality of life.
The intent of this document is to assist respiratory therapists and other healthcare providers to
transition chronically ventilated individuals from hospital to the community. A successful hospital-
to-home transition requires careful planning, and plenty of patient and family education. Prior to
planning the transition, the patient must meet discharge criteria, such as being medically stable.
These criteria can be found in this manual. For a smooth transition to occur, the patient needs a
supportive family, caregivers and a medical team that communicates well. Once the ICU discharge
criteria are met, the process of educating the patient and caregivers can begin. The Education
Checklist and Learning Log will assist the educator and learner track the education process.
It is important to observe the caregivers participating in the care of the patient, while the
patient is in the acute care setting. It is critical as a healthcare provider to document the learner’s
competency. A number of checklists have been provided in this manual to assist with this
documentation requirement. All must be competent and comfortable prior to discharge.
The education process can take 2 - 4 weeks to complete, prior to a patient’s discharge. To ensure
the skills have been mastered, and to provide ongoing support, a comprehensive follow up plan is
then continued within the community.
Introduction Introduction & Glossary of Terms
The material provided to the patient includes basic anatomy and physiology of the respiratory
system, ventilator parameters, alarms, circuit changes, and backup power sources. Also covered
are suctioning, stoma and tracheostomy care and how to respond in an emergency. This
information is found in the Home Ventilation & Tracheostomy Care manuals.
There is also a Troubleshooting Guide, as an additional reference. For those patients on

non-invasive ventilation refer to the Non-Invasive Positive Pressure Ventilation guide.
There are other tools and checklists to help you

prepare the patient, their families and caregivers.
The Useful Web Resources and Glossary of Terms can
also be helpful. Team meetings need to take place,
prior to and following discharge, between the acute
care healthcare providers and the Community Care 180 Dundas Street West, Suite 2103
worker. Tel: 416-591-7800
Fax: 416-591-7890
The intent of this document is to assist respiratory Toll free: 1-800-261-0528
Email: [email protected]
therapists and other healthcare providers to Web site: www.crto.on.ca
transition the chronically ventilated individual from
the hospital to the community. If you have any
suggestions or comments about this manual please
forward them to The CRTO.
Introduction to the CD
The CD, found in the inside back cover, contains all
the information and worksheets that are presented
here in this manual. The materials are sorted by ‘tab’
Optimizing
or topic and are ready for print. To view the files, you
must have Adobe Reader software. To obtain Adobe Respiratory
Reader, visit, http://get.adobe.com/uk/reader. Therapy
Services
A Continuum of Care
from Hospital to Home
RESOURCE CD
A Training Manual for Paediatrics & Adults
Healthcare Professionals, Patients/Clients and Caregivers
June 2010
Glossary of Terms Introduction & Glossary of Terms
Glossary of Terms
The following is a list of words that you will find in the manual. Some of the terms are things you
may hear your healthcare worker say. Always ask if you do not understand something.
A Cardiopulmonary resuscitation (CPR):

Artificially supporting breathing and the
Aerosol: Solution that is given in a mist circulation
Apnea: Not breathing Carina: The point of where the right and left
Antibiotics: Medicines that fight infections bronchi separate
Artificial nose: A device that warms and Catheter: A small tube placed inside the body
moistens the air to add or remove liquids
Artificial airway: A cut made in the trachea CPAP: A ventilation mode that helps a patient’s
resulting in an opening that bypasses the own breathing efforts. Stands for continuous
nose and mouth. Also called “trach” or positive airway pressure
“tracheostomy” Cuff: The inflatable balloon on some trach
Aspiration: Food or liquid breathed into the tubes
airway instead of swallowed Cyanosis: A bluish color of the skin due to
Asthma: Difficult breathing with wheezing reduced oxygen in the blood
that is caused by swelling or spasms of the
airways
D
Decannulation: Removal of the trach tube
B
Diaphragm: The big muscle below the lungs
Bacteria: Germs that controls breathing
Bacterial: Caused by bacteria Dysphagia: Difficulty swallowing
Breathing bag: Ventilating bag used for Dyspnea: Labored or difficulty breathing,
manual resuscitation shortness of breath
Bronchi: The two main branches leading from
the trachea to the lungs
E
Edema: Swelling of tissue.
C
Encrustation: Hard and dried mucus that can
Cap: A small cap used to plug the trach build up around the inner cannula.
opening
ENT: It is a term used for type of doctor that
Cannula: The tube part of the trach tube specializes in the ‘ear nose throat’. ENT doctors
Carbon Dioxide (CO2): Gas eliminated from do tracheotomy surgery
the lungs with exhalation
ET tube (endotracheal tube): A tube used to Home healthcare supplier: Also called medical
provide an airway through the mouth or nose equipment supplier. They provide equipment,
into the trachea. oxygen, trach care supplies.
Epiglottis: “Trap door”. A piece of cartilage that Humidity: Moisture in the air
hangs over the larynx like a lid and stops food,
Hydrogen peroxide (H2O2): Mild cleaning
and liquids from going down into the lungs
agent
Esophagus: The tube between the throat and
Hypoventilation: Reduced rate and depth of
the stomach
breathing
Exhale: To breathe out
Hypoxemia: A low amount of oxygen in the
Extubation: Removal of the endotracheal tube blood
Expiration: Breathing out of air from lungs
I
F Inflation line: The thin plastic line attached
to trach tube balloon on one end and pilot
Fenestrated: Having an opening in the trach
balloon on the other. It is used to inflate and
tube to allow speech
deflate the trach tube balloon (cuff ).
Fenestrated inner cannula: An inner cannula
Inflation syringe: A plastic syringe without
with holes in it. This lets air go from the trach
needle used to inflate the trach tube balloon
tube up to the mouth, and nose. The outer
(cuff )
cannula must also have holes in it to work
Inhale: To breathe in.
Fenestration: A single hole or pattern of
smaller holes Inner cannula: The inner removable tube that
fits inside the outer cannula. May be removed
Flange: Part of the trach tube, also called the
to clean or exchanged with different inner
neck plate
cannula.
Inspiration: To breathe in
G
Intubation: Placement of a tube into the
Glottis: The sound producing part of the trachea to help with breathing.
larynx that consists of the vocal cords
L
H
Larynx: “Voice box” or “Adams apple”. Is just on
Heat moisture exchanger (HME): A filter top of the trachea.
device that fits into the end of the trach tube
Lumen: The inside of the trach tube through
to warm and moisten the air the patient
which air passes.
breathes
Home healthcare professional: Individual
who gives care at home
M Retractions: Pulling or jerky movement of

the chest and neck muscles. It’s a sign of
Mucous: Slippery fluid that is made in the respiratory distress
lungs and windpipe
Mm: Short form for millimeter. One millimeter
equals .039 inches S
Secretions: Another word for mucous.
N Speaking valve: A one way valve that lets air
come into the trach tube when you breathe
Nebulizer: A machine that puts moisture and
in. When you breathe out, the valve closes
or medicine into the airway and lungs
sending air out past the vocal cords and
Neck plate: Part of the trach tube that sits through the mouth so speech is possible.
against the neck, also called the flange
Speech language pathologist: A person
Nosocomial infection: An infection that you trained to help with speaking and swallowing
got during your hospital stay problems
Stoma: The hole in the neck where you insert
O the trach tube
Sterile: Very clean and free from germs
Obstruction: Blockage
Suctioning: One way to keep the inside of the
Obturator: The guide that goes in the trach
trach tube clean and free of mucus. A small
tube to help insert the tube into the trachea
catheter is connected to a suction machine
Outer cannula: The main tube with neck plate and placed into the trach tube to remove
that is placed into the trachea mucous
Oximeter: Equipment that monitors the Swivel neck plate: A neck plate that can swivel
amount of oxygen in the blood up and down and/or side to side. Allows for
greater range of head and neck movement
Oxygen: A gas that the body needs to stay
without discomfort.
alive
Syringe: Device to measure medicine
P
Patent: Open, clear airway T
Pneumonia: Swelling of the lung that is often Trach: An opening into the trachea
caused by germs Trach mask: A device that fits on the end of
the trach tube to provide moisture
R Trachea: “Windpipe”. The tube through which
air flows between the larynx and the lungs
Respirologist: A doctor who looks after the
lungs Tracheal wall: The inside lining of the trachea
Respite: A break for caregivers who care for a Trach Tube: A tubular device placed into the
disabled family member at home trach
Trach Ties: Cotton twill or Velcro tapes used to

hold the trach tube in place. Connects to the
slots in the trach tube neck plate
V
Ventilator: A machine that helps a person
breathe
Virus: A germ that can cause illness
Viscid: Thick or sticky
Vocal cords: Two strips of tissue in the voice
box in the neck, which allows vocalization
W
Wheeze: A whistling sound coming from the
lungs because of a narrowing in the wind pipe
or airways.
Glossary of Terms
Introduction &
Professionals
Healthcare
Patients/Clients
& Caregivers
Appendices
Glossary of Terms
Introduction &

Professionals
Healthcare
Patients/Clients
& Caregivers
Appendices
Identification
and
& Preparation
Identification
Preparation
Discharge
Tool
Notes
& Preparation
Identification
Discharge
Identification
and
Preparation
Tool
Identification and Preparation Tool Healthcare Professionals
Evaluation and Discharge Planning
Discharge Assessment
The following is a high-level approach the interdisciplinary team can use during the
preliminary stages of identifying a candidate for home or community placement.
Assessment of the Home Environment
Assessment includes geographic location, available space, and accessibility.
 A home to go to
 Home environment prepared in advance to accommodate the patient’s needs
 Adequate number of grounded electrical outlets
 Respiratory equipment supplier is aware of individual
 Sturdy bedside table for the ventilator placement
Assessment of Caregivers
Caregivers must be motivated and able to learn the care routines.
 Patient is able and willing to supervise/direct care

 Individual is able and willing to participate in self care, or has sufficient caregiver
assistance to adequately meet medical, respiratory, and personal care needs
Education and Training
There is a comprehensive education plan with learning objectives and evaluation for
individual, family and caregivers.
 Caregivers identified and trained prior to discharge (See Home Ventilation &
Tracheostomy Care, and Education Checklist and Learning Log provided in this
manual)
 Adequate nutrition program is in place
 Successful and stable trials: for at least two weeks prior to discharge with no changes
B On home equipment ventilator prior to discharge, (e.g. ventilator, monitor,
oxygen, if applicable)
B Leaving the hospital setting with home caregivers
Page 1
Assessment of Resources
This includes professional services, support systems, individual’s financial resources.
 Adequate financial resources and mechanisms for reimbursement identified prior to

discharge
 Potential referrals in place: Respirologist, Occupational Therapist, Physical Therapist,
Social Worker, Registered Dietitian, Pharmacist, Community Care Access Centres
(CCAC)
 Appropriate application forms completed:
B Assistive Devices Program:
o Tracheostomy
o Ventilator
o Enteral feeds, if applicable
B Home Oxygen Program, if applicable
B Special services at home
B Handicapped parking permits
B Wheelchair
 Contact the Ventilator Equipment Pool (VEP) to discuss the most appropriate
equipment available and lead time for delivery
Plan of Care
A written management plan for respiratory, medical care, and emergencies.
 Individual is medically stable: oxygen requirement less than, or equal to 40%; stable
blood gases; mature tracheostomy and no events requiring CPR for at least one
month
 Comprehensive discharge plan in place
 The treatment plan for all medical conditions is in place
B Plan does not require frequent changes
B Plan is transferable to the community
 Discharge planning meetings in place, including the individual, caregivers, healthcare
team and community services
Page 2
Team Meetings
Initial team meeting are to take place while the ventilator assisted individual (VAI) is in the
hospital.
First Team Meeting
Primary aims of this meeting are:
 Determine the short and long term goals

 Identify issues and potential barriers to discharge
 Create plans to manage issues and potential barriers to discharge
 Complete feasibility assessment of required community support
 Identify additional funding opportunities for the patient
Team members should include the individual, their caregivers and the inter-professional
team:
 Individual  Speech Language Pathologist

 Family and caregivers  Occupational Therapist (OT)
 Most responsible physician  Registered Dietitian (RD)
 Nurse (RN)  Pharmacist
 Community Respiratory Therapist (RT)  CCAC Case Manager
 Social Worker (SW)  Discharge planner
 Physical Therapist (PT) 

Second Team Meeting
 Determine if discharge to home or community facility is achievable

 Prioritize goals and timelines; those to be achieved prior to discharge
 Determine a realistic discharge date
 Delineate roles and responsibilities for all team members, including the caregiver and
family
B Care plans
B Funding applications
B Discharge guidelines
B Learning needs assessments
B Education training programs
B Equipment acquisition
Page 3
Additional team members at this meeting should include the community care providers:
 Community RT
 Community PT
 Community OT
 Nursing agency provider
Follow up Meetings
 Monitor progress toward goals

 Update the patient and caregivers
 Identify other barriers to discharge and develop a resolution plan
 Communicate among the inter-professional disciplinary team
Page 4
Placement Considerations in the Home
Adequate Daily Care Coverage

In addition to the care provided by the caregiver(s), the patient may receive additional care
hours through CCAC. Access to immediate assistance is recommended for any individual who
requires 24 hours ventilation or is fully dependent in their activities of daily living. This can be
a trained community care provider, such as a Registered RT, Nurse, PSW or trained family
member.
Individuals who live in Ontario who require suctioning or catheterization as part of their
normal daily routine have a legislated exemption in the Regulated Health Professional Act
(RHPA) allowing non-registered professionals to provide this service, provided they are
competent to do so.
Additional Considerations
Mobility
A VAI may require a wheelchair with ventilator and oxygen carrying capacity. The vehicle
used for mobility must be able to safely carry a ventilator and external battery without
tipping. Home ventilators can weigh up to 35 lbs. Ventilator shelves can be attached to
some standard wheelchairs, but some of these chairs may not be wide enough or
balanced enough to hold the additional weight. Often a VAI has their own wheelchair that
can be adapted by the supplier to carry the ventilator and battery. If this is not possible,
an application for a customized wheelchair with ventilator carrying capability can be
made.
Assessment and applications are usually made by the OT or PT and signed by the
physician. The chair supplier will need the ventilator and battery dimensions. Information
that can be obtained from the RT.
Other mobility devices may be required, such as ambulation aids and positioning devices
(lifts).
Applying early in the process will reduce delays. Check with the equipment provider for
the anticipated delivery date.
Page 5
Equipment Acquisition
The Ministry of Health and Long-Term Care (MOHLTC) funds 75% of the cost of
respiratory supplies through the Assisted Devices Program (ADP). The remaining 25% is
the responsibility of the individual.
Contact the VEP or alternate provider for details on equipment acquisition. Note: some
individuals are not eligible for equipment through the VEP. For example, patients
discharged to long term care facilities do not have access to VEP equipment. See VEP
website for more information on eligibility http://www.ontvep.ca.
Home Mechanical Ventilators
A VAI discharged to the community is provided with:
 Ventilator(s)
 Battery charger
 Heated humidifier
 External battery for emergency power only
 Battery cable
 Re-useable ventilator circuits
The cost of this equipment is 100% covered by the MOHLTC, through ADP. Applications
must be signed by the physician.
The VAI should have completed several successful trials on a home mechanical ventilator,
before setting them up for indefinite use.
Other Respiratory Supplies
Requests are made by the home respiratory care service, to the ADP. This equipment may
include:
 Apnea cardiorespiratory monitors  Tracheostomy supplies

 Compressors for aerosolized  Percussors
medication delivery  Resuscitators
 Postural drainage boards  Positive airway pressure systems
 Suction machines
75% of the cost of this equipment may be covered by the MOHLTC. The remaining 25% is
the responsibility of the individual.
Page 6
Some equipment, although necessary for some VAIs, may not be funded through ADP.
The following equipment is not funded:
B cough-assist devices
B oximeters for individuals 18 years or older
B 12 volt batteries for mobility purposes
Other Medical Supplies
Other medical supplies may be necessary in the community setting and eligible for ADP
funding e.g. enteral feed equipment. Check with the interprofessional healthcare team
for details.
Individual, Home Care Providers and Family Education
A successful discharge requires a simplified and comprehensive transfer of care routines

from healthcare team to the community provider team. Ideally the community team
would receive the transfer of skills within the acute care facility. This allows them to be in
direct contact with the individual and work closely with the acute care team. This training
technique serves to increase the confidence and comfort of both the community care
providers, the individual and the caregivers.
Information provided in respiratory teaching packages typically should cover:
 Tracheostomy and ventilator care

 Individual-specific training checklist that must be completed prior to discharge; can
also be used as a scheduling guide
 Emergency guidelines that are provided to address common problems that may arise
within the home environment
Respiratory Education
The training should include, but is not limited to:
 Respiratory anatomy and physiology  Use of the manual resuscitator bag

 Hands-on training with tracheal  Switching to ventilator battery
suctioning  Charging the ventilator battery
 Ventilator troubleshooting and  Circuit assembly
maintenance  Emergency planning
 Tracheostomy tube cuff care; changing  Cleaning of equipment
if applicable  Volume augmentation manoeuvres
Page 7
Emergency Plan and Recommended Physician Coverage
Emergency guidelines are provided to address common problems that may arise within
the home environment. These guidelines are provided for each individual and placement
situation. Included are: what should be done; who should do it; what services should be
called, etc.
The individual's wishes regarding resuscitative efforts should be addressed and be

available in the home for emergency response personnel.
The individual must have:
 A Family Physician who will manage day to day general medical needs
 A Respirologist or other consultant who has expertise in mechanical ventilation, to
manage ventilation needs
 A “home-base” hospital location should an emergency occur that cannot be solved at
home. Ideally this is the acute-care facility discharging the individual home
For those caregivers wishing for Cardiopulmonary Resucsitation (CPR) certification,

discuss this training with your healthcare provider.
Guidelines are provided that include contact numbers of home care providers and
support services.
Communication and Transfer of Information to Community Providers
With the individual’s consent, the discharge team should ensure the community care
partners receive information on:
 Medical history
 Written consent
 Care plan, preferences, daily routines, typical patterns where interventions are
required
 Transfer and discharge notes from the discharging physician
 Emergency guidelines
 Equipment and supplies list
Page 8
References
Dyson, J., Vrlak, A., & Provincial Respiratory Outreach Program (PROP). (2004). Provincial
Respiratory Outreach Program discharge planning guide (User Guide). Vancouver: BC
Association for Individualized Technology and Supports for People with Disabilities (BCITS).
Long-term Ventilated Patient Transfer Working Group. (2007). Preparation of an ICU patient
for transfer to LTV Unit. Toronto: Toronto Central Local Health Integration Network.
Make, B., Hill, N., Goldberg, A., Bach, J., Criner, G., Dunne, P., et al. (1998). Mechanical
ventilation beyond the intensive care unit. Quick reference guide for clinicians. Highlights of
patient management.
Make, B., Hill, N., Goldberg, A., Bach, J., Criner, G., Dunne, P., et al. (1998). Mechanical
ventilation beyond the intensive care unit. Report of a consensus conference of the American
College of Chest Physicians. Chest, 113(5 Suppl), 289S-344S.
Montgomery, J. (2006). An aid for identification and considerations for community placement
of the long term ventilator dependent person. London: Respiratory Community care, London
Health Sciences Centre.
Page 9
Notes
Page 10
Preparation
for ICU
Discharge
Preparation
for Hospital
Discharge
Notes
Preparation
for ICU
Discharge
Preparation for ICU Discharge Healthcare Professionals
Decrease Invasive Monitoring
Lines
 Remove arterial line
 Remove Nasogastric tube (NG tube), and other invasive lines/tubes
 If patient cannot have oral intake, switch NG tube to Gastrostomy tube (G-tube) or a
Jejunostomy tube (J-tube)
 Cap Peripherally Inserted Central Catheter (PICC) lines if possible
Blood Work
 Reduce blood work frequency
Ventilation and Oxygenation

 Reduce to lowest FiO2 to maintain SpO2 88-92%, and lowest PEEP (if at all required)
 Avoid using continuous pulse oximetry once Arterial Blood Gases (ABG) and oximetry
have determined oxygen requirements. Use for periodic assessments of SpO2
 If available, switch the patient from a critical care ventilator to one that would be used in
the home/community setting
Page 1
Treatment Plan
Ventilation & Weaning

 If weaning is an option, consult/refer to Toronto East General Weaning Centre of
Excellence
 Have ICU staff and allied healthcare professionals refrain from using the word “weaning”
Instead, encourage staff to use the phrase “ventilator free time”
 Encourage the patient to increase their ‘ventilator free time’, even if it is in small
increments. In the event of an accidental disconnect from the ventilator at home, the
longer the ventilator free time, the safer. This also reduces caregiver anxiety
 For mechanical ventilation, use the simplest settings. Use assist control mode whenever
possible since it is the most widely used ‘invasive’ mode. Most home ventilators do not
have a pressure support option. However, one can petition the Ministry of Health for a
ventilator with pressure support, if this is the only approach to ventilate
Tracheostomy Tube
Select a tracheotomy tube that is most appropriate for the patient’s comfort and goals. The
most desirable features for the new tracheostomy tube are:
 Cuffless or ‘Tight to Shaft’ Cuff: This decreases secretions caused from irritation of the
cuff, increases potential for speech and increases sense of smell and taste
 Nonfenestrated Limitations: Tends to cause granulomatous tissue in the airway
 Reusable Inner Cannula: To decrease the frequency of suctioning, teach the patient to
cough to the inner cannula and keep it clear
 Other tracheostomy tube models or characteristics are fully acceptable, if the above
choices are not suitable
 Changing the tracheostomy tube to one of these desirable tubes is not a necessity before
transferring out of the ICU, but will ease the transition
 If the caregivers in the community or the long-term care facility do not have access to or
experience with alternative tracheostomy tubes, it would be best for the patient to wait
before transitioning home
 If a specialty tracheostomy tube is selected, ensure that the caregivers or the long-term
care facility knows how to reorder the speciality tubes
 Assess the patient for the ability to communicate/speak while ventilated
B cuff deflation
B cuffless tube
B speaking valve/one way valve usage
Page 2
 Ensure that the patient is well rested and there are no nutritional deficiencies
 Consider a swallowing study by a Speech-Language Pathologist, if not already completed
Increase Independence
 Discuss differences between ICU care and care in the home/community or long-term care
facility e.g.:
B Expectation that patient will dress daily
B Radically reduced “patient/staff” ratio
B Increased independence
 Educate and train patient/family/caregivers on manual resuscitation bagging and
suctioning techniques (these will be reinforced in the community)
 Move the patient to an area of the ICU with less activity, if possible
 Step down nursing complement. Consider the patient to nurse ratio
 Encourage use of a call bell, if able
 Dress the patient in his/her own clothes
 Encourage the patient to move to an upright chair as often as possible
 Have Occupational Therapy (OT) assess and begin process for obtaining equipment
necessary for mobility and increased independence
 Consider taking the patient out of ICU for short periods of time, i.e. with staff and/or
family
 Establish a routine bowel/bladder plan of care – regular day/night routine
 If going to a long-term care facility have someone from the receiving facility speak with
family/caregivers about the program and take a tour of the facility
Other
 Co-payment charges should be discussed with the family
 Possible equipment and service charges such as TV, telephone, chiropody, hairdressing
Page 3
Notes
Page 4
Preparation
for Hospital
Discharge
Preparation for Hospital Discharge Healthcare Professionals
Hospital Discharge Checklist
Tasks Initials Date

of HCP Completed
Patient/client  Stable blood gases
is Medically
 Oxygen less than, or equal to 40%
Stable
 Established tracheostomy
 No CPR required for at least one month
Successful  Plan for family/caregivers to do more
Trial on Home independent care
Equipment
 Home ventilator obtained
 Patient/Client set-up on home unit
 Hospital walks, off unit
 Trial car ride
 Car seat test, if applicable
 Monitors
 Oxygen
 Feeding pump
Decrease  Remove any invasive lines
Invasive
 Ensure education for lines that will remain in
Monitoring
place at home
 Ensure feeding is established
B NG tube
B G-tube
B J-Tube
B oral
 Reduce blood work frequency
 Switch over to home ventilator
 Ensure patient is weaned on current settings
 Self inflating resuscitation bag to be with
patients at all times
Treatment  Use simplest ventilation settings, if possible
Plan
 Use a trach tube that is appropriate for the
patient’s comfort/goals
 Ensure schedule is established for other
therapies
Page 1
Tasks Initials Date

of HCP Completed
 Suctioning
 Tracheostomy mask
 Breath stacking
 In-Exsufflator
 Speaking valve
 Other: ____________________________
Caregiver and  Caregiver education is complete (See My
Family Education Checklist and Learning Log)
Education
 Plan for caregivers to do more independent
care (including walks off the unit and trial car
rides)
 CPR Certification
 Care by parent completed (at least 24 hours
unassisted) using own home equipment.
 Tour of ICU/NICU Education of community
caregivers (including Daycare or School).
 Family/Caregiver visit to current home
ventilated patient
 Ensure the home care company has provided
all the necessary equipment and training in
the use of equipment provided to the family,
i.e. compressor, cardiorespiratory monitor,
suction unit and their accessories
Documents  Discuss ADP funding
 Complete ADP applications (contact ADP if
help is required)
 Equipment from the Ventilator Equipment
Pool; Ventilators, Oximeters, Bilevel devices.
Contact VEP for estimated delivery time;
often takes 2-4 weeks
 For other related respiratory supplies,
contact the vendor of client’s choice
 Complete Assistance for Children with
Severe Disability (ACSD) application with
physician letter, if appropriate
 Complete HOP form with qualifying oximetry
strip, if appropriate
Page 2
Tasks Initials Date

of HCP Completed
 Insurance contacted
 Contact Ontario Disability Support Program
(ODSP) or other funding agency for battery
to be mounted on wheelchair, if appropriate
 Family to contact private insurance, if
appropriate
 Social worker to assist in securing additional
funds
 Phone contact list for family/caregivers
 “Who to call and when” list to
family/caregivers
 Ensure family/caregivers have teaching
material, manuals needed
 Letters given to family to provide to police,
ambulance, hydro, and telephone facilities
(to alert community providers)
 Application for Accessible Parking Permit
 Discharge summary
 Rehab reports and referrals; including respite
care
 Prescriptions provided and medications
ordered
Equipment  Confirm delivery date of equipment
Needs
 Car seat test done
 Specialty seating and mobility devices set up
 Equipment set up on wheelchair or stroller
 For patients that are off their ventilators for
short periods or all day, a trach hood and
appropriate humidity set ups are also
required
 Contact OT for assistance in mounting
ventilator on wheelchair
Follow-up  Community paediatrician identified and
patient summary delivered
 Follow-up appointments made
Page 3
Tasks Initials Date

of HCP Completed
Home and  Home ready including electrical needs
Community
 Emergency action plan has been devised
 Enhanced respite funding (CCAC)
 Letter to police, fire, ambulance, hydro, and
telephone facilities
 Arrangements made with pharmacy
 Calendar of appointments
 Contact List: “Who to call and when” list to
family/caregiver
Healthcare Provider (HCP) Signature Initials

Name/Designation
Page 4
Glossary of Terms
Introduction &
Ventilation & Tracheostomy Care
Home Ventilation &
Tracheostomy Care (for Adults)
Non-Invasive Positive Pressure
Home Ventilation &
Tracheostomy Care (for Pediatrics)
Professionals
Healthcare
Pulmonary Clearance Techniques
Education Checklists
Routine Tasks
My Education Checklist and Learning Log
Oximeter Teaching Checklist
Troubleshooting
Troubleshooting Guide
Emergency Contacts & Planning
Patients/Clients
& Caregivers
Emergency Contacts and Planning
Acknowledgement of Source
Appendices
Glossary of Terms
Introduction &

Home Ventilation &
Tracheostomy Care (for Adults)
Non-Invasive Positive Pressure
Home Ventilation &
Tracheostomy Care (for Pediatrics)
Professionals
Healthcare

Routine Tasks
My Education Checklist and Learning Log
Oximeter Teaching Checklist
Troubleshooting
Troubleshooting Guide
Patients/Clients
& Caregivers
Emergency Contacts and Planning

Acknowledgement of Source
Appendices
Home
Ventilation &
Tracheostomy
Care
Teaching Manual for Adults
Non-Invasive
Positive Pressure
Ventilation
(for Adults)
Home
Ventilation &
Tracheostomy Care
Tracheostomy Care
Ventilation &
Teaching Manual for Paediatrics
Notes
Tracheostomy Care
Ventilation &
Home
Ventilation &
Tracheostomy
Care
Teaching Manual for Adults
Table of Contents
Introduction ...................................................................................................................... 1
The Normal Respiratory System ........................................................................................ 2

What Happens When I Breathe? ............................................................................................ 6
Preventing Infection .......................................................................................................... 7

What can I do to Prevent Infections? ..................................................................................... 7
What is Pneumonia? ............................................................................................................... 8
What are the signs of an infection? ........................................................................................ 8
What should I do if I have an infection? ................................................................................. 8
Washing Your Hands at Home ................................................................................................ 9
Sterilizing Distilled Water...................................................................................................... 10
Tracheostomy Care ......................................................................................................... 11

What is a Tracheostomy?...................................................................................................... 11
How do I Prepare to go Home With a Tracheostomy? ......................................................... 12
Where should I do my trach care? ........................................................................................ 13
Description of Tracheostomy (Trach) Tubes ......................................................................... 14
Types of Trach Tubes ............................................................................................................ 17
How do I know when I should replace my trach tube? ........................................................ 19
Stoma Care ............................................................................................................................ 20
Trach Tube Care .................................................................................................................... 22
Other Information About Trach Tubes ................................................................................. 26
Speaking Valves..................................................................................................................... 29
Trach Kit ................................................................................................................................ 32
Special Considerations .......................................................................................................... 29
Tracheal Suctioning ............................................................................................................... 33
Other Helpful Tips ................................................................................................................. 37
Changing the Trach Tube ...................................................................................................... 38
Mechanical Ventilation ................................................................................................... 41
What is Mechanical Ventilation? .......................................................................................... 41
Why is Mechanical Ventilation Needed? .............................................................................. 41
Ventilator Settings ................................................................................................................ 42
Modes of Ventilation ............................................................................................................ 42
Ventilator Rate ...................................................................................................................... 43
Ventilator Power Sources ..................................................................................................... 45
The Ventilator Circuit ............................................................................................................ 50
Ventilator Safety and Trouble Shooting................................................................................ 54
Other Equipment ............................................................................................................ 57

Using and Cleaning the Portable Suction Unit ...................................................................... 57
The Manual Rescusitation Bag .............................................................................................. 59
Humidifiers ............................................................................................................................ 63
Inhaled Medicine .................................................................................................................. 68
Other Issues .................................................................................................................... 69

Assistive Devices Program (ADP) Funding for Respiratory Supplies ..................................... 69
The Ventilator Equipment Pool............................................................................................. 71
References ...................................................................................................................... 73
Home Ventilation and Tracheostomy Care Training Manual for Adults
Introduction
This Manual has been written to help you learn how to care for your ventilator and tracheostomy.
It will provide instructions on the basic care of a tracheostomy tube and will be yours to keep as a
reference guide. This Manual will give you some instruction on how to suction, change the trach
ties, change the trach tube, and some general safety guidelines. This book is only a guide. If you
have any questions, ask any of your healthcare professionals.
Important terms are used in this manual. Please refer to the Glossary of Terms for a complete list
of definitions. A Troubleshooting section is also available.
Page 1
The Normal Respiratory System

The respiratory system is made up of the:
Upper Respiratory Tract

 Nose
 Mouth
 Larynx (voice box)
Lower Respiratory Tract

 Trachea (windpipe)
 Right and Left Lung
 Airways (bronchi)
 Alveoli (air sacs)
 Capillaries
Respiratory Muscles
 Diaphragm (largest
muscle)
 Intercostals (rib cage
muscles)
 Abdominal Muscles
Figure 1: Respiratory System

Illustration used with permission from Hamilton Health Sciences
The nose is the best way for outside air to enter the lungs. In the nose the air is cleaned, warmed
and moistened. There are hairs lining the inside of the nose that filter the air.
When you breathe through your mouth you are not filtering the air, but it will be warm and moist.
When you have a cold and your nose is blocked you may not be able to breathe through your nose.
Page 2
The larynx (voice box) contains the vocal cords. This is the
place where air, when breathed in and out, creates voice
sounds. It is also used to build up pressure for a strong
cough.
Figure 2: Larynx
Reproduced with permission from
Ottawa Rehabilitation Centre
The epiglottis is a flap of tissue that hangs over the larynx

(voice box). When you swallow food or drink this flap
covers the voice box and windpipe so you do not choke.
Figures 3 & 4: Epiglottis

The trachea (wind pipe) is the tube leading

from the voice box to the lungs.
Figure 5: Trachea
Ottawa Rehabilitation Cente
Page 3
The bronchi are tubes that let air in and out of the lungs.
The bronchi lead to tiny air sacs called the alveoli.
Mucous is made in the smaller tubes. The mucous traps

dust, germs and other unwanted matter that has been
breathed into the lungs.
Tiny hairs called cilia move back and forth moving the
mucous up toward the throat where it is can be coughed
out or swallowed.
Figure 6: Bronchi
The capillaries are blood vessels that are in the walls of the
alveoli (air sacs). Blood flows through the capillaries,
removing carbon dioxide from the air sacs and picking up
oxygen.
Figure 7: Capillaries and Air Sac

Diagram courtesy of SIMS Portex Inc
Tracheostomy Care Handbook 1998
The ribs are bones that support and protect the chest
cavity. They move up and out, helping the lungs expand
and contract.
Figure 8: Rib Cage

Page 4
The diaphragm is a large strong muscle that separates the lungs from the belly. When the
diaphragm contracts it moves downward, creating a suction effect, drawing air into the lungs.
The intercostals are the muscles in-between the ribs.

There are two types of intercostals muscles.
The external intercostals help you take deep breaths in,

such as when you prepare to cough.
The internal intercostals help you forcefully breathe out,

such as when you cough or sneeze.
The abdominal muscles help create a good strong cough.
Figure 9: Intercostal and

Abdominal Muscles
Reproduced with
permission from
Ottawa Rehabilitation
Centre
Page 5
What Happens When I Breathe?

Breathing In
When you breathe in a large muscle called the diaphragm contracts causing air to be sucked
into the lungs. The air that is carried into the lungs contains oxygen that your body needs to
survive.
When you breathe in, the diaphragm moves down and the ribs move out and up. This causes a
suction effect that lets air come into the lungs. The air comes into the nose where it is warmed,
filtered and moistened. The air then goes down the windpipe past the voice box. From there it
moves into two large main branches of the lungs called the left and right bronchi. The air moves
through airways that get smaller and smaller until they reach tiny air sacs. These air sacs let
oxygen into the capillaries. The blood flows from these capillaries to the heart where it is
pumped out to the body.
Breathing Out
When you breathe out the lungs remove carbon dioxide, a gas that your body does not need.
Just before you begin to breathe out the carbon dioxide goes across from the capillaries into the
air sacs. The air sacs begin to relax and the air begins to move out of the lungs. Then the
diaphragm and the muscles between the ribs also relax. This causes the ribs to gently fall,
helping to push the air out from the lungs. Under normal conditions, the diaphragm and rib
cage muscles are relaxed when you breathe out. However, when you cough or sneeze, these
muscles work hard to push the air out quickly.
Normally breathing takes place without any thought. Some conditions can cause breathing
problems. Every condition is different. So talk to your healthcare professionals about how your
condition affects your breathing.
Page 6
Preventing Infection
What can I do to Prevent Infections?

Keep Things Clean!
Hands
 Insist that everyone wash their hands, often
 Buy hand sanitizers for your home
Air
 Make your home smoke free. Insist that no one smoke around you
 Tell friends and family to stay away if they have a cold or the flu. If they need to be near you
they must wear a mask and wash their hands often
Trach
 Follow trach care instructions carefully. Clean trach tubes
 Keep the trach dressings and the stoma (opening) clean and dry
Equipment
 Clean equipment regularly, such as ventilator tubing and suction equipment
 Replace equipment on a regular schedule. Ask your healthcare professional when supplies
are to be thrown out
IMPORTANT! It is very important that everyone wash their hands.

Wash your hands before and after doing anything with the trach
tube or the stoma.
Page 7
What is Pneumonia?
It is important to protect the lung from viruses and germs. If the air you breathe is clean and moist,
it will stop an infection from happening.
Breathing in dry, dirty air can cause germs and viruses to get into the lung, which can lead to
pneumonia. Pneumonia is a lung infection where the airways swell and more mucous than normal,
is made. Pneumonia can lower the amount of air getting into the lungs. It can also lower the
amount of oxygen getting into the blood.
IMPORTANT! Wash your hands before and after doing anything

with the tracheostomy.
What are the signs of an infection?

If you have any of these signs, it may mean you have an infection.
You are: You need:
 coughing more  to be suctioned more often

 have a fever or the chills  to take your puffers more often
 feeling unwell or are really tired
 more short of breath Your ventilator:
 having chest tightness
 has higher than normal pressures
Your mucous: Your stoma:
 is thick and/or there is more of it  is red, swollen or is painful

 is yellow or green
 has an unpleasant smell
What should I do if I have an infection?

 Call your doctor or healthcare professional if think you have an infection.
 Follow your doctor's orders on taking medicine, such as antibiotics.
 If you have an action plan, go over it with your healthcare professional. Do not be afraid to
ask for advice.
Page 8
Washing Your Hands at Home
Figure 10 : Hand Washing

Reproduced with permission from the World Health Organization
Accessed on July 7, 2009 from: http://www.who.int/gpsc/tools/GPSC-HandRub-Wash.pdf
Page 9
Sterilizing Distilled Water

Why do I need sterile distilled water?
You will be instructed to use sterile distilled water several times in this manual. To help stop
infections from happening you need to make sure you use sterile distilled water.
You will need sterile distilled water when you:
 Suction the trach tube

 Fill a pass over humidifier
 Clean the tracheostomy opening
 Clean the trach tube inner cannula
Legionella is a germ that can grow in water. To stop germs from growing, use sterile distilled
water. You can buy sterile distilled water or you can boil distilled water to sterilize it. You can
buy distilled water from your home care company, drug store or supermarket.
IMPORTANT! Only use distilled water that has been sterilized.

This will help stop lung infections from happening. 1
How do I make sterile distilled water? 2

Follow the directions below to make enough sterile distilled water to last 2 or 3 days. Do not
use the water after the 3rd day. Make or buy more.
1. Find one pan with a lid, large enough to boil enough water for 2-3 days. Use this pan for
sterilizing distilled water only. Do not use this pan to cook with
2. Bring the distilled water to a boil. Let boil for 5 minutes 3
3. Turn off heat and cover the pan. Never leave the pan unattended. Use the boiled distilled
water as soon as it has cooled or put it in a clean container and seal. It does not need to be
refrigerated
4. To sterilize the containers, put the containers in the water and let the water boil for 10
minutes. Turn off heat and cover the pan with a lid
5. Leave the lid on the pan while the water is cooling. Do not use ice to cool down the water
1
The APIC Curriculum for Infection Practice, Vol. III. 1988.
2
This section on distilled water is courtesy of Hamilton Health Science and Saint Elizabeth Care.
3
http://www.phoenixchildrens.com/emily-center/child-health-topics/handouts/Sterile-Water-Saline-861.pdf
Page 10
Tracheostomy Care
What is a Tracheostomy?
A tracheostomy is an opening made into the windpipe just below the vocal cords. The hole, called
the stoma, is where the trach tube is put in. You can breathe and cough through the trach tube as
long as it stays clear.
Your nose normally warms and moistens the air you breathe. With a trach, the air goes right into
the lungs and not through the nose first. Without moisture your mucous will become thick and it
will be hard to cough out. This can lead to problems breathing.There are ways to warm, filter and
moisturize the air for those with a trach tube in place.
When you have a trach tube you need a way to moisten and filter the air. This can be done using a
nebulizer, a humidifier or a heat moisture exchanger (‘HME’).
A trach tube can be cuffed or uncuffed. When the trach tube is cuffed, there is a balloon on the
tube, called a cuff. When it is inflated it seals the airway. When the trach tube is uncuffed, some air
can pass around the tube and up through the mouth and nose. People with a cuffed trach tube
cannot speak when the cuffed balloon is inflated. This is because no air is reaching the voice box. If
the trach tube is uncuffed or the cuffed tube has the balloon deflated, the person can often speak
with the trach tube in the airway. There are devices that can help the person with a trach speak.
A tracheostomy tube is often called a “trach tube.” There are many kinds of trach tubes.
You have a __________________________________ trach tube
Page 11
How do I prepare to go home with a tracheostomy?

While you are in the hospital you and your support person will learn how to take care of your
tracheostomy. Caregivers will visit you in your home on a regular basis. Your community respiratory
therapist, nurse or personal support worker, will be available to help you care for your trach.
Contact List
Make a Contact List with the following information:
 Include all your Doctors names and  Your community healthcare support
phone numbers telephone number
 Oxygen company, if you have one  Community Care Access (CCAC) phone
 Ventilator Equipment Pool phone number
number  Equipment supplier number, e.g. home
 Ventilator settings care company
 Trach tube information: size, type  Put the Contact List in a place where
 Emergency Phone numbers you and others can easily find it
Diary
You may find that keeping a diary of your questions or problems will help you communicate
with your healthcare professionals.
 Changes to the trach tube  Changes to the ventilator settings

 When it was changed  When it was done
 What size tube was put in  What settings where changed
 Why the tube was changed  Why it was changed
Page 12
Where should I do my trach care?

Consider a room that is private and away from distractions. It should be away from any open
windows, heating ducts and fans. Children and pets should not be allowed in this room.
Your room should have:
 A mirror
 Good lighting
 A comfortable spot to sit or lie down
 Shelves or large drawers for all your supplies; they should be easy to clean
When doing your trach care:
 Do your care around the same time every day

 Set aside 20 to 45 minutes to complete the care and make sure you are not going to be
interrupted. For example, do not answer the phone while you are doing your trach care
 Change the trach tube when you doctor tells you to. Some people need to change their
trach tubes once a month. Others will be told when to change it
 Read the directions that are in the trach tube package
IMPORTANT! If you have any questions, ask your doctor.
Page 13
Description of Tracheostomy
(Trach) Tubes
Trach tubes are man-made airways that are made to
fit into a cut in your neck.
There are many kinds of trach tubes. They can be

made from rubber, plastic, silicone, nylon, Teflon,
polyethylene, or metal. The most common type of
tube is made from a plastic called Polyvinyl Chloride
(PVC). All trach tubes are made with non-toxic
materials.
Everyone has a different size neck, so the tubes Figure 11: Trach Tubes
come in different sizes. The length can vary from Reproduced with permission from Great Ormond
Street Hospital for Children NHS Trust. Copyright
5cm to 15cm and the width of the opening can vary GOSH 2008.
from 2mm to 12 mm wide. http://www.ich.ucl.ac.uk/gosh_families/information
_sheets/speaking_valves/inhalation.gif
Trach Tube Parts

Flange
Figure 12: Trach Tube Parts

Reproduced with permission from the Ohio State
University Medical Centre (OSUMC).
http://medicalcenter.osu.edu/pdfs/PatientEd/Ma
terials/PDFDocs/procedure/tube-
care/trach/fenestr.pdf
Page 14
Obturator (OB-ter-ay-ter)
 This is an important piece. The obturator goes into the trach tube and is used to put the
trach tube in the stoma (opening). It is also used when changing trach tubes
 The obturator is specially made for the size of trach tube in that package. So you will not be
able to use an obturator from one size trach tube to put in a tube that is a different size
IMPORTANT! Keep the obturator somewhere where it is easy to find.

If the trach tube falls out by accident, you need to use the obturator
that came with that trach tube to put the trach tube back in.
Inner Cannula (CAN-you-luh)

 This is a smaller tube that fits inside the trach tube. It can be removed quickly if it becomes
blocked with mucous
 Most inner cannulas are disposable, but some inner cannulas are reusable and need to be
cleaned. Ask your nurse or respiratory therapist about what type you have and how to take
care of it
 Some trach tubes do not have an inner cannula
Cuff
 Trach tubes are made with and without cuffs. An uncuffed trach tube has no cuff and no
pilot balloon. A cuffed trach tube has a balloon-like device at the end
 The cuff is a small balloon that is at the end of the trach tube. When this balloon is inflated
it seals against the wall of your windpipe. A seal is often needed when you are on a
ventilator. The seal stops the air flow from going into your mouth
 Some cuffs are filled with air, some are filled with water. It is important to know what your
cuff needs to be filled with
 The cuff needs to be filled (inflated) with the smallest amount of air, or water to seal the
airway
 When you inflate the cuff you are putting air or water into the pilot balloon. When the cuff
is full of air or water it is said to be “up”. There is a set amount of air or water to fill the cuff
and it is measured with a syringe. The amount or air (or water) will be different for each
person and will depend on the size of the trach tube
 Be careful when inflating the balloon. Too much pressure can cause damage to the
windpipe. Have your nurse or respiratory therapist shows you how to properly fill your cuff
Page 15
 When the cuff is flat, or deflated, it said to be “down”. When the cuff is down there is no
seal against the windpipe wall and air can go up through the vocal cords and out the mouth
Cuff Inflation Line

 This is a thin piece of tubing that carries air to and from the cuff
Flange or Neck Plate

 This is the piece found at the top of the trach tube that lies flat against the neck and has
holes to secure the trach ties to. The flange will have the brand and size of trach tube
printed on it
Ties or Trach Holder

 Ties are used to hold the trach tube to the neck so it will not fall out. There are foam,
Velcro®, and twill trach ties
 Care must be taken when putting the trach ties on. They are not to be tied too tight or too
loose. When tied correctly you will be able to fit one or two fingers between the trach ties
and the neck
Cork
 The cork is a plug for the trach tube. It is also called a button, plug, or cap, depending upon
the type of tube. When the cork is placed over the trach tube, it seals off air entering the
trach tube
 When the cork is in place the cuff is to be ‘down’ or deflated, so you can breathe around the
trach tube. This will allow air to pass over the voice box allowing you to talk
IMPORTANT! Make sure the cuff is deflated, or in the “down”

position before using a cork. Take off the cork before you inflate
the cuff.
Page 16
Speaking Valve
 These are one-way valves. When using a speaking valve, you need to first put the cuff
‘down’. When the valve is placed on the end of the trach tube, air goes into your lungs when
you breathe in. When you breathe out the valve shuts and the air will go up through your
voice box and out your mouth. This will allow speech
 Speaking valves can also help with coughing and swallowing
IMPORTANT! Make sure the cuff is deflated, or into the “down”

position before using a speaking valve. Take off the speaking valve
before inflating the cuff.
Types of Trach Tubes

There are many kinds of trach tubes; there are Portex,
Shiley and Bivona TTS Tubes
Bivona TTS Tubes

 A Bivona Tight-to-the shaft (TTS) Tube is made of
silicone and has no inner cannula
 Cuffed Bivona TTS Tube. When the cuff is deflated,
it flattens very close to the shaft of the trach tube,
allowing for speech. Fill the cuff with sterile distilled
water
 Uncuffed Bivona Tube. It looks the same as the Figure 13: Bivona Tubes
Reproduced with permission from Smiths
Bivona TTS tube except there is no cuff or pilot line Medical North America http://www.smiths-
medical.com/upload/products/mainImages
Cleaning Bivona Tubes /670180.jpg
 You can re-sterilize these tubes up to 10 times.

 These tubes have a special Superslick® coating on them that keeps mucous from sticking to
them. Do not scrub too hard or the coating will come off.
IMPORTANT! Only use sterile distilled water to inflate TTS tube cuffs. If you fill
it with air, it will leak.
Page 17
Portex and Shiley Tubes

These tubes are made of plastic and can come with or
without a cuff. If these brands have a cuff, the cuff is
always filled with air. Some models have an inner
cannula, some do not. The Portex Blueline Ultra tubes
are colour coded.
IMPORTANT! Always fill Portex and Shiley tube cuffs with

air. Never fill with water. Figure 14 : Portex Tube
Source:www.vitalitymedical.com/isroot/Sto
res/VitalityMedical/picxl/S PX505080.jpg
See your personal information for your tube and size.
Figure 15: Shiley Tubes

Reproduced with permission from the
American College of Chest Physicians
(Pulmonary & Critical Care Updates; Vol. 18,
lesson 15)
www.chestnet.org/images/education/onlin
e/pccu/vol18/lesson15/Fig1.jpg
Page 18
How do I know when I should replace my trach tube?

You need to replace your trach tube when the:
 Obturator is too tight

 Trach shaft is not centred
 Trach tube is ‘off color’
 Trach tube markings have faded
IMPORTANT! Always have an extra trach tube with you at all times.
Have a trach tube that is one size smaller than one in use. Keep the
obturator on hand at all times.
 My trach tube type is: ________________________________

 The trach tube size is: ________________________________
 My trach has an inner cannula
 My trach does not have an inner cannula
 My trach has a cuff:
B needs to be filled with _______ml of air
B needs to be filled with _______ml of water
 My trach does not have a cuff
Page 19
Stoma Care
The stoma is the hole made in your windpipe that is kept open with a trach tube. Stoma care is
the cleaning of the skin around the opening in the neck. Good stoma care will help prevent
infections. Do stoma care at least once a day, such as first thing in the morning or just before
going to bed. Clean it more often when the skin is swollen, red, or tender to touch.
How do I clean the stoma?

1. You will need:
 Sterile distilled water (or sterile normal saline)
 Cotton tipped swabs or gauze
 Sterile trach dressings
 Disposable cups for water
 Suction equipment
 Disposable gloves
2. Wash hands well

3. Put on clean gloves
4. Make sure you are in a comfortable position and can see the trach area easily. You may find
using a mirror helpful
5. Suction, if needed
IMPORTANT! Make sure the trach tube is stable and not at risk of falling
out during the cleaning process.
6. Take off the old dressing and throw it in the garbage. Note the colour of the mucous, the
amount of mucous and if there is any unpleasant smell
7. Check the skin around the trach opening (stoma) every day for signs of an infection
Watch for:
 Redness or swelling
 Creamy yellow or green mucous
 Crusting, dry mucous
 An unpleasant smell
 Pain or tenderness around the stoma
 Any extra tissue growth
Page 20
Take note of any differences and report them to

your healthcare professional
8. Dip a cotton swab or gauze in sterile distilled water

and clean the area around the opening, gently
removing any dried mucous
9. Clean from the skin opening outward. Check to see
that the opening is not open more than usual.
Throw away each swab or gauze after use
10. Dip a new cotton-tipped swab or gauze in sterile
distilled water and clean/rinse the area
Figure 16: Stoma Care
11. Dry with fresh applicator swab or gauze Reproduced with permission from the Ohio
12. Put on the sterile dressing being careful not to twist State University Medical Centre (OSUMC)
http://medicalcenter.osu.edu/pdfs/PatientE
the trach tube or pull on the flange d/Materials/PDFDocs/procedure/tube-
care/trach/t-non-di.pdf
13. Change trach ties when they are dirty or when the
Velcro® is no longer holding properly
14. Pour the water into the toilet and clean
the containers
15. Take off gloves and wash hands well
16. Gather clean supplies so they are ready
for the next cleaning
Figure 17: Putting on the trach dressing

University Medical Centre (OSUMC)
http://medicalcenter.osu.edu/pdfs/PatientEd/Materials/
PDFDocs/procedure/tube-care/trach/t-non-di.pdf
IMPORTANT! Dirty swabs and dressings may cause infections so

they should be thrown away carefully. Wrap them in a plastic or
paper bag and then put them in the garbage.
Page 21
Trach Tube Care

How do I clean my inner cannula and corks?
Many trachs have an inner cannula that needs to be cleaned or replaced on a daily basis. If
there is a lot of mucous in the inner cannula, you need to clean it more often. Proper cleaning of
the inner cannula will help stop lung infections from happening.
Daily
1. You will need:
 A clean inner cannula, cork or speaking valve
 Tweezers
 Pipe cleaners
 Clean small plastic bags or dry container
 Suction machine and supplies
 Two covered containers to be numbered and labelled
2. Label the containers #1 and #2 to avoid mixing up the clean and dirty containers
3. Container #1 is for the dirty cannula and corks. Pour hydrogen peroxide or sterile distilled
water into this container
4. Container #2 is to rinse the cleaned cannula and corks. Pour sterilized distilled water into
this container
5. Wash hands well and put on clean gloves
6. Make sure you are in a comfortable position. Make sure you can see the trach area easily.
You may find using a mirror helpful
8. Remove the dirty inner cannula, the cork or speaking valve from the trach tube and place it
into container #1 (hydrogen peroxide or sterile distilled water)
9. Put in a clean inner cannula, cork or speaking valve and lock in place
Page 22
Inserting the
Twist to lock
cannula
Figures 18, 19: Cleaning the Cannula

Reproduced with permission from the Ohio State University Medical Centre (OSUMC)
http://medicalcenter.osu.edu/pdfs/PatientEd/Materials/PDFDocs/procedure/tube-
10. Remove the dirty cannula from container #1 with tweezers and clean with a cotton swab,
gauze, or pipe cleaners. Do not scrub
11. Look for cracks or breaks in the tube
and locking mechanism. If there are
cracks or breaks the trach tube needs
to be changed
12. Place the cannula in container #2
(sterile distilled water) and rinse well Figure 20: Drying the inner cannula
Reproduced with permission from the Ohio State University
13. Remove the cleaned cannula from Medical Centre (OSUMC)
container #2 (sterile distilled water) http://medicalcenter.osu.edu/pdfs/PatientEd/Materials/PDF
with the tweezers Docs/procedure/tube-care/trach/t-non-di.pdf
14. Dry the outside of the inner cannula with clean dry gauze. Tap it against the gauze to
remove any drops of water from inside the cannula
IMPORTANT! Do not whip or shake the cannula to remove drops as

this can spread drops into the air.
15. Store the now clean inner cannula in a small clean plastic bag or dry container
16. Throw out all soiled supplies, along with the dirty distilled water and hydrogen peroxide
17. Wash all containers in soap and water. Rinse well. You can wash the containers on the top
shelf in the dishwasher
Page 23

19. Get clean supplies ready for the next use
IMPORTANT! Be sure to change the distilled water and hydrogen

peroxide every day!
Weekly
Soak each container and lid in a solution of 1 part vinegar and 3 parts water for 20 minutes.
Rinse and let air dry.
How do I clean a metal or silver trach tube?

Hydrogen peroxide can damage these tubes. If you have a metal or silver trach tube, ask your
respiratory therapist for cleaning instructions.
How do I change my trach ties? 4

Keeping the trach ties clean and dry will prevent skin irritation, sores and infections from
occurring around the neck area.
The only thing holding your trach tube in place is the trach ties. These ties are usually made of
twill cotton or cloth with a Velcro® closure.
When changing the ties be careful not to accidentally remove the trach tube. The ties should be
changed by two people. One person will hold the trach in place, while the other person cleans
the skin and changes the ties. If a second person is not around to help, tie the clean ties first and
then remove the old ones. This will keep the trach tube from coming out by accident.
4
This section on changing trach ties is courtesy of “Changing Tracheostomy Ties” from the Department of Inpatient Nursing,
The Ohio State University Medical Center 2005
http://medicalcenter.osu.edu/pdfs/PatientEd/Materials/PDFDocs/procedure/tube-care/trach/changing.pdf
Page 24
Change the tie tapes daily and as needed.

Example of one method
of securing cotton ties
1. You will need:
 New trach tube ties
 Clean gloves
 Ask second person to assist, if available
 Tweezers
 Scissors Figure 21: Securing Trach Ties
 Suction machine and supplies Reproduced with permission from the Ohio State
 Tracheostomy Kit University Medical Centre (OSUMC)
2. Make sure you are in a comfortable

position. Make sure you can see the trach
area easily. You may find using a mirror
helpful
4. Have the second person hold on to the
trach tube by gently holding onto the edges
of the flange
5. Cut and remove the dirty trach ties. If you
have a pilot line on the cuff, take care that
you do not cut it by accident Figure 22: Assisting with Trach Ties
6. Put one end of the clean trach tie through University Medical Centre (OSUMC)
the hole on one side of the flange. Use the
tweezers to pull the trach tie through the
hole
7. Pull the ends of the ties so they are even
8. Bring both pieces of the ties around the
back of the neck to the other side of the
trach flange
9. Using tweezers take one end of the tie and
pull it through the hole on one side of the Figure 23: Securing Trach Ties
flange
10. Bring the ends of the tie to the side of the
neck and tie them in a knot
Page 25
11. Do not tie them too tightly. Allow enough space for 1-2 fingers between your neck and the
trach ties. To check this, place 1 or 2 fingers under the tie at the side of the neck, your
fingers should fit snuggly under the tie
Other Information About Trach Tubes

What is a cuff?
The cuff is a balloon around the outside of the
trach tube. When the balloon is inflated it fits the
shape of your windpipe and it seals off the space
between the wall of your windpipe and the trach
tube. This seal might be needed if you are on a
breathing machine (ventilator). If the cuff is not
inflated, air can pass around the outside of the
trach tube up through the voice box.
The cuff is inflated by putting either air or water in

through the pilot line. If you have a cuffed Shiley or
a Portex trach tube, you will fill the balloon with Figure 24: Inflated Cuff
air. If you have a Cuffed Bivonia TTS Tube, you will Reproduced with permission from the Ohio State
fill the balloon with distilled water.
The pilot balloon on the inflation line shows whether the cuff is ‘up’ or ‘down’. The pilot balloon
does not tell you how much air or water is in the cuff. Ask your respiratory therapist or nurse
how much air or water needs to be in your cuff.
IMPORTANT! Make sure that you know how much air or water
needs to go into your cuff. Ask your healthcare professionals to
show you how.
Page 26
Deflating the Cuff – Putting the Cuff “down”

1. Suction the mouth, if needed
Note: Sometimes mucous sits in the throat or on
top of an inflated cuff. When the cuff is deflated,
this mucous can fall from around the cuff into the
lungs making you cough. It is a good idea to have
a suction catheter ready in case this happens.
2. Get a syringe (without the needle) and push the Figure 25: Syringe
plunger all the way in to remove the air from the Reproduced with permission from the Ohio
State University Medical Centre (OSUMC)
syringe
3. Attach the syringe to the cuff pilot line
4. Slowly pull back on the plunger of the
syringe until the pilot balloon on the cuff
pilot line is flat and the syringe plunger
cannot be pulled back any more
5. You have now deflated the cuff
Figure 26: Deflating the Cuff

Inflating the Cuff- Putting the Cuff “up”

1. Make sure that the trach tube is not blocked, so the air can move freely through it. Before
inflating the cuff, attach a syringe to the cuff pilot line. Draw back on the syringe to suck out any
air that may be in the cuff. The cuff needs to be fully “down” before filling it again. If the pilot
balloon already has air in it you should not add more air
IMPORTANT! Never add air to a cuff that already has air in it.
 My trach has a cuff that needs to be filled with:

 _______ml of air (Shiley or Portex tubes)
 _______ml of distilled water (Bivona TTS Tube)
Page 27
2. Attach the syringe to the cuff pilot line.

Slowly push the plunger in so the air (or
distilled water) fills the cuff with the right
amount
3. Remove the syringe. There is a valve in the
pilot line that stops the air or water from
leaking out
4. If there is a leak around the cuff, see “How
do I fix a Cuff Leak?” question below
Figure 27: Inflating the Cuff
IMPORTANT! If the cuff is filled with too much air or water, it will
cause damage to the trachea. Do not over inflate the cuff.
How do I fix a cuff leak?

First remove all the air (or distilled water) from the cuff. Then reinflate the cuff with the right
amount of air or distilled water. Wait a few minutes. If there is a leak, then:
1. Remove all the air or distilled water from the cuff

2. If the amount removed was less than it was suppose to be, and then re-inflate with the
correct amount
3. If your cuff is filled with air you can try this. Put the pilot balloon in a cup of water while it is
“inflated”. If you see bubbles then there is a leak in the pilot line or pilot balloon
4. If there is still a leak, the trach tube needs to be changed
I have tried everything and there is still a leak in the cuff, what do I do now?
If you have been given directions on how to do this, and you are comfortable doing a trach
change, then change the tube. If you have not been told what to do, or you are not comfortable
call your home care worker or respiratory therapist for help. If no one is available to help , go to
the nearest emergency room.
Page 28
Speaking Valves
A speaking valve is a one-way valve that
allows air in but not out. The one-way valve
connects to the trach tube and only opens
when you breathe in, letting air go into your
lungs. The valve will close when you breathe
out, forcing the air up around the outside of
the trach tube, through the voice box, and
out your mouth, so you can speak.
There are many brands of speaking valves, Figure 28: Passy-Muir® Tracheostomy Speaking Valve
but the Passy Muir valve is the most This section on speaking valuves is courtesy of “Passy-Muir®
Tracheostomy Speaking Valve” from the Department of
common. Speaking valves can be used while Inpatient Nursing, The Ohio State University Medical Center,
you are on humidity or oxygen and even if 2002
you are on a ventilator. http://medicalcenter.osu.edu/pdfs/PatientEd/Materials/PDF
Docs/procedure/tube-care/trach/passey.pdf
Speaking valves can improve:
 Swallowing – You will be less likely to choke on your food

 Smelling – You will smell your food and improve your appetite
 Coughing – You will have a stronger cough and will not need to be suctioned as often
Special Considerations
 Do not use with inflated trach cuff
 The valve may occasionally pop off; just be sure connections are tight
 The valve can be attached to the trach tie with a fastener
Remove the speaking valve when:
 Having an aerosol treatment
 Suctioning is needed
 Sleeping
IMPORTANT! Never use a speaking valve when the cuff is “up” or in

the inflated position.
Page 29
 Your trach speaking valve is: ___________________________
Figure 29: One Way Valve

Reproduced with permission from the Ohio
How do I use a speaking valve?

If you are not on a ventilator and are able to breathe on your own:
1. Cough out any mucous in your lungs or mouth. If the mucous cannot be coughed out, then
suction it out
2. Completely deflate the trach tube cuff
3. Remove the oxygen and humidity, if you have it on
To put the valve on:
1. Gently hold on to the edges of the trach tube flange and put the speaking valve onto the
trach tube
2. Twist the valve gently to make sure it is on the trach tube properly.The valve may
sometimes pop off. If this happens just replace it and be sure the connection is tight
3. Replace the oxygen and humidity, if you have it
Page 30
To remove the valve:
1. Gently hold the flange and twist the valve off

If you are on a ventilator and cannot breathe on your own:
1. Cough out any mucous in your lungs or mouth. If the mucous cannot be coughed out, then
suction it out
2. Completely deflate the trach tube cuff (put the cuff ‘down’)
3. Place the valve in-line with the ventilator tubing in the following way. Have your nurse or
respiratory therapist fill in the steps you should follow below:
a. _______________________________________
b. _______________________________________
c. _______________________________________
4. Change the ventilator settings to:
FiO 2 or O 2 litre flow: __________ Tidal Volume: _____________
Pressure Control: ____________
Alarms: Low Pressure; test to be sure that the Low Pressure Alarm is working with the valve
in-place
5. To remove the valve, take the valve out of the ventilator circuit
6. If you are on a ventilator return the settings to:
FiO 2 or O 2 litre flow: ____________________ Tidal Volume: __________________
Alarms: ____________________________________________________________
Other: _____________________________________________________________
7. When the speaking valve is removed, it is safe to inflate the cuff again
Page 31
How do I clean my speaking valve?

If you take care of these valves they will last a long time. Before replacing a valve with a new
one, first wash and dry it carefully. If the valve is still sticky, noisy or begins to vibrate talk to
your respiratory therapist for more information.
Clean the speaking valve every day using a mild soap and warm water. Rinse well. Allow to air
dry. When dry, store it in sealed plastic container.
Some cleaning products will damage the valve.
Do not use the following:

Hot water or harsh chemicals
Hydrogen Peroxide, bleach
Alcohol
Cleaning brushes
Trach Kit
 Trach tube of current size
 Trach tube that is half a size smaller than the current one
 Obturator
 Trach ties
 Water soluble lubricant
 Normal saline nebules
 Trach gauzes
 Scissors
 Suction unit
 Suction catheters
 Suction tubing
 Oximeter with probe
 Manual Resuscitator Bag
Page 32
Tracheal Suctioning
Suctioning removes mucous from the windpipe and the trach, keeping the airway open.
A suction catheter is a tube that is used to take out mucus from the lungs and mouth.
 Patient specific suction unit pressure set at 5: ______________

 Size of suction catheters to be used: ____________________ fr
NOTE: The following steps to suction are directed towards the person doing the suctioning
procedure.
Suctioning is considered a clean process. It is not a sterile process. Clean disposable gloves are
fine to use. You do not need sterile gloves. However it is very important to keep the process as
clean as possible.
Sometimes masks and gloves are worn by the person doing the suctioning so that the mucous
and germs are not transferred to them.
IMPORTANT! Check your suction equipment every day;

it must always be ready-for-use.
5
Simmons K.F. (1990). Airway Care. In Scanlan C.L, Spearman C.B., & Sheldon R.L.. (Eds.). (1990). Egan’s Fundamentals of
th
Respiratory Care (5 Ed). Toronto: The C.V. Mosby Company.
Page 33
1. You will need:

 Suction machine – electrical or portable
 Suction tubing
 Sterile Distilled water (flushing solution)
 Clean container for flushing solution
 Disposable suction catheters of correct size
 Clean disposable gloves
 Hand sanitizer
 Manual resuscitation bag with flex hose and trach adapter, if needed
 Extra inner cannula, if needed
 Obturator
 Suction unit plug and charger, if needed
 Plastic bag for disposal of materials
2. Wash hands well

3. Fill the container with sterile distilled water
4. Attach the suction catheter to the connecting tubing of the suction machine
5. Turn on the suction machine and be sure there is good suction
6. Make sure the person you will be suctioning is in comfortable position. Their head should be
above their shoulders
7. Put on clean gloves being careful not to touch anything except the catheter
IMPORTANT! Use a clean suction catheter for each suction session.
8. Withdraw the catheter from package slowly. Hold the catheter with your gloved hand 10 to
15 cm (4 to 6 inches) from the tip
9. Remove the cork, trach mask, ventilator or manual resuscitator bag from the trach, if
needed
10. Gently put the catheter 4 to 5 inches into the trach opening. Stop if there is resistance or if
there is a cough. It is normal for someone to cough when they are being suctioned. But not
everyone will cough
IMPORTANT! Do not push or force the catheter.
Page 34
11. If you hit resistance, pull back slightly

12. You are now ready to apply the suction. Cover the thumb hole on the catheter and slowly
take the catheter out while twisting, or ‘rolling’ it between your fingers. You can pull the
catheter straight out or roll it back and forth between your fingers. It all depends on what
works best to remove the mucous. It takes practice to find what works best to remove the
mucous
IMPORTANT! Do not cover the thumb hole on the catheter until

you are ready to suction. Suction only when you are removing the
catheter.
IMPORTANT! The suction catheter should not be in the trach for

more than 20 seconds.
13. Rinse the catheter out by dipping the catheter tip into sterile distilled water and suction
water through the catheter and suction tubing until it is clear. You can use the same
catheter to suction a few times, as long as it is kept clean. However, if the catheter becomes
blocked with mucous, remove it and use a new one
14. Ask the patient “Do you need to be suctioned again?” Suctioning is needed if you hear
“gurgling” sounds during breathing. Repeat steps 10 to 14, if more suctioning is needed
15. Note: Suctioning can cause the patient to feel very short of breath. So take breaks between
suction attempts. You may need to place the patient back on ventilator for a while or give
them some manual breaths with the resuscitation bag in between the suctioning sessions
16. Look at the mucous being suctioned out. Take note of the amount, the colour, the thickness
and the smell
17. When you are finished suctioning, put the cork, trach mask or ventilator back on the trach
tube, if needed. Be sure to replace the cork/speaking valve and/or the heat and moisture
exchanger (HME) after the suction session
18. Coil or wrap the suction catheter around the fingers and palm of one hand, then pull the
cuff of the glove over the top of the coiled catheter to completely cover it. Throw out the
gloves and dirty catheter. Throw out the suction catheter after each suction session
19. Turn off the suction unit
20. Empty and clean the suction drainage bottles and containers, if needed
Page 35
21. Wash hands well

22. Be sure the suction equipment and supplies are ready for the next use. You never know
when a trach patient needs to be suctioned. Have all your suctioning equipment ready in
case you need it quickly
When should I suction?

Many people suction at least once a day, such as first thing in the morning or before going to
bed.
A person needs to be suctioned when they:
 Are not able to cough out the mucous

 Are having trouble breathing or breathing sounds harsh
 Are on a ventilator and the airway pressures are higher than normal
 Have mucous in the trach tube or in the ventilator tubing
Why does the person feel so short of breath when they are suctioned?
The suction catheter removes both mucous and oxygen from the airway when suctioning. Try to
keep the suction time to less than 20 seconds. This will help. Allow time between suction
attempts to allow them to catch their breath.
You may also manually ventilate, using a manual resuscitator, before and after suctioning. This
often helps move mucous up the airway so it is easier to suction or cough up. This may also help
relieve the shortness of breath that occurs when being suctioned.
Why is blood coming up the suction tube?

This may happen if the suction catheter is too large. Bleeding may also happen if the catheter is
pushed too hard into the airway, causing tissue damage. Introduce the catheter gently. Do not
force it if you meet resistance. You can prevent bleeding by using the right size catheter and not
forcing the catheter down the airway.
Page 36
Suctioning on the go
Before going out make sure the portable suction unit is fully charged and you have all your
supplies.
Portable suction supplies:
 Suction catheters
 Connecting tubing
 Gloves
 Masks
 Hand sterilizer
 Distilled water, if desired
 Spare inner cannula, if applicable
 Manual resuscitator
 Trach Kit
Other Helpful Tips

 The same catheter may be used during each suction attempt as long as it has remained
clean
 The same suction catheter should not be used for more than one suction session
 If the catheter becomes plugged, throw it out. Replace with another sterile catheter
 Some individuals may have to be manually ventilated (bagged) before and after suctioning
This may help move mucous higher in the airway. This may also help with breathing
 Replace cork/speaking valve and/or the heat and moisture exchanger when needed
 Suctioning is a clean procedure so it does not require the use of sterile gloves. Clean gloves
are used to act as a protective barrier so that secretions or organisms cannot be transferred
to the caregiver.
Page 37
Changing the Trach Tube

Many people change their own trach tubes. Some people change their trach tube once a month,
others change it more often. Some will change it if it becomes plugged or falls out by accident. The
following are steps everyone in the family needs to know. In case of an emergency, you need to be
prepared and know what to do. Everyone in the family should know what to do if the trach were to
become plugged, or falls out by accident. Do a practice-drill at home, so you can remain calm if
these situations arise.
For a trach change, it is best if you have a second person to help you.
1. You will need:

 Clean or new trach tube with obturator; same size as the one that is currently in
 One size smaller trach tube – in case of an emergency where you cannot get the new
same size tube in
 Trach ties
 Supplies to clean the stoma
 Syringe, if the tube is cuffed
 Scissors
 Sterile distilled water
 Manual resuscitation bag and mask
 Water soluble lubricant
 Suction machine and suction catheter
2. Wash your hands well and put on clean gloves

3. Check the new trach tube:
 Remove the trach tube from the package. Look at the new tube. If you notice any cracks
or breaks get a new tube
 If there is a cuff on the tube, check that it is working by inflating it and deflating it
 Inflate the cuff with air or water, as ordered by your doctor. If you notice a leak, get
another tube. If there are no problems, deflate the cuff completely
4. To keep the tube as clean as possible, touch only at the flange

5. Put the obturator into trach tube
6. Lubricate the end of the trach tube with a water soluble lubricant
7. Make sure the person is comfortable and lying on their back with their neck tilted slightly
backward. To do this, some people find it helpful to put a rolled towel under their shoulders
Page 38
8. Do stoma care, if needed

10. Have the second person hold the trach tube at the flange. Remove the old trach ties. Take
care the trach tube does not fall out accidently
11. If the patient has a cuffed tube, deflate the cuff completely
12. Take out the old trach tube but try not to pull it straight out. Use a motion that follows the
curve of the trach tube
13. Guide the new trach tube into the stoma. Again, try using a motion that follows the curve of
the trach tube
14. As soon as the new trach tube is in, remove the obturator
15. If the person is on a ventilator and has a cuffed tube, inflate the cuff
16. Place back on ventilator, or oxygen, if needed
17. Tie the trach ties and put on a clean dressing
18. Wash your hands
What should I do if I cannot get the trach tube in?

1. Moisten the trach tube with sterile distilled water and try again
2. Make sure you are using the obturator and that the cuff is completely deflated
3. Make sure the neck is extended. You may need to reposition the person
4. If the person can breathe and is not in distress:
 Ask the person to take a big breath in. Guide the tube in as they breathe in
 Try to put in a smaller size trach tube in
5. Put the obturator into the stoma and gently pull down on the skin around the opening. This
should open the stoma a little more giving you room to put in the smaller trach tube
6. If the smaller tube will not go in and the person is having trouble breathing:
 Put the face mask on the manual resuscitator bag and place the mask over the nose and
mouth to ventilate. You will need to cover the stoma
 Have the second person call 911
Page 39
The trach tube is out a little, but has not completely fallen out.
What do I do?
1. Deflate the cuff on the trach tube (if it has one)
2. Gently push the tube back in
3. Adjust the ties so the trach tube will not fall out
What do I do if the trach tube is plugged?

1. If the patient is on a ventilator, the high pressure alarm will probably go off
2. Check to see if the patient is having trouble breathing
3. If so, try suctioning. If the suction catheter does not go down the trach very far then it may
mean that the tube is plugged
4. If the patient is having trouble breathing you will need to act fast. Remove the trach tube
and insert a new one
Page 40
Mechanical Ventilation
What is Mechanical Ventilation?

You may need a ventilator to move air in and out of your lungs because you cannot breathe well
enough on our own. The ventilator can do all of the breathing (total support) or just partly help your
own breathing effort (partial support). Most ventilators can also give extra pressure (PEEP pressure)
to hold the lungs open so the air sacs do not collapse. Mechanical Ventilation can be done using a
ventilator and a trach tube, a ventilator and a mask, or a ventilator and a mouthpiece.
Total Support
Those people who need the ventilator to do all their breathing would be on total support. A
trach tube is often used for those who need the ventilator to do all their breathing. People on
‘total support’ are not able to use a mask.
Partial Support
This is when the person is able to breathe on their own in between the breaths delivered by the
ventilator. The ventilator does not have to deliver the full breath, if the person has some
breathing effort of their own.
Why is Mechanical Ventilation Needed?

Certain lung diseases change how the respiratory system works. Mechanical ventilators are used
when the:
 Brain cannot send signals to the lungs to breathe

 Lung is too stiff to expand fully
 Lung tissue is damaged causing breathing problems
 Muscles for breathing are not strong enough to move air in and out of the lungs
 Heart has been damaged and causes the lungs to work very hard
Page 41
Ventilator Settings
Below is a list of the most common ventilator settings. Your ventilator settings will depend on your
ventilator type and mode.
Modes of Ventilation
The ventilator mode is the how the ventilator delivers the breath.
Common ventilator modes are:
AC or C - Assist/Control or Control
IMV - Intermittent Mandatory Ventilation
SIMV - Synchronized Mandatory Intermittent Ventilation
CPAP- Continuous Positive Airway Pressure
PS - Pressure Support
When Pressure Support is working, the machine will deliver a set pressure when the person
breathes a breath on their own. It helps to boost the breath, so it is larger than they might
do on their own
PC - Pressure Control
This sets the highest pressure to be delivered during a breath. This pressure is held for the
whole ‘breathing in’ time
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Ventilator Rate
 Also known as Breath Rate and Respiratory Rate
 The number of breaths the ventilator delivers in one minute
Tidal Volume
 The amount of air the ventilator gives with each breath
Inspiratory Time
 The time it takes for the ventilator to give one breath
Inspiratory Flow Rate

 How fast the air travels during one breath
I: E Ratio (Inspiratory to Expiratory Ratio)

 The length of time it takes to breathe in compared to the time it takes to breathe out
 This is often expressed as a ratio
Peak Inspiratory Pressure (PIP)

 This shows the amount of pressure it takes to fill up the lungs when you breathe in
 The number shown may be slightly different with each breath
 Each person has a normal PIP
 The amount of pressure is displayed on the control panel of the ventilator, either as a
number on a screen or on a gauge
PEEP (Positive End Expiratory Pressure)

 This is the pressure the ventilator holds at the end each breath. PEEP helps to keep the air
sacs open so they do not collapse
Sensitivity or Breathing Effort

 This control shows how much effort is needed to start a new breath from the ventilator
Page 43
Low Pressure Alarm

 This is a safety alarm that goes off when the ventilator does not reach the pressure needed
to give the full breath
 This usually means there is a leak somewhere in the tubing or that the ventilator tubing has
come off the patient’s trach tube. For a more information on low pressure alarms, see the
Troubleshooting section
High Pressure Alarm

 This is a safety alarm that goes off when the ventilator reaches the high pressure setting.
 This usually happens when:
B There is a blockage in the airway, often caused by too much mucous. The patient might
need to be suctioned
B The patient is wheezing, coughing or hiccupping
B There is a kink in the ventilator tubing
Oxygen
 If your doctor wants to give more oxygen, it may be added into the ventilator tubing
Your ventilator is a: __________________________________________

The ventilator settings are: ____________________________________
Page 44
Ventilator Power Sources

Ventilators operate on electricity. There are three sources of electricity that are available to run the
ventilator: Alternating Current (A/C), External D/C battery and Internal D/C battery
Alternating Current (A/C)

Most of the time your ventilator will be plugged into your home wall outlet which is 120 volts of
alternating current (A/C). Always use wall outlet power if you are planning to stay in one place.
Internal Direct Current (D/C)

This is the battery inside the ventilator. It is used when there is a sudden drop in electricity to
power the ventilator. This may happen when the ventilator is unplugged accidently, or during a
power failure. A fully charged battery should keep the ventilator working for about 30-60
minutes.
This battery should not be used often. This battery is a safety feature and is only to be used in
an emergency. Keep the ventilator plugged into a wall outlet so the battery will always be
charged.
The Internal D/C battery is:
 Built into the ventilator

 For short term emergency power only
 On when the ventilator is on
 On when you unplug the ventilator from the wall or an external D/C battery
 Recharged when the ventilator is plugged in to a wall outlet
 Able to power the ventilator for 30-60 minutes, if it is fully charged
 To be discharged and recharged every month
Note: Depending on the ventilator, this battery may not recharge when the ventilator is
plugged into a D/C external battery. Check with your respiratory therapist.
Page 45
External Direct Current (D/C)

If a power failure were to last longer than 30-60 minutes, the battery inside your ventilator will
not last. So you need to have another way to power the ventilator, if this were to happen.
The Ventilator Equipment Pool (VEP) provides an external D/C battery for emergencies such as a
power outage. The battery is a standard 12 volt battery that would provide power to the
ventilator for 5-12 hrs.
IMPORTANT! This battery should not be used for portability, such

as with a wheelchair. They are for emergency backup power only.
How do I hook up the external battery to the ventilator?

1. Check to make sure the battery is fully charged. If it needs charging, do so first. Never
charge the battery while the battery is connected to the ventilator
2. Place the battery in a safe place away from the ventilator’s inlet filter (on the back of the
ventilator panel). Do not put the battery on top of ventilator
3. Plug the battery cable into the proper connection on the ventilator
4. Plug the battery cable into the battery
IMPORTANT! Some internal ventilator batteries may not recharge

when the ventilator is plugged into an external D/C battery.
How do I remove the external battery from the ventilator?

1. Unhook the battery cable from the battery
2. Unhook the battery cable from the ventilator
3. Make sure ventilator is plugged into the wall outlet (A/C power source)
4. Recharge the battery in a well ventilated area
I would like to use my ventilator with my wheelchair. What battery should I use?
 A battery is needed when you use your ventilator with your wheelchair. You will need to
buy another battery for this purpose
Page 46
 Do not use the external battery that VEP has given you. That one is for emergency use only.
VEP does not supply batteries for wheelchair use
When do I need to recharge the external battery?

 Recharge the battery after every use in a well ventilated area
 Old batteries will lose their charge quickly so check the battery charge every week
 Discharge and recharge the battery monthly
How do I recharge the external battery?

1. Charge the battery in a well ventilated area
2. Do not charge the battery when it is hooked up to the ventilator
3. Use a 12 volt battery charger to recharge the battery
4. Connect the battery to the charger
5. Connect the charger to the wall outlet (A/C power)
6. Let the battery charge. Note: It will take one hour of recharge time for every hour that
it was used
7. When the battery is 80% charged, the yellow light will flash
8. When the battery is 90% charged the green light will come on. When the green light is on
it means the charge is complete
9. Leave the battery hooked up to the charger for another 3 hours after the green light
comes on
10. When the battery is fully charged, unplug the charger from the wall outlet first, before
unhooking the charger from the battery
Page 47
Back of ventilator External D/C battery 12 volt battery charger
Figure 30: Ventilator & Battery

Photo courtesy of Ventilator Equipment Pool
General Tips: Ventilator Management

 Place the ventilator on a night stand or a table away from drapes or other things that could
block the air flow to the inlet filter opening
 Spills will damage the ventilator and cause it to not work properly. Never place food or
liquids on top of the ventilator
 Use the protective doors, covers or lock out features on the ventilator. They protect the
settings from being changed by mistake
 Make sure the humidifier is lower than your head
 Make sure the alarm port is not blocked by objects. If it is blocked, it may not be heard if it
goes off
Page 48
Daily
 Make sure the ventilator is plugged into a 3 - pronged wall outlet (A/C power source)
 Turn the ventilator on and check that the proper lights and sounds come on. Your ventilator
manual will tell you what to look for
 Check the ventilator settings to make sure that they are set correctly
 Check the respiratory rate. To do this the person cannot be connected to the ventilator.
Hold a glove tightly over the flex tube connector where it would attach to the patient. Count
the number of breaths for one minute (60 seconds). It should be the same as the set breath
rate on the machine
 Test the Ventilator Circuit by doing a ‘Low Pressure Test’ and a ‘High Pressure Test’
Weekly
 Wipe down the ventilator with a damp cloth
 Clean and change the Ventilator Circuit
 Clean the Portable Suction machine
 Check that the external battery is charged
Monthly
 Change the bacteria filter in the breathing circuit
 Change or clean the inlet filters on the ventilator. These must be replaced/cleaned as
needed
 Discharge and recharge the external battery
Annually, or as needed
 Preventive maintenance is recommended by the manufacturer. Some ventilators need to
be serviced every 1-2 years, or after a certain number of hours of use
 The Ventilator Equipment Pool staff will call you when your ventilator needs maintenance
Page 49
The Ventilator Circuit

Below is a picture of a ventilator circuit.Your ventilator circuit may look a little different than this
picture.Circuits are currently provided through the Ventilator Equipment Pool. Please see specific
user’s manual for circuit details
A.Exhalation valve B. Ventilator circuit tubing
C. Pressure line D. Exhalation valve line
E. Outlet filter (not shown)
Figure 31: Ventilator Circuit

Courtesy of Ventilator Equipment Pool
Page 50
A The exhalation valve: is a balloon that closes when you breathe in and opens when you breathe
out. The flex tube attaches to one end and the ventilator circuit tubing to the other end.
B The ventilator circuit tubing: is a 6 foot hose that attaches to the exhalation port at one end and
to the outlet port on the ventilator on the other end.
C The pressure line: is a small tube that is connected to two pressure ports; one on the ventilator
and the other on the exhalation valve.
D The exhalation valve line: is connected to the exhalation valve and the exhalation valve port on
the ventilator.
E The outlet filter: this filters gas coming from the ventilator, going into the ventilator circuit tubing
(not shown in the picture above).
Figure 32: LTV 950 Ventilator

Reproduced with permission of CareFusion www.CareFusion.com
Figure 32 shows the LTV 950 ventilator. Your ventilator may look different than the picture
shown here.
Page 51
How do I clean and change the ventilator circuit?

Clean the ventilator circuit, resuscitation bag, humidifier and suction canister at least once a
week.
1. You will need:

 Mild dishwashing soap
 Pail for soaking
 Water
 White vinegar
 Clean towel
 Storage bag
2. Take apart the ventilator circuit. This includes the tubing, connectors and humidifier
reservoir jar, if used. Refer to your Patient Circuit Assembly Instructions
IMPORTANT! The ventilator will not work properly if water gets

into the pressure sensor line or exhalation valve.
3. Wash tubing and connectors in warm soapy water

4. Rinse with tap water to remove the soap
5. Make a solution of 1 part vinegar to 3 parts water in the pail. Soak humidifier jar, tubing,
and connectors in the vinegar solution for 30 minutes. Make sure that all the parts are in
the solution
6. Drain and rinse well. Place connectors and humidifier jar on a clean towel to air dry. Hang
the hoses to dry. Allow all parts to air dry completely before putting back together
7. Look carefully at the tubing and equipment for breaks or cracks. Check that everything is
clean. Replace anything that is broken or cannot be cleaned properly
8. Put the ventilator circuit together, so it is ready to use. If it is to be stored, cover the circuit
with a clean towel or store it in a clean plastic bag
Page 52
Testing the Ventilator Circuit

1. Inspect the Circuit
 Make sure that all connections are tight
 Make sure the humidifier and exhalation valve are put together properly
 Check that the sensor lines are all connected
2. Do the “Disconnect Test” (Low Pressure Test)
 Make sure the low pressure alarm setting is set correctly
 Turn on the ventilator with the circuit connected
 Do not connect the circuit. Wait to see if the low alarm goes off
3. If the alarm does not sound, check the alarm setting to make sure it is set correctly
4. If it still is not alarming:
 Check the exhalation valve
 Try another circuit or use another ventilator, if you have one. You may need to use a
manual resuscitation bag to ventilate the person
 Then contact the Ventilator Equipment Pool (VEP) right away if it is still not alarming
5. Do the “High Pressure Test”. The purpose of this test is to check that there are no holes or
leaks in the tubing or connections
 Glove one hand
 Block the end of the trach adapter with your gloved hand and wait for the ventilator to
give a breath
 A high pressure alarm should sound after 1 - 3 breaths
 If there is no alarm check the high pressure alarm setting to make sure it is set correctly
Also check all the connections to make sure they are tight and secure
 If still not alarming, try another circuit or use another ventilator if available
IMPORTANT! Use a manual resuscitation bag to ventilate the

patient. Call the Ventilator Equipment Pool (VEP) if your ventilator
continues to not work.
Page 53
Ventilator Safety and Troubleshooting

Below is some information to help you troubleshoot some common problems that may occur. For
more information read the user manual supplied with your ventilator. Also read the “Problems and
Emergency Manual”.
What do I do if an alarm is sounding?

When a ventilator alarms you will see a warning light come on and hear a warning sound.
Alarms are to alert you to a safety concern. When an alarm goes off you need to pay attention
to it right away!
IMPORTANT! Do not change the alarm settings!
Page 54
Ventilator Troubleshooting Guide

Alarm Possible Causes Steps to Take
Ventilator IN OP There is a problem with how the Turn the main power switch on the
ventilator is working ventilator off and then on again.
You will see a If the IN OP alarm is still alarming, do
warning light and not use this ventilator
hear a warning  Switch to another ventilator, if
sound. available
 Use manual resuscitator bag
 Call VEP right away
High Pressure 1. Mucous is blocking the airway 1. Suction to remove mucous.

2. Wheezing or bronchospasm 2. Give inhaled medicine
You will see a 3. There is a respiratory infection 3. Contact the healthcare
warning light and professional
hear a warning 4. Alarm setting is not set correctly 4. Change alarm to proper setting
sound. 5. Damaged Exhalation Balloon 5. Replace exhalation valve or
(valve) change the circuit.
6. Kink in the tubing 6. Straighten the tubing
7. Water in tubing 7. Drain water
8. Coughing, swallowing or 8. If coughing, try suctioning
hiccupping
Page 55

Low 1. Visual and auditory 1. Look and feel for any leaks. Do
Pressure/Apnea the “Disconnect Test”
2. Leaks in the ventilator circuit 2. Recheck circuit and test
You will see a (exhalation valve, humidifier,
warning light and pressure line, holes in tubing)
hear a warning 3. Water in the pressure line 3. Drain water
sound. 4. The ventilator has come off the 4. Connect the ventilator to trach
patient’s trach tube
5. Leak around patient’s trach 5. Verify the volume in the trach
and/or cuff cuff. Deflate and reinflate cuff
Reposition the patient and/or
tube. May need a trach tube
change
6. Alarm set incorrectly 6. Set the correct alarm setting
7. Incorrect circuit 7. Change circuit
8. Loose trach ties 8. Tighten trach ties
9. Loose inner cannula 9. Change inner cannula or change
trach tube
Setting 1. Settings are incorrect 1. Correct the settings

2. Dirty inlet filter 2. Replace filter
Power Switch Over 1. Power source has changed from 1. Make sure the ventilator is
AC (wall outlet) to internal or plugged in and there is power and
external power source press the reset button
2. Power source has changed from
external to internal
Low Power Internal battery has drained and Operate ventilator on AC power for at
needs to be recharged least three hours
Always follow the instructions found in your ventilator manual.
IMPORTANT! When a ventilator alarms, look at the person on the

ventilator to see how they are doing. If they are not doing well, use
a manual resuscitation bag to ventilate them.
Page 56
Other Equipment
Using and Cleaning the Portable Suction Unit
Figure 33: Portable Suction Machine

Reproduced with permission from Hamilton Health Sciences Centre
These units are portable so if you are going somewhere, make sure the machine’s battery is
fully charged and that you have all your supplies (see “Suctioning on the Go”, page 37).
Page 57
How do you set the suction pressure?

The suction pressure is preset by your healthcare professional. To check the suction pressure,
first turn on the unit. Then cover the open end of the connective tubing with your finger and
look at the number on the gauge.
How do I charge the battery?

Plug the portable suction machine into AC power (home wall outlet) when it is not in use. When
using the machine on AC power, the on/off light will come on. When using the machine from
the battery power the on/off switch does not light up.
How do I clean the suction unit?
Daily
The canister should be emptied daily into the toilet. Wash it with soapy water and rinse well.
Leave a little water in the bottom of the canister as it will stop mucous from sticking to the
bottom.
Weekly
Clean the suction canister at least once a week.
1. You will need:

 White vinegar
 Water
 Two pails:
o One for warm soapy water
o One for vinegar (1 part) and water (3 parts) mix
 Clean towel
2. Remove the short tubing from the lid. Unfasten the canister and remove the lid from the
suction unit. Empty the contents into the toilet
3. Wash all parts in warm soapy water
4. Rinse with tap water to remove soap
Page 58
5. Sink the pieces in one part vinegar to three parts water for 30 minutes. Rinse well and
remove the extra water. Place parts on a dry towel to air dry
6. Put the tubing and canister back together. Look for any cracks and tears. Throw away and
replace any broken or cracked parts
7. Wipe the machine down with a damp cloth
8. Change the connecting tubing weekly or when soiled
9. Wash hand well
Monthly
Look at the filter and change it when it looks dirty or at least once every 2 months.
The Manual Rescusitation Bag

The resuscitation (re-suss-i-TAY-shun) bag is
a football-shaped bag that can help give
breaths to someone who needs help
breathing or is unable to take breaths on
their own. When the bag is squeezed, the air
leaves the bag and goes into the person’s
lungs. The air they breathe out goes out of
the lungs and through a valve in the
Figure 34: Laerdal Bag
resuscitation bag. Manual resuscitations Photo Courtesy of Hamilton Health Sciences, used with
bags are also called “bags”, “ambu bags” or permission of Laerdal Medical Canada Ltd www.laerdal.ca
“manual ventilators”.
Your manual resuscitator bag may look different from the picture above.
When do I need to use a manual resuscitator bag?

 When the person is having trouble breathing
 When there is a problem with the ventilator, or there is no power available to operate the
ventilator
 Before and after suctioning, if needed
Page 59
How to use the Manual Resuscitator Bag

1. You will need:
 Manual resuscitator bag
 Adaptor for the trach tube
 Flex hose/tube
 Oxygen tubing, if needed
2. Take the patient off the ventilator

3. Connect the resuscitator bag to the patient’s trach tube
4. Squeeze the bag gently – try to deliver about 1/3 - 1/2 the volume of the resuscitator bag
Squeezing the bag should take about 1 second
5. Look at the patient to make sure:
 The chest is rising
 They are comfortable, are awake and aware of what is happening
 They are not turning blue
6. As soon as you finish squeezing the bag completely, release the bag to let the patient
breathe out. Make sure you give the person enough time to breathe out before squeezing
the bag again
7. Squeeze the resuscitator bag in a regular pattern, about once every 4 - 5 seconds. Ask “Is
this enough air? Do you want more?” Adjust how much and how fast and how much you are
giving based on the person’s needs and comfort level
IMPORTANT! Never squeeze too hard on the manual resuscitator bag,

as it could damage the lungs. Do not squeeze the bag too fast. If the
patient is not responding while bagging, then call 911 right away.
Page 60
How do I care for a Manual Resuscitator Bag?

A leak in the resuscitator bag will stop the right amount of air from filling the lungs. In order for
the bag to work well it must be leak free. Every day you must do these two simple tests to make
sure there are no leaks in the manual resuscitator bag.
Test # 1
1. Wash hands well and put on gloves

2. Cover the outlet of the resuscitator bag with the palm of your gloved hand
3. With your other hand squeeze the resuscitator bag; you should feel the pressure in the bag
against your hand
4. If you hear or feel a leak then tighten all the connections
5. After checking all the connections, test again for leaks by repeating steps 2 & 3. If it does not
leak continue to Test #2
6. If it still leaks, you will have to replace your manual resuscitator bag. Call your respiratory
home care professional
Test # 2
1. Squeeze the resuscitator bag to empty it

3. Release the resuscitator bag while keeping the outlet covered with your gloved hand
4. The resuscitator bag should fill up freely. If it does not, then the inlet valve maybe sticking
5. If the bag does not refill, unscrew the inlet valve assembly (pieces 6, 7 and 8 in picture) and
gently loosen the valve. Then put it back together
6. Do the test over again to make sure the resuscitator bag fills freely. If it still does not fill
freely, you will have to get another manual resuscitator bag. Call your respiratory healthcare
professionals
Page 61
How do I clean the Manual Resuscitator Bag?

1. Clean the bag at least once a month, or when it is dirty
2. Take apart all the pieces of the resuscitator bag
3. Fill sink/pail with warm soapy water
4. Put all the pieces in the soapy water making sure all pieces are covered for 20 minutes
5. Rinse the pieces well
6. Fill sink/pail with 1 part vinegar to 3 parts water. Soak for 20 minutes
7. Rinse well
8. Place on clean towel to dry
9. Reassemble pieces of resuscitator and do both the leak and pressure tests
The pieces go together in order from 1 to 8 from photo below.
Figure 35: Manual Resuscutator Bag

Photo Courtesy of Hamilton Health Sciences, used with permission of
Laerdal Medical Canada Ltd www.laerdal.ca
IMPORTANT! Anyone who needs a ventilator to breathe, will need

a manual resuscitation bag.Those with a trach but do not need a
ventilator to breathe, may also need a manual resuscitation bag.
Page 62
Humidifiers
Humidification means to make moist or wet. Proper humidification helps keep the mucous thin and
easy to cough up. There are two common types of humidifiers; the Heat and Moisture Exchanger
(HME) and the pass-over humidifier.
What is a Heat and Moisture Exchanger (HME)?

An HME is a filter-like sponge that is put onto the trach tube and stays there while the person
breaths. It traps the heat and moisturize from the air that is breathed out from the lungs. On
the next breath in, the air passes through the HME and becomes warm and moist.
HMEs are sometimes called an ‘artificial nose’.
IMPORTANT! Never dampen the HME with water.
Figure 36: Illustration of an Heat Moist Exchanger

Reproduced with permission from West Park Healthcare Centre Long-
Term Ventilation Centre of Excellence.
When do I need to change the HME?

Change the HME:
 Every day, if you are always using one

 Every second day, if you are using it only at night time
 When it becomes dirty
Page 63
What is a Pass-Over Humidifier?

Air from the ventilator passes over heated water, becoming warm and moist before going to the
lungs.
Outlet port
Heater plate Inlet port
Heater control On/Off Switch
Figure 37: Fisher Paykel MR 410 Humidifier

Reproduced with permission from Fisher & Paykel Health Care Inc
There are a many types of pass-over humidifiers. All work in the same way, but the parts may
look different. A common brand is The Fisher-Paykel humidifier. To learn more about how to
care for your unit, read the user manual that comes with your equipment.
Page 64
All units have:
 Three pronged wall plug for electricity

 Reservoir unit to hold the water
 Heater control that controls water temperature
 Heating plate that heats the water to the temperature that is dialled in
IMPORTANT! Only use sterile distilled water. Sterile distilled water

is very clean and free of germs.
Changing the Temperature

 The numbers on the heating control are “guides” for changing the temperature
 The temperature will depend on your comfort level and your healthcare professional’s
instructions
 It takes a little time for the unit to warm up
 The water temperature can change depending on the room temperature, heaters, fans, or
blankets
How do I fill the reservoir unit with water?

The humidifier works best when you keep the water in the reservoir unit between the ‘refill’
and the ‘full’ line. Keep the water level in the reservoir at the highest water level mark.
Although the water between the lines will last for a number of hours, you will have to fill or refill
the humidifier often. Once the level is at the low water level mark, throw out any water left in
the reservoir.
Ensure that you change the water every day and that the humidifier is in a safe place so it will
not get tipped over.
IMPORTANT! Never drain water from the ventilator tubing back

into the reservoir. Always drain the water from the ventilator
tubing into a separate container.
Page 65
If the ventilator is not in use:

1. Wash your hands well
2. Use a funnel or a measuring cup
3. Disconnect the humidifier tubing and throw out the water
4. Rinse well and refill with sterile distilled water (Fill to the ‘full line’ marking)
5. Reconnect the circuit tubing to the reservoir port opening
If you are using the ventilator:

You will need to know how long the person can stay off the ventilator, while breathing on their
own, before doing this next step. You will need to complete all the steps in the time they are off
the ventilator and breathing on their own. Ensure you have a manual resuscitation bag on hand,
in case they need to be given some breaths while off the ventilator.

2. You will need to change the circuit to ‘go around’ the humidifier. You can do this by
following these steps:
 Take off the short hose going to the humidifier from the ventilator outlet port
 Separate the patient tubing from the humidifier port
 Connect the patient tubing directly to the ventilator outlet port. Make sure there is no
water in the circuit
3. Throw out any water that is in the reservoir unit and rinse well
4. Fill the reservoir unit by using a funnel or measuring cup and fill with sterile distilled water
to the “fill line” marking
5. Disconnect the patient tubing from the ventilator outlet port and reconnect it to the
humidifier port
6. Re-connect the short humidifier tubing to the ventilator outlet port
Page 66
There is water in the tubing, what should I do?
Sometimes when the air leaves the humidifier it cools in the tubing and water will collect in the
ventilator tubing. Water in the circuit can:
 Cause problems ventilating the patient

 Cause germs to grow in the tubing which can lead to a lung infection
To remove the water from the circuit:
1. Wash your hands well.

2. If the circuit has a “water trap”, let the water inside the tubing run down into the water
trap. Then empty the water trap collector. Note: you do not have to unhook the ventilator
circuit when emptying the “water trap” collector
3. Disconnect the ventilator tubing from the patient at the trach site
4. Empty the short flex hose tubing by stretching it out and letting any water drain into a
container
5. Remove the ventilator tubing from the humidifier outlet and drain it away from the
exhalation valve
6. Drain the flex hose away from the exhalation manifold
7. Do not shake water from the tubing as it may spread germs
8. Attach the short flex hose to the patient's trach tube
Page 67
Inhaled Medicine
The use of inhalers or “puffers” is
Canister
one way to give medicine. Often
only a small amount is needed.
Because the medicine is breathed
into the lungs, it does not take long
AeroVent®
to work.
Chamber
Puffers can be given to someone on

a ventilator, by using a special
chamber such as the AeroVent®. Figure 38: Puffer Cannister and Aerovent Chamber
Reproduced with permission from Trudell Medical International
How do I give a puffer to someone on a ventilator?

1. Make sure that your are using the most current puffer ordered by your doctor
2. Check the expiry dates
3. Check that there is medicine in the canister. Shake the canister slowly close to your ear to
feel if it is full
4. Place the chamber into the inspiratory side of the ventilator circuit. If you have an HME on,
take it off
5. Shake the canister 10 times
6. Attach the puffer canister to the chamber adaptor (AeroVent®)
7. Press down on the canister once, just as the patient begins to breathe in
8. Remove the canister. Replace the cap on the inlet port, to stop any leaks
9. Wait 30 seconds. If another puff is needed, repeat steps 5-8
Clean the chamber once a week, or when you clean the ventilator circuit.
Also inspect the puffer adaptor for cracking and leaks.
Page 68
Other Issues
Assistive Devices Program (ADP) Funding for Respiratory Supplies

How do I get funding for a ventilator and other supplies?
Anyone getting a ventilator and related supplies has to apply to ADP for funding assistance.
While you are in the hospital getting ready to go home, you and your doctor will be asked to
complete an ADP form to see if you qualify for funding.
To be approved for funding you must:
 Be an Ontario resident
 Have a valid Ontario Health Card
 Have a physical disability for at least 6 months
 Have the proper ADP forms completed by your doctor
B A sample ADP form can be found in Appendix A in this Manual
B The ADP forms need to be filled out every 3 years to renew the funding
The Assistive Device Program will pay for 100% of the cost of your ventilators and some of the
accessories. ADP will pay 75% of the cost of your respiratory care supplies, such as:
 Custom-made masks
 Commercial masks
 Ventilator circuit supplies
 Suction units
 A manual resuscitation bag
 Disposable trach supplies
There is a limit on the amount of supplies that will be covered. To find out more about what is
covered and what is not, you can read the ADP Respiratory Manual or talk to your respiratory
therapist.
The Ventilator Equipment Pool (VEP) supplies your ventilator and ventilator circuits, battery,
battery cable and humidifier. The VEP is located in Kingston Ontario. You will not need to go
there to get your equipment. It will be sent to your home.
Page 69
ADP is a part of the Ontario Ministry of Health & Long Term Care (MOHLTC) which is part of the
Ontario government. Your ADP bill will be sent to the MOHLTC who will pay for your
equipment. You will need to pay the remaining cost, which is 25% of the total for respiratory
supplies.
What other funding sources are there?

If you cannot afford to pay the remaining 25%, there are also some other options. Try the
following agencies.
Insurance Companies
 Extended Health Care (EHC) Insurance through workplace or privately e.g. Ontario Blue
Cross
Government assistance programs

 Ontario Disability Support Program (ODSP)
 Ontario Works
 Assistance for Children with Severe Disabilities (ACSD)
If you are interested in finding out more about other funding sources, contact your CCAC case
worker, social worker or physician who will help you find out what is best for you.
Page 70
The Ventilator Equipment Pool

What is the Ventilator Equipment Pool (VEP)?
The VEP is a central place where the ventilators are kept. VEP is part of Assistive Devices
Program (ADP). The VEP supplies your ventilator and related equipment for those who are
approved by ADP.
Getting your Ventilator

Once ADP approves your request they inform VEP. VEP will then send you the equipment that
your doctor has ordered.
Ventilator Circuits
VEP will send you two ventilator circuits for every ventilator you are approved for. You will get 2
new circuits every 2 years.
The equipment is to be returned to VEP if you:
 No longer need it
 Are not approved for funding
 Are admitted to hospital and are not coming home for quite a while
 Are living in Long Term Care
The VEP does not give ventilators for use in long term care facilities. Patients entering these
facilities must tell VEP that their status has changed.
Who will service and repair the ventilator?

The ventilator will need regular service. Service and repairs are done by the VEP at no cost to
you. It is important to make sure that your ventilator receives the service when it should. Read
the manual that came with the ventilator for more information.
VEP will not pay for equipment that is lost, stolen or damaged through neglect or abuse.
 When it is time for service, the VEP will call and to make arrangements to pick up the
ventilator
 The replacement ventilator will be sent from Kingston and it will become your new
ventilator. You will keep this ‘new’ ventilator until the next time your ventilator needs to be
sent back for service
Page 71
 Make sure the ventilator settings and alarm limits are set properly, before using the new
ventilator
I am having problems with my ventilator. Who do I call?

If you are having problems with your ventilator first look at the manual and the trouble shooting
section in this book. Your home care company may be able to help you to find out what the
problem might be. If you are still having problems with the ventilator, then contact your
equipment provider.
Call your home care company if you have problems with your ventilator circuit, such as the
tubing and connectors.
IMPORTANT! Call your ventilator equipment provider if you are

having trouble with your ventilator.
My ventilator equipment provider is:

 VEP
VEP phone number is 1-800-633-8977 or 1-613-548-6156.
Follow the prompts on the message for service after business
hours. A respiratory therapist is available 24 hours a day.A
respiratory therapist is available 24 hours a day.
 My ventilator supply provider’s name is:

_____________________________________________________
Phone number is: ______________________________________
Page 72
References
Department of Critical Care Nursing. (2002). Passy-Muir® tracheostomy speaking valve. Ohio: The
Ohio State University Medical Center.
Department of Critical Care Nursing. (2007). Tracheostomy suctioning. Ohio: The Ohio State
University Medical Center.
Department of Inpatient Nursing. (2005). Changing tracheostomy ties. Ohio: The Ohio State
Department of Inpatient Nursing. (2005). Reinsertion of a tracheostomy tube. Ohio: The Ohio State
Department of Inpatient Nursing. (2005). Tracheostomy care. Disposable inner cannula. Ohio: The
Department of Inpatient Nursing. (2005). Tracheostomy tubes. Ohio: The Ohio State University
Medical Center.
Department of Inpatient Nursing. (2007). Tracheostomy care with non-disposable inner cannula.
Ohio: The Ohio State University Medical Center.
Division of Nursing: The James Cancer Hospital and Solove Research Institute. (2004). Tracheostomy
cuffs. Ohio: The Ohio State University Medical Center.
Page 73
Notes
Page 74
Non-Invasive
Positive Pressure
Ventilation
(for Adults)
This booklet has been developed by
Kingston General Hospital Staff
Including:
Layout and Design: F. Toop RPSGT
Illustrations: K. Thibault RPSGT
Contributors
L. Anderson RPSGT, E. Crochrane RRT RPSGT B.Comm,
L. Danahy RT RPSGT, C. Dawson BA Honours RPSGT,
H. Driver PhD RPSGT D.ABSM,
N. Farr RPSGT, Dr. M. Fitzpatrick M.D. FRCPC D.ABSM
S. Fodey RRT, A. Leach RRT, Dr. P. Munt M.D. FRCPC,
C. Phillips MSc RRT, C. Pugh RRT, K. Thibault RPSGT, F. Toop RPSGT
Copyright© 2008, Kingston General Hospital

All rights reserved.
Edited by Rosanne Leddy RRT
Reproduced with permission from Kingston General Hospital.
Table of Contents
Funding Coverage ............................................................................................................. 1
Getting Started ................................................................................................................. 2
Living With Bi-Level ........................................................................................................... 4
Bi-Level Units .................................................................................................................... 5
Cleaning ............................................................................................................................ 9
Troubleshooting .............................................................................................................. 12
Contact Information ........................................................................................................ 16
Non-Invasive Positive Pressure Ventilation For Adults
Funding Coverage
The Assistive Devices Program (ADP) funds the Ventilator Equipment Pool (VEP). Equipment
from the VEP is provided free-of-charge to you on a loan basis for as long as it is required.
The ADP will help cover some of the cost of the mask, headgear, tubing, and filters required.
For example, ADP will currently contribute to a mximum of 75% of $350.00 toward the
purchase of a mask. ADP will also contribute funding towards consumable supplies such as a
non-invasive circuit (tubing and filters), and provide up to 3 masks over a claim period. Your
healthcare provider will discuss this with you. Once you have been approved by ADP you will
become a client of the VEP. You may have additional financial assistance through your
insurance company. You may beentitled to social assistance benefits such as Ontario Works
(OW), Ontario Disability Support Program (ODSP), or Assistance to Children with Severe
Disabilities (ACSD).
The application process for the Bi-Level unit generally takes 6-8 weeks. Under special
circumstances some people may receive a machine on loan or as a rental before they have
been officially approved. Once you have been approved, you will then become a client of the
VEP. This means that you will be loaned a Bi-Level unit for as long as you require it. Once you
no longer need the unit, it should be returned to the VEP.
Contact VEP:
http://www.ontvep.ca
1-800-633-8977 (Toll free in Ontario)
or (613) 548 6156
Page 1
Getting Started
Bi-Level machines consist of inspiratory and expiratory pressures. Your unit will also have a
back-up rate, which ensures a minimum number of breaths are provided each minute. Some
patients with respiratory disorders may show a breathing pattern of small lung volumes and
increased breath rates. This can cause a decrease in the amount of oxygen in your blood, and
an increase in the carbon dioxide levels. When the Bi-Level unit is set correctly, lung volumes
and breath rates return to acceptable values, resulting in more normal breathing patterns.
This in turn will help improve your levels of oxygen and carbon dioxide.
These machines are loaned free of charge , to clients approved by the ADP through the
Ontario ministry of Health & Long Term care. In order to qualify for funding you must meet
the following criteria:
1. Must be an Ontario resident with a valid Ontario Health Card

2. You must reside in either the community or a group home setting where the facility is
your long-term residence
You are not eligible if you meet one of the following:
1. If you live in an acute or chronic care hospital

2. If you reside in a Long Term Care Facility
3. You are eligible to receive benefits from the Worker’s Compensation Board (WCB) or
Veteran’s Affairs (DVA) Group A. Check with DVA as they may only fund certain
situations. This may avoid wasted time and longer application wait time due to
eligibility criteria
The VEP was developed in order to provide a cost-effective way of allowing patients to return
home with respiratory equipment to assist with their breathing.
Although this machine will help your breathing, it is not intended for life support. You have
or will be given 2 ADP/Equipment Supply Authorization (ESA) forms to sign along with
instructions. One of these forms will be sent to Toronto with a letter from the doctor
concerning your diagnosis and the need for this type of machine. The second form is for you
to take to the homecare vendor of your choice for the purchase of masks, headgear, filters,
tubing etc. This form is valid for 3 years and after that time a new ADP form will be filled in.
The client may purchase any quantity of masks to a maximum of three in the three year claim
Page 2
period. For example, clients may choose to purchase two masks up front and then purchase
the third mask in year two or year three. Often having a spare mask is a good idea although
purchasing all three at once is discouraged in case there is a weight loss requiring a new mask
during the claim period.
Numerous styles of masks are available from these vendors. You will want to ensure that you
are comfortable with the mask you will be wearing on a nightly basis. Choose a vendor who
will be willing to try different masks with you and who is helpful in teaching you how to apply
and clean them.
Page 3
Living With Bi-Level

In this section we will go over some basic information about:
 Some ways you can help yourself get used to using Bi-Level
 How to fix basic problems that people often have with Bi-Level
Getting used to Bi-Level

It may take a little time to get used to wearing Bi-level. If so there are strategies that you can
use to help yourself to get used to wearing it. The risk can be life threatening so make every
effort to become comfortable with Bi-Level ventilation.
Discuss with your physician different scenarios that may lead to the inability to use the
bi-level device . Ask what is a safe e.g. “Can I sleep a night without it?“ Also ask about
different situations such as power failure, blocked nose, equipment failure, away from home
and cannot return home.
Set-up
Place the Bi-Level next to your bed at the same height as or below your head. It should not be
placed on the floor or over the head of the bed.
Page 4
Bi-Level Units
Here are some examples of Bi –Level devices
TYPE #1
Figure 1: ©ResMed 2006.

Reproduced with permission.
If you have this Bi-Level unit please put on your mask and have it connected BEFORE you turn
on the machine.
Figure 2: ©ResMed 2006.

Page 5
Type #2
Figure 3: Synchrony®
©Respironics Inc. Murrysville, PA.
Figure 4: Detail of the Synchrony® Control Panel.

©Respironics Inc., Murrysville, PA.
Page 6
Masks
Finding a mask that fits you well is one of the most important steps in getting used to Bi-
Level. Don’t get discouraged if the first mask you try isn’t comfortable after a night or two.
Most vendors will allow you to trial masks. The number of masks that they will let you try and
the length of the trials vary by vendor. Mask trials can save you from buying something that
doesn’t work for you.
Poorly fitting masks lead to discomfort and often to not wearing your Bi-Level. Leaking masks
or severe mouth leak can decrease the effectiveness of the therapy, making it harder to get
used to. Masks that are a good fit improve the effectiveness of of the therapy.
Speak to your physician about the serious health implications of not wearing your Bi-Level
mask.
Some people find it helpful to use more than one kind of mask. Your face changes shape
slightly each day, and you may find that some days your mask just doesn’t fit perfectly. If you
have another mask it might work better for you on those days. This doesn’t mean that you
have to go out and purchase two masks right from the start, but if you are having a lot of
difficulty finding a mask that will work well for you all of the time it may be worth
considering.
There are four basic types of masks:
Nasal Masks cover only your nose. They are usually the least expensive masks and work
well for most people. If you have any trouble breathing through your nose only, this may
not be the mask for you. Every time that you open your mouth with a nasal mask the
pressure that is holding your airway open escapes. This means you will not get the full
benefit of wearing Bi-Level. A sign that you are not breathing through your nose is when
you wake up with a very dry mouth. Sometimes increasing the humidity setting will help.
If the problem continues then using a chinstrap (see next page) may help. The next step
would be to move to a full face mask.
Full Face Masks cover both your nose and mouth. They are usually more expensive than
nasal masks. They work very well if you breathe through your mouth. Some people find
them more comfortable. Typically there will be more problems with air leaking around
the mask than with a nasal mask because it will shift any time that you move your jaw. If
there is a reason that you can’t breathe through your nose (like congestion or a broken
nose) a full face mask may be a good option for you. If you would really like to use a nasal
mask you should speak with your doctor to see if something can be done to help you
Page 7
breathe through your nose. It is important that you continue to use Bi-Level while these
steps are taken, so a full face mask may be necessary while you and your doctor work
toward a solution.
Nasal Pillows are becoming quite popular and there are several different brands
available. They fit against or inside your nostrils. Since they put less pressure around your
nose than nasal masks they can be more comfortable. As with the nasal mask you need to
be able to breathe through your nose. Sometimes they can cause irritation in your nostril.
This can be from having the wrong size cushion (or pillow) for you nostril. If the pillow is
too large it can put pressure against the inside of your nostril and make it sore. If the
pillow is too small then air can leak around it and cause dryness and a burning sensation.
They are generally more expensive than nasal masks.
Oral Masks are probably the least popular of all the masks. They do work well for a very
select group of people. They require you to breathe only through your mouth. They fit
into your mouth like a mouthpiece for scuba diving. The most common complaints are
pressure on the gums and oral dryness. Air may leak out the nostrils and this may require
a method to plug the nose to stop nasal leak.
Chin Straps
Chin straps can help you wear a mask more effectively. If you find that you are opening
your mouth when using a nasal mask you can try wearing a chinstrap. Sometimes people
find it helpful to wear one along with their full face mask to keep their jaw from opening
wide enough to push the mask off. The chinstrap fits around your head and under your
jaw to help keep your jaw from falling open in your sleep. There are several types
available from vendors or you can make one yourself.
Page 8
Cleaning
If you don’t clean your Bi-Level system it can lead to many problems. Masks that are not
cleaned can lead to sores on your face, and may not seal against air leaks. They do not last as
long because the oils from your skin can cause the plastic to break down more quickly. Tubing
that is not cleaned can gather dust and sometimes even mold. Filters are made for trapping
dust but must be cleaned or replaced to prevent the dust from getting into your tubing.
Headgear sits against your hair and skin; like any clothing it will last longer if it is washed
regularly. The humidification chamber provides the perfect warm moist place for mold and
bacteria to grow and should be rinsed and dried after use. All this can increase the chance of
infection.
IMPORTANT! Do not use bleach, chlorine, alcohol or

antibacterial products.
You will need:
 Mild liquid dish soap, unscented with no antibacterial component

 Distilled water, which has been boiled for five minutes for use in the heated humidifier
 Clean sink
 Somewhere you can hang the tubing to air dry - example: towel rail, shower
 Please check the manufacturer’s specifications as the instructions and recommendations
for Bi-Level units, mask cleaning and disinfecting (including the humidification chamber)
vary (refer to the user’s manual)
How to clean your mask or nasal pillows:
 Remove headgear from the mask

 Gently wash the mask in warm water, mixed with dish soap
 Rinse thoroughly with warm water
 Shake mask to remove excess water or wipe gently with a soft cloth
 Let it air dry for the rest of the day
 For daily cleaning, specially designed wipes are available. Ask your vendor if available to
use with your style of mask or nasal pillows
IMPORTANT! Clean your mask or nasal pillows every day.
Page 9
How to clean your headgear:
 Hand-wash with soap and water, or put it into the washing machine on the cold setting
 Air drying will extend the life of the headgear
IMPORTANT! Clean your headgear once a week.

Do not use heat to dry the headgear. It will shrink the cloth
and ruin the Velcro®.
How to clean your tubing:
 Remove tubing from machine

 Place in sink of warm soapy water
 Place one end of the tubing under the tap and rinse until the water is clear
 Shake off excess water
 Hang to air dry (e.g. shower, back of chair) before reconnecting to your Bi-Level unit
IMPORTANT! Clean your tubing at least once a week.
How to dust your Bi-Level machine:
 Wipe off the exterior of the Bi-Level machine with a damp cloth
 Keep the back of the machine clear from dust by cleaning off dust from tabletop
IMPORTANT! Dust your Bi-Level machine and table once a

week.
How to clean your filters:
Rinse-able – once a week (usually black or gray)
 Remove filter from Bi-Level unit

 Rinse in warm water (no soap)
 Gently squeeze out excess water
 Leave to air dry before replacing
Page 10
Disposable – monthly (usually white)
 Check filter weekly

 Replace every 4 weeks/monthly
 If blocked by dirt, replace. (It will look grey or brown)
IMPORTANT! Clean your filters regularly
How to clean your humidifier:
 Wash daily
 Warning: The water and heater plate may be hot
 Discard excess water
 Some chambers can be washed in the dishwasher. Consult the manufacturer’s manual for
instructions
 Rinse thoroughly with water and air dry
 Make sure that the docking station or hot plate is dry before replacing the chamber
 Use only distilled water that has been boiled and cooled prior to use in the humidifier in
the humidifier
IMPORTANT! Check the manufacturer’s specifications as the

instructions and recommendations for cleaning and
disinfecting the humidification chambers may vary.
IMPORTANT! Clean your humidifier at least once a week
It might be helpful to draw up a cleaning schedule to help you remember when each piece of
equipment should be cleaned.
When you first start using your Bi-Level the cleaning can seem a little overwhelming. Your
investment of time is well spent in improving your health.
Page 11
Troubleshooting
Why does it feel hard to breathe out? Will anything make it easier?
B Remember that it is normal to feel uncomfortable at first. Since you are breathing out
against a pressure, it will feel more difficult. Relax and take slow deep breaths
My eyes are red and sore in the morning or wake me up because they hurt.
What should I do?
B This can be caused by air leaking around the mask and into your eyes. You should
solve this problem quickly to avoid further injury to your eyes
B Start by reapplying the mask and adjusting the straps on the headgear. If you have an
adjustable forehead rest on your mask adjust it until the air is not leaking into your
eyes (usually moving the button down toward your chin or by turning the adjustable
device clockwise)
B Make sure not to over-tighten your mask. If your mask is pressing hard on the skin by
your eyes it can also make your eyes sore
B If these steps do not solve your problem then try some different masks. You will need
to call your vendor to discuss your options
My face is red where the mask touches it. What should I do?
B Try loosening your mask. As long as it is not leaking severely, or leaking into your eyes
there isn’t a need to have it really tight. In fact over-tightening your mask can cause it
to leak more
B Try a different mask. Not all masks are the same shape so a different one may not
irritate your skin or put pressure in the same places. You will need to call your vendor
to discuss your options
B Because a mask is pushing against your skin it can cause irritation. Sometimes using a
barrier or cushioning the bridge of the nose with a product like moleskin can help. Ask
your vendor about these products
B It is also possible that you are allergic to the mask material or the cleaning agent
B Please be certain that whatever soap you are using is not anti-bacterial. Try using a
hypoallergenic soap
Page 12
Why is my nose runny when I put on my Bi-Level?
B This is a reaction to the airflow of Bi-Level. Start by increasing the setting of your
heated humidifier. Moist air shouldn’t irritate your nose as much. If this does not
work then please book an appointment to see your doctor. It is possible that you will
need to use nasal medication
Why is my nose stuffy when I put on my Bi-Level?
B The first things to check are the filters in the back of your Bi-Level machine. If they are
clogged with dust then it is likely dust is being blown through your Bi-Level unit and
into your mask. This not only makes your nose stuffy but is hard on the motor of your
Bi-Level unit and it may wear out faster
B This can be another reaction to the airflow of Bi-Level. Adjust your heated humidifier
to a higher setting. As long as water is not collecting in your tubing it is OK to turn up
the heater. If the stuffy nose lasts more than a week, consult your doctor
B You have a cold
B If you have a cold and just can’t breathe through your nose you may need to
discontinue use of Bi-Level until your cold is gone, but CONSULT YOUR DOCTOR FIRST.
Alway discuss missing treatment scenarios with your physician
It feels like the machine is puffing the air faster than I am breathing. What should I do?
B Try just relaxing and see if you can get used to this different way of breathing
B If your breathing rate was fast when you first started therapy, it may slow down with
using Bi-Level. A normal breathing rate is 10 to 12 breaths per minute
B Call the VEP or your vendor to explain your problems. They will work with you to find
a solution that will help you be more comfortable on Bi-Level therapy
My nose is dry and burning inside. What can I do?
B Use a heated humidifier. If you are already using one then adjust it to a higher setting
B If you use nasal pillows talk with your vendor to make sure you have the proper size
B Air leaking out around the edges of your nostrils can dry out your nostrils and make it
uncomfortable to wear your Bi-Level
B Bi-Level units have heated humidifiers that make the air you breathe more moist. You
should adjust the setting on the heater plate to a level that is comfortable
Page 13
My throat is dry when I wake up. What can I do?
B The unit will blow more air to try and make up for air leaking out the mouth. Try using
a chinstrap or a Full Face Mask. Your vendor should be able to help you
My ears hurt or feel like they need to pop. Why?
B It can be normal for your ears to feel like they need to pop when you first wear Bi-
Level. When the Bi-Level air under pressure enters the nose (or mouth) it hits the
back of your throat on its way to the trachea and lungs. The pressurized air can enter
the Eustachian tube(s) and give a sense of pressure in the ear. Sometimes increasing
your heated humidity setting will help. If you have a cold, post nasal drainage,
sinusitis, sore throat, or allergies you can also get inflammation and a little swelling in
the back of your throat, that will aggravate the problem, and sometimes bacteria
from the throat can cause an infection. If your ears hurt (and don’t just pop) please
contact your physician
My sinuses hurt when I put on Bi-Level. What can I do?
B Try increasing your heated humidity setting, but since pain in your sinuses can be a
sign of a sinus infection you should contact your family doctor
I turned up my heated humidifier and now get woken up by a popping or thumping sound
from my tubing. What can I do?
B The sound is caused by water collecting in the tubing. This can happen because the air
around the tubing cools the warm, moist air as it leaves the heated humidifier. Cooler
air cannot hold as much moisture so some of the water drops out into your tubing.
Make sure there is no air blowing on the tubing such as from a fan or open window.
This will cool the tubing and cause more water to develop inthe hose. You may try to
keep the hose under the sheets if possible. You should call the VEP for possible
solutions to this problem
B Empty the water from the tubing . Do not attempt to empty the water back into the
humidifier. To decrease the amount of rainout, try using a rainout reduction kit. These
are available from your equipment provider
Page 14
I push the power button and nothing happens. What should I do?
B Make sure the power cord is plugged into the wall, the power adapter (if your unit
has one), and at the back of the unit
B Make sure that the outlet you used is providing power. Plug something else into it,
like a lamp
B Try unplugging it for a few minutes and then plugging it back in. Sometimes after a
drop or surge in the power lines the units need to reset
IMPORTANT! If these steps don’t work then you will need to

contact the Ventilator Equipment Pool or your equipment
provider.
Page 15
Contact Information
Questions concerning your treatment should be directed to:
Your equipment provider for equipment concerns: _________________________________
Your health professional/doctor for concerns about your medical condition: _____________
___________________________________________________________________________
You respiratory vendor for supplies/oxygen: _______________________________________
Questions regarding your application can be directed to: ___________________ ext._____
Equipment issues should be brought to the attention of

the Ventilator Equipment Pool at (613) 548-6156 or 1-800-633-8977.
Questions regarding your application can be directed to

the Ventilator Equipment Pool at (613) 548-6156 or 1-800-633-8977.
Date: ______________________________________
Your current mask: ___________________________
Your current Bi-Level settings:
IPAP: __________ cmH2O

EPAP: __________ cmH2O
Rate: __________ breaths per minute
Page 16
Home
Ventilation &
Tracheostomy
Care
Teaching Manual for Paediatrics
Table of Contents
Introduction ...................................................................................................................... 1
The Normal Respiratory System ........................................................................................ 2

What does the Respiratory System do? ................................................................................. 6
Preventing Infection .......................................................................................................... 7

What can I do to Prevent Infections? ..................................................................................... 7
What is Pneumonia? ............................................................................................................... 8
What are the signs of an infection? ........................................................................................ 8
What should I do if my child has an infection? ....................................................................... 8
Washing Your Hands at Home ................................................................................................ 9
Sterilizing Distilled Water...................................................................................................... 10
Tracheostomy Care ......................................................................................................... 11

What is a Tracheostomy?...................................................................................................... 11
Going Home with a Trach ..................................................................................................... 12
Description of Tracheostomy (Trach) Tubes ......................................................................... 13
Types of Trach Tubes ............................................................................................................ 16
Stoma Care ............................................................................................................................ 19
Trach Tube Care .................................................................................................................... 21
Other Information About Trach Tubes ................................................................................. 25
Speaking Valves..................................................................................................................... 28
Trach Kit ................................................................................................................................ 32
Tracheal Suctioning ............................................................................................................... 32
Changing the Trach Tube ...................................................................................................... 37
Mechanical Ventilation ................................................................................................... 40

What is Mechanical Ventilation? .......................................................................................... 40
Why is Mechanical Ventilation Needed? .............................................................................. 40
Ventilator Settings ................................................................................................................ 41
Modes of Ventilation ............................................................................................................ 41
Ventilator Rate ...................................................................................................................... 42
Ventilator Power Sources ..................................................................................................... 44
The Ventilator Circuit ............................................................................................................ 49
Ventilator Safety and Trouble Shooting................................................................................ 53
Other Equipment ............................................................................................................ 56
Using and Cleaning the Portable Suction Unit ...................................................................... 56
The Manual Rescusitation Bag .............................................................................................. 58
Humidifiers ............................................................................................................................ 62
Inhaled Medicine .................................................................................................................. 67
Other Issues .................................................................................................................... 68

Assistive Devices Program (ADP) Funding for Respiratory Supplies ..................................... 68
The Ventilator Equipment Pool............................................................................................. 70
References ...................................................................................................................... 72
Home Ventilation and Tracheostomy Care Training Manual for Paediatrics
Introduction
This Manual has been written to help you learn how to care for your child’s tracheostomy.
It will be used to provide instructions on the basic care of a tracheostomy tube and will be yours to
keep as a reference guide. This Manual will give you some instruction on how to suction, change the
trach ties, and some general safety guidelines. This book is only a guide. If you have any questions,
ask any of your healthcare teamprofessionals.
Important terms are used in this manual. Please refer to the Glossary of Terms for a complete list
of definitions. A troubleshooting section is also available.
Page 1
The Normal Respiratory System

The respiratory system is made up of the:
Upper Respiratory Tract

 Nose
 Mouth
 Larynx (voice box)
Lower Respiratory Tract

 Trachea (windpipe)
 Right and Left Lung
 Airways (bronchi)
 Alveoli (air sacs)
 Capillaries
Respiratory Muscles
 Diaphragm (largest muscle)
 Intercostals (rib cage muscles)
 Abdominal Muscles
Figure 1: Respiratory System

Illustration used with permission from Hamilton Health Sciences
The nose is the best way for outside air to enter the lungs. In the nose the air is cleaned, warmed
and moistened. There are hairs lining the inside of the nose that filter the air.
When you breathe through your mouth you are not filtering the air, but it will be warm and moist.
When you have a cold and your nose is blocked you may not be able to breathe through your nose.
Page 2
The larynx (voice box) contains the vocal cords. This is the
place where air, when breathed in and out, creates voice
sounds. It is also used to build up pressure for a strong
cough.
Figure 2: Larynx
The epiglottis is a flap of tissue that hangs over the larynx

(voice box). When you swallow food or drink this flap
covers the voice box and windpipe so you do not choke.
Figures 3 & 4: Epiglottis

The trachea (wind pipe) is the tube leading

from the voice box to the lungs.
Figure 5: Trachea
Ottawa Rehabilitation Cente
Page 3
The bronchi are tubes that let air in and out of the lungs.
The bronchi lead to tiny air sacs called the alveoli.
Mucous is made in the smaller tubes. The mucous traps

dust, germs and other unwanted matter that has been
breathed into the lungs.
Tiny hairs called cilia move back and forth moving the
mucous up toward the throat where it is can be coughed
out or swallowed.
Figure 6: Bronchi
Infants and small children make more mucous than Ottawa Rehabilitation Centre
adults. They often have a harder time getting rid of the
mucous. Mucous tends to build up and block the nose
making it hard to breathe.
The capillaries are blood vessels that are in the walls of

the alveoli (air sacs). Blood flows through the capillaries,
removing carbon dioxide from the air sacs and picking
Figure 7: Capillaries and Aveoli
up oxygen. Diagram courtesy of SIMS Portex Inc
Tracheostomy Care Handbook 1998
Reproduced with permission
http://www.tracheostomy.com/resources/
pdf/TrachHandbk.pdf
The ribs are bones that support and protect the chest
cavity. They move up and out, helping the lungs expand
and contract.
Infants and children have weak bucket-handle

shaped ribs. This translates into inefficient rib
action and lower volumes taken into the lungs.
Figure 8: Rib Cage

Page 4
The diaphragm is a large strong muscle that separates the lungs from the belly. When the
diaphragm contracts it moves downward, creating a suction effect, drawing air into the lungs.
Infants and children have diaphragms that are higher than in adults. This means they have to work a
little harder to breathe in than adults do.
The intercostals are the muscles in-between the ribs.

There are two types of intercostals muscles.
The external intercostals help you take deep breaths in,

such as when you prepare to cough.
The internal intercostals help you forcefully breathe out,

such as when you cough or sneeze.
The abdominal muscles help create a good strong cough.
Figure 9: Intercostal and

Infants and children have a large tummies compared
Abdominal Muscles
to their size. This places extra pressure on the chest Reproduced with
and gets in the way with how the lungs expand. permission from
Ottawa Rehabilitation
Centre
Page 5
What does the Respiratory System do?

Breathing In
When you breathe in a large muscle called the diaphragm contracts causing air to be sucked
into the lungs. The air that is carried into the lungs contains oxygen that your body needs to
survive.
When you breathe in, the diaphragm moves down and the ribs move out and up. This causes a
suction effect that lets air come into the lungs. The air comes into the nose where it is warmed,
filtered and moistened. The air then goes down the windpipe past the voice box. From there it
moves into two large main branches of the lungs called the left and right bronchi. The air moves
through airways that get smaller and smaller until they reach tiny air sacs. These air sacs let
oxygen into the capillaries. The blood flows from these capillaries to the heart where it is
pumped out to the body.
Breathing Out
When you breathe out the lungs remove carbon dioxide, a gas that your body does not need.
Just before you begin to breathe out the carbon dioxide goes across from the capillaries into the
air sacs. The air sacs begin to relax and the air begins to move out of the lungs. Then the
diaphragm and the muscles between the ribs also relax. This causes the ribs to gently fall,
helping to push the air out from the lungs. Under normal conditions, the diaphragm and rib
cage muscles are relaxed when you breathe out. However, when you cough or sneeze, these
muscles work hard to push the air out quickly.
Normally breathing takes place without any thought. Some conditions can cause breathing
problems. Every condition is different. So talk to your healthcare professionals about how your
child’s condition affects their breathing.
Page 6
Preventing Infection
What can I do to Prevent Infections?

Keep Things Clean!
Hands
 Insist that everyone wash their hands, often
 Buy hand sanitizers for your home
Air
 Make your home smoke free. Insist that no one smoke around you
 Tell friends and family to stay away if they have a cold or the flu. If they need to be near you
and your child they must wear a mask and wash their hands often
Trach
 Follow trach care instructions carefully. Clean trach tubes
 Keep the trach dressings and the stoma (opening) clean and dry
Equipment
 Clean equipment regularly, such as ventilator tubing and suction equipment
 Replace equipment on a regular schedule. Ask your healthcare professional when supplies
are to be thrown out
IMPORTANT! It is very important that everyone wash their hands.

Wash your hands before and after doing anything with the trach
tube or the stoma.
Page 7
What is Pneumonia?
It is important to protect the lung from viruses and germs. If the air your child breathes is clean and
moist, it will stop an infection from happening.
Breathing in dry, dirty air can cause germs and viruses to get into the lung, which can lead to
pneumonia. Pneumonia is a lung infection where the airways swell and more mucous than normal,
is made. Pneumonia can lower the amount of air getting into the lungs. It can also lower the
amount of oxygen getting into the blood.
IMPORTANT! Wash your hands before and after doing anything

with the tracheostomy.
What are the signs of an infection?

If your child has any of these signs, it may mean they have an infection.
Your child is: Your child needs:
 coughing more  to be suctioned more often

 has a fever or the chills  to take puffers more often
 feels unwell or are really tired
 is more short of breath Your child’s ventilator:
 is having chest tightness
 has higher than normal pressures
Your child’s mucous:
Your child’s stoma:
 is thick and/or there is more of it
 is yellow or green  is red, swollen or is painful
 has an unpleasant smell
What should I do if my child has an infection?

 Call your doctor or healthcare professional if think your child has an infection
 Follow your doctor's orders on giving your child medicine, such as antibiotics
 If you have an action plan, go over it with your healthcare professional. Do not be afraid to
ask for advice
Page 8
Washing Your Hands at Home
Figure 10: Hand Washing

Reproduced with permission from the World Health Organization
Accessed on July 7, 2009 from: http://www.who.int/gpsc/tools/GPSC-HandRub-Wash.pdf
Page 9
Sterilizing Distilled Water

Why do I need sterile distilled water?
You will be instructed to use sterile distilled water several times in this manual. To help stop
infections from happening you need to make sure you use sterile distilled water.
You will need sterile distilled water when you:
 Suction the trach tube

 Fill a pass over humidifier
 Clean the tracheostomy opening
 Clean the trach tube inner cannula
Legionella is a germ that can grow in water. To stop germs from growing, use sterile distilled
water. You can buy sterile distilled water or you can boil distilled water to sterilize it. You can
buy distilled water from your home care company, drug store or supermarket.
IMPORTANT! Only use distilled water that has been sterilized. This
will help stop lung infections from happening. 1
How do I make sterile distilled water? 2

Follow the directions below to make enough sterile distilled water to last 2 or 3 days. Do not
use the water after the 3rd day. Make or buy more.
1. Find one pan with a lid, large enough to boil enough water for 2-3 days. Use this pan for
sterilizing distilled water only. Do not use this pan to cook with
2. Bring the distilled water to a boil. Let boil for 5 minutes 3
3. Turn off heat and cover the pan. Never leave the pan unattended. Use the boiled distilled
water as soon as it has cooled or put it in a clean container and seal. It does not need to be
refrigerated
4. To sterilize the containers, put the containers in the water and let the water boil for 10
minutes. Turn off heat and cover the pan with a lid
5. Leave the lid on the pan while the water is cooling. Do not use ice to cool down the water
1
The APIC Curriculum for Infection Practice, Vol. III. 1988.
2
This section on distilled water is courtesy of Hamilton Health Science and Saint Elizabeth Care.
3
http://www.phoenixchildrens.com/emily-center/child-health-topics/handouts/Sterile-Water-Saline-861.pdf
Page 10
Tracheostomy Care
What is a Tracheostomy?
A tracheostomy is an opening made into the windpipe just below the vocal cords. The hole, called
the stoma, is where the trach tube is put in. You can breathe and cough through the trach tube as
long as it stays clear.
The nose normally warms and moistens the air we breathe. With a trach, the air goes right into the
lungs and not through the nose first. Without moisture your child’s mucous will become thick and it
will be hard to cough out. This can lead to problems breathing. There are ways to warm, filter and
moisturize the air for those with a trach tube in place.
When someone has a trach tube you need a way to moisten and filter the air. This can be done
using a nebulizer, a humidifier or a heat moisture exchanger (HME).
A trach tube can be cuffed or uncuffed. When the trach tube is cuffed, there is a balloon on the
tube, called a cuff. When it is inflated it seals the airway. When the trach tube is uncuffed, some air
can pass around the tube and up through the mouth and nose. Children with a cuffed trach tube
cannot speak when the cuffed balloon is inflated. This is because no air is reaching the voice box. If
the trach tube is uncuffed or the cuffed tube has the balloon deflated, the child can often speak
with the trach tube in the airway. There are devices that can help the child with a trach speak.
A tracheostomy tube is often called a “trach tube.” There are many kinds of trach tubes.
Your child has a __________________________________ trach tube
Page 11
Going Home with a Trach

While in hospital you or a support person will learn how to care for your child’s trach. When you go
home your caregivers will assist you if you need help. Your community respiratory therapist, nurse
or personal support worker will also support you.
Have a spare trach tube at all times. Keep the obturator available at all times.
This unit will cover the following:
 Description of trach tubes – parts and brands

 Stoma care – cleaning
 Trach tube care – cleaning and changing ties/holders
 Other information about trach tubes – cuffs, fenestrations and speaking valves
 Tracheal suctioning
When your child has a trach, it is a good idea to:
 Have your emergency numbers close by

 Have your community healthcare support telephone number close by
 Equipment supplier number, e.g. home care company, Community Care Access (CCAC)
 Keep a list of questions, problems, notes in a book or diary
 Keep a calendar for follow-up appointments
Setting up your home:
 Good lighting
 A place to put all your child’s supplies; a room with shelves or an empty large drawer
 A room that is easy to keep clean and free of dust
 A comfortable spot in the room to sit or lie down
 A safe area away from other children and pets
 A place free of drafts away from open windows, heating ducts and fans
When doing your child’s trach care:
 Your child’s trach tube needs to be changed every 1 to 2 weeks

 Do trach care at the same time each day
 Set aside 20 to 45 minutes
 Limit distractions (do not answer your phone)
Page 12
Description of Tracheostomy
(Trach) Tubes
Trach tubes are man-made airways that are made to
fit into a cut in the neck.
There are many kinds of trach tubes. They can be

made from rubber, plastic, silicone, nylon, Teflon,
polyethylene, or metal. The most common type of
tube is made from a plastic called Polyvinyl Chloride
(PVC). All trach tubes are made with non-toxic
materials.
All children have a different size neck, so the tubes Figure 11: Trach Tubes
come in different sizes. The length can vary from Reproduced with permission from Great Ormond
Street Hospital for Children NHS Trust. Copyright
5cm to 15cm and the width of the opening can vary GOSH 2008
from 2mm to 12mm wide. http://www.ich.ucl.ac.uk/gosh_families/information
_sheets/speaking_valves/inhalation.gif
Trach Tube Parts

Flange
Figure 12: Trach Tube Parts

http://medicalcenter.osu.edu/pdfs/PatientEd/Ma
terials/PDFDocs/procedure/tube-
care/trach/fenestr.pdf
Page 13
Obturator (OB-ter-ay-ter)
 This is an important piece. The obturator goes into the trach tube and is used to put the
trach tube in the stoma (opening). It is also used when changing trach tubes
 The obturator is specially made for the size of trach tube in that package. So you will not be
able to use an obturator from one size trach tube to put in a tube that is a different size
IMPORTANT! Keep the obturator somewhere where it is easy to find.

If the trach tube falls out by accident, you need to use the obturator
that came with that trach tube to put the trach tube back in.
Inner Cannula (CAN-you-luh)

 This is a smaller tube that fits inside the trach tube. It can be removed quickly if it becomes
blocked with mucous
 Most inner cannulas are disposable, but some inner cannulas are reusable and need to be
cleaned. Ask your child’s nurse or respiratory therapist about what type you have and how
to take care of it
 Some trach tubes do not have an inner cannula
Flange
 This is the piece at the top of the trach tube that lies against the neck and is used to hold
the trach to the child’s neck
 Markings on the flange show the size and make of the trach tube
Ties or holder
 Ties are used to hold the trach tube to the neck so it will not fall out. There are foam,
Velcro®, and twill trach ties
 Care must be taken when putting the trach ties on. They are not to be tied too tight or too
loose. When tied correctly you will be able to fit one or two fingers between the trach ties
and the neck
Page 14
Cork
 A plug for the trach tube is also called a button, plug, or cap, depending upon the type of
tube. It seals off the cannula of the trachtrach tube
 It allows the individual to breathe around the trach tube, through the upper airway. It also
allows for speaking
 Not all patients can be corked
 Never inflate the cuff when the cork/cap is in use
IMPORTANT! Make sure the cuff is deflated, or in the “down”

position before using a cork. Take off the cork before you inflate
the cuff.
Speaking Valve
 These are valves that are placed on the end of a trach tube to allow air to enter as your child
breathes in. Air is sent around the tube and out the upper airway as your child breathes out
 Helps with speaking , and swallowing, and in some cases, coughing
 These valves are one-way
 Never inflate the cuff with speaking valve in place
 Not all patients can use a speaking valve
IMPORTANT! Make sure the cuff is deflated, or into the “down”

position before using a speaking valve. Take off the speaking valve
before inflating the cuff.
Cuff
 Trach tubes are made with and without cuffs. An uncuffed trach tube has no cuff and no
pilot balloon. A cuffed trach tube has a balloon-like device at the end. Most of the time
uncuffed tubes are used for children
 The cuff is a small balloon that is at the end of the trach tube. When this balloon is inflated
it seals against the wall of the windpipe. A seal is often needed when your child is on a
ventilator. The seal stops the air flow from going into the mouth
 Some cuffs are filled with air, some are filled with water. If your child has a cuffed tube, it is
important to know what the cuff needs to be filled with
 The cuff needs to be filled (inflated) with the smallest amount of air, or water to seal the
airway
Page 15
 When you inflate the cuff you are putting air or water into the pilot balloon.When the cuff is
full of air or water it is said to be “up”. There is a set amount of air or water to fill the cuff
and it is measured with a syringe. The amount or air or water will be different for each
person and will depend on the size of the trach tube
 Care must be taken when inflating the balloon to avoid causing damage to the windpipe.
Have your nurse or respiratory therapist show you how to properly fill the cuff
 When the cuff is flat, or deflated, it said to be “down”. When the cuff is down there is no
seal against the windpipe wall and air can go up through the vocal cords and out the mouth.
Types of Trach Tubes

There are many kinds of trach tubes; there are Portex, Shiley and Bivona TTS Tubes.
Portex and Shiley Tubes

 These tubes are made of plastic and can come with or without a cuff
 If these brands have a cuff, the cuff is always filled with air
 Some models have an inner cannula, some do not
 The Portex Blueline Ultra tubes are colour coded
IMPORTANT! Always fill Portex and Shiley tube cuffs with air.
Never fill with water.
Bivona TTS Tubes

 A Bivona Tight-to-the shaft (TTS) Tube is made of silicone and has no inner cannula.
 Cuffed Bivona TTS Tube. When the cuff is deflated, it flattens very close to the shaft of the
trach tube, allowing for speech. Fill the cuff with sterile distilled water
 Uncuffed Bivona Tube. It looks the same as the Bivona TTS tube except there is no cuff or
pilot line
Cleaning Bivona Tubes

 You can re-sterilize these tubes up to 10 times
 These tubes have a special Superslick® coating on them that keeps mucous from sticking to
them. Do not scrub too hard or the coating will come off
Page 16
IMPORTANT! Only use sterile distilled water to inflate TTS tube

cuffs. If you fill it with air, it will leak.
How do I know when I should replace my trach tube?

You need to replace your trach tube when the:
 Obturator is too tight

 Trach shaft is not centred
 Trach tube is ‘off color’
 Trach tube markings have faded
IMPORTANT! Always have an extra trach tube with you at all times.
Have a trach tube that is one size smaller than one in use. Keep the
obturator on hand at all times.
My child’s trach tube type is: _______________________________

My child’s trach tube size is: _______________________________
My child’s trach:
 has an inner cannula
 does not have an inner cannula
 My child’s trach has a cuff that:
B needs to be filled with _______ml of air
B needs to be filled with _______ml of water
 My child’s trach does not have a cuff
Page 17
Figure 13: Bivona Tubes

Reproduced with permission from Smiths
Medical North America http://www.smiths-
medical.com/upload/products/mainImages
/670180.jpg
Figure 15: Various Tracheostomy Tubes

Reproduced with permission from the
American College of Chest Physicians
Figure 14: Shiley Neonatal Tracheostomy (Pulmonary & Critical Care Updates; Vol.
Tube 18, lesson 15)
Reproduced with permission www.chestnet.org/images/education/onli
of Vitality Medical www.vitalitymedical ne/pccu/vol18/lesson15/Fig1.jpg
/isroot/Stores/VitalityMedical/picx1/SPX50
5080.jpg
See your personal information for your child’s tube type and size.
Page 18
Stoma Care
The stoma is the hole made in your child’s windpipe that is kept open with a trach tube. Stoma
care is the cleaning of the skin around the opening in the neck. Good stoma care will help
prevent infections. Do stoma care at least once a day, such as first thing in the morning or just
before going to bed. Clean it more often when the skin is swollen, red, or tender to touch.
How do I clean the stoma?

1. You will need:
 Sterile distilled water (or sterile normal saline)
 Sterile trach dressings
 Disposable cups for water
 Suction equipment
2. Wash hands well

3. Put on clean gloves
4. Make sure you are in a comfortable position. Make sure you can see the trach area easily.
IMPORTANT! Make sure the trach tube is stable and not at risk of
falling out during the cleaning process.
6. Take off the old dressing and throw it in the garbage. Note the colour of the mucous, the
amount of mucous and if there is any unpleasant smell
7. Check the skin around the trach opening (stoma) every day for signs of an infection
Watch for:
 Redness or swelling
 Creamy yellow or green mucous
 Crusting, dry mucous
 An unpleasant smell
 Pain or tenderness around the stoma
 Any extra tissue growth
Page 19
Take note of any differences and report them

to your healthcare professionals
8. Dip a cotton swab or gauze in sterile

distilled water and clean the area around
the opening, gently removing any dried
mucous
9. Clean from the skin opening outward.
Check to see that the opening is not open
more than usual. Throw away each swab
or gauze after use
10. Dip a new cotton-tipped swab or gauze in Figure 16: Stoma Care
sterile distilled water and clean/rinse the Reproduced with permission from the Ohio
area http://www.trach.com/resources/pdf/trach
eotomymanual.pdf
11. Dry with fresh applicator swab or gauze
12. Put on the sterile dressing being careful
not to twist the trach tube or pull on the
flange
13. Change trach ties when they are dirty or
when the Velcro® is no longer holding
properly
14. Pour the water into the toilet and clean
the containers
Figure 17: Putting on the trach dressing
16. Gather clean supplies so they are ready
for the next cleaning University Medical Centre (OSUMC)
http://medicalcenter.osu.edu/pdfs/PatientEd/Materials/
PDFDocs/procedure/tube-care/trach/t-non-di.pdf
IMPORTANT! Dirty swabs and dressings may cause infections so

they should be thrown away carefully. Wrap them in a plastic or
paper bag and then put them in the garbage.
Page 20
Trach Tube Care

How do I clean my child’s inner cannula and corks?
Many trachs have an inner cannula that needs to be cleaned or replaced on a daily basis. If
there is a lot of mucous in the inner cannula, you need to clean it more often. Proper cleaning of
the inner cannula will help stop lung infections from happening.
Daily
1. You will need:
 A clean inner cannula, cork or speaking valve
 Tweezers
 Pipe cleaners
 Clean small plastic bags or dry container
 Suction machine and supplies
 Two covered containers to be numbered and labelled
2. Label the containers #1 and #2 to avoid mixing up the clean and dirty containers
3. Container #1 is for the dirty cannula and corks. Pour hydrogen peroxide or sterile distilled
water into this container
4. Container #2 is to rinse the cleaned cannula and corks. Pour sterilized distilled water into
this container
6. Make sure you are in a comfortable position. Make sure you can see the trach area easily
8. Remove the dirty inner cannula, the cork or speaking valve from the trach tube and place it
into container #1 (hydrogen peroxide or sterile distilled water)
9. Put in a clean inner cannula, cork or speaking valve and lock in place
Page 21
Inserting the
Twist to lock cannula
Figures 18, 19: Cleaning the Cannula

Reproduced with permission from the Ohio State University Medical Centre (OSUMC)
http://medicalcenter.osu.edu/pdfs/PatientEd/Materials/PDFDocs/procedure/tube-
10. Remove the dirty cannula from container #1 with tweezers and clean with a cotton swab,
gauze, or pipe cleaners. Do not scrub
11. Look for cracks or breaks in the tube and locking mechanism. If there are cracks or breaks
the trach tube needs to be changed
12. Place the cannula in container #2
(sterile distilled water) and rinse
well
13. Remove the cleaned cannula from
container #2 (sterile distilled water)
with the tweezers
Figure 20: Drying the inner cannula
14. Dry the outside of the inner cannula Reproduced with permission from the Ohio State University
with clean dry gauze. Tap it against Medical Centre (OSUMC)
the gauze to remove any drops of http://medicalcenter.osu.edu/pdfs/PatientEd/Materials/PDF
Docs/procedure/tube-care/trach/t-non-di.pdf
water from inside the cannula
IMPORTANT! Do not whip or shake the cannula to remove drops as

this can spread drops into the air.
15. Store the now clean inner cannula in a small clean plastic bag or dry container
16. Throw out all soiled supplies, along with the dirty distilled water and hydrogen peroxide
17. Wash all containers in soap and water. Rinse well. You can wash the containers on the top
shelf in the dishwasher
Page 22

19. Get clean supplies ready for the next use
IMPORTANT! Be sure to change the distilled water and hydrogen

peroxide every day!
Weekly
Soak each container and lid in a solution of 1 part vinegar and 3 parts water for 20 minutes.
Rinse and let air dry.
How do I clean a metal or silver trach tube?

Hydrogen peroxide can damage these tubes. If you have a metal or silver trach tube, ask your
respiratory therapist for cleaning instructions.
How do I change my child’s trach ties? 4

Keeping the trach ties clean and dry will prevent skin irritation, sores and infections from
occurring around the neck area.
The only thing holding the trach tube in place is the trach ties. These ties are usually made of
twill cotton or cloth with a Velcro® closure.
When changing the ties be careful not to accidentally remove the trach tube. The ties should be
changed by two people. One person will hold the trach in place while the other person cleans
the skin and changes the ties. If a second person is not around to help, tie the clean ties first and
then remove the old ones. This will keep the trach tube from coming out by accident.
4
This section on changing trach ties is courtesy of “Changing Tracheostomy Ties” from the Department of Inpatient Nursing,
The Ohio State University Medical Center 2005
http://medicalcenter.osu.edu/pdfs/PatientEd/Materials/PDFDocs/procedure/tube-care/trach/changing.pdf
Page 23
Change the tie tapes daily and as needed.

Example of one method
of securing cotton ties
1. You will need:
 New trach tube ties
 Clean gloves
 Second person to assist, if available
 Tweezers
 Scissors Figure 21: Securing Trach Ties
 Suction machine and supplies Reproduced with permission from the Ohio State
 Tracheostomy Kit University Medical Centre (OSUMC)
2. Make sure your child is in a comfortable position

4. Have the second person hold on to the
trach tube by gently holding onto the edges
of the flange
5. Cut and remove the dirty trach ties. If your
child has a pilot line on the cuff, take care
that you do not cut it by accident
Figure 22: Securing Trach Ties
6. Put one end of the clean trach tie through Reproduced with permission from the Ohio State
the hole on one side of the flange. Use the University Medical Centre (OSUMC)
tweezers to pull the trach tie through the
hole
7. Bring both pieces of the ties around the
back of the neck to the other side of the trach flange
8. Using tweezers take one end of the tie and pull it through
the hole on one side of the flange
9. Bring the ends of the tie to the side of the neck and tie them
in a knot
Figure 23: Tapes with Velcro
10. Do not tie them too tightly. Allow enough space for 1 finger strips
between your child’s neck and the trach ties
Page 24
Other Information About Trach Tubes

What is a cuff?
A trach cuff is a balloon around the outside of the trach tube. When the balloon is inflated it fits
the shape of your child’s windpipe and seals off the space between the wall of your child’s
windpipe and the trach tube. This seal might be needed when your child is on a breathing
machine (ventilator). If the cuff is not inflated, air can pass around the outside of the trach tube
up through the voice box.
The cuff is inflated by putting either air or water

in through the pilot line. If your child has a
cuffed Shiley or a Portex trach tube, you will fill
the balloon with air. If it is a Cuffed Bivonia TTS
Tube, you will fill the balloon with distilled
water.
The pilot balloon on the inflation line shows

whether the cuff is ‘up’ or ‘down’. The pilot
balloon does not tell you how much air or water
is in the cuff. Ask your respiratory therapist or
nurse how much air or water needs to be in
your child’s cuff. Figure 24: Inflated Cuff
IMPORTANT! Make sure that you know how much air or water
needs to go into your child’s cuff. Ask your healthcare professionals
to show you how.
Page 25
Inflating the Cuff – Putting the Cuff “up”

1. Make sure that the trach tube is not blocked, so the air can move freely through it. Before
inflating the cuff, attach a syringe to the cuff pilot line. Draw back on the syringe to suck out
any air that may be in the cuff. The cuff needs to be fully “down” before filling it again. If the
pilot balloon already has air in it you should not add more air
IMPORTANT! Never add air to a

cuff that already has air in it.
Figure 25: Inflating the Cuff

 Your child’s trach has a cuff that needs to be filled with:

_______ ml of air (Shiley or Portex tubes)
_______ ml of distilled water (Bivona TTS Tube)
2. Attach the syringe to the cuff pilot line. Slowly push the plunger in so the air (or distilled
water) fills the cuff with the right amount
3. Remove the syringe. There is a valve in the pilot line that stops the air or water from leaking
out
4. If there is a leak around the cuff, see see “How do I fix a Cuff Leak?” question below.
IMPORTANT! If the cuff is filled with too much air or water,

it will cause damage to the trachea. Do not over inflate the cuff.
Page 26
Deflating the Cuff – Putting the Cuff “down”

1. Suction the mouth, if needed
Note: Sometimes mucous sits in the throat or on
top of an inflated cuff. When the cuff is deflated,
this mucous can fall from around the cuff into the
lungs making your child cough. It is a good idea to
Figure 26: Syringe
have a suction catheter ready in case this happens.
Reproduced with permission from the Ohio
2. Get a syringe (without the needle) and push the
plunger all the way in to remove the air
from the syringe
3. Attach the syringe to the cuff pilot line
4. Slowly pull back on the plunger of the
syringe until the pilot balloon on the cuff
pilot line is flat and the syringe plunger
cannot be pulled back any more Figure 27: Deflating the Cuff
5. You have now deflated the cuff
How do I fix a cuff leak?

First remove all the air (or distilled water) from the cuff. Then reinflate the cuff with the right
amount of air or distilled water. Wait a few minutes. If there is a leak, then:
1. Remove all the air or distilled water from the cuff

2. If the amount removed was less than it was suppose to be, and then re-inflate with the
correct amount
3. If your child’s cuff is filled with air you can try this. Put the pilot balloon in a cup of water
while it is “inflated”. If you see bubbles then there is a leak in the pilot line or pilot balloon
4. If there is still a leak, the trach tube needs to be changed
Page 27
I have tried everything and there is still a leak in the cuff, what do I do now?
If you have been given directions on how to do this, and you are comfortable doing a trach
change, then change the tube. If you have not been told what to do, or you are not comfortable
call homecare professional or respiratory therapist for help. If no one is available to help , go to
the nearest emergency room.
Speaking Valves
A speaking valve is a one-way valve that allows air in but not out. The one-way valve connects to
the trach tube and only opens when your child breathes in, letting air go into the lungs. The valve
will close when your child breathes out, forcing the air up around the outside of the trach tube,
through the voice box, and out the mouth, so your child can speak.
There are many brands of speaking valves, but the Passy Muir valve is the most common. Speaking
valves can be used while your child is on humidity or oxygen and even if they are on a ventilator.
Speaking valves can improve:
 Swallowing – You child will be less likely to choke

on food
 Smelling – Your child will smell food and have an
improved appetite
 Coughing – Your child will have a stronger cough
and will not need to be suctioned as often
Special Considerations
 Do not use with inflated trach cuff
 The valve may occasionally pop off; just replace it
cleaned and be sure
connections are tight
 The valve can be attached to the trach tie with a Figure 29: Boy with Speaking Valve
fastener Reproduced with kind permission from
www.trach.com
Page 28
Remove the speaking valve when:
 Having an aerosol treatment

 Suctioning is needed
 Sleeping
Figure 28: Passy-Muir® Tracheostomy Speaking Valve

This section on speaking valuves is courtesy of “Passy-Muir®
Tracheostomy Speaking Valve” from the Department of
Inpatient Nursing, The Ohio State University Medical Center,
2002
http://medicalcenter.osu.edu/pdfs/PatientEd/Materials/PDF
Docs/procedure/tube-care/trach/passey.pdf
IMPORTANT! Never use a speaking valve when the cuff is “up” or in the
inflated position.
Your child’s trach speaking valve is: ________________________
Page 29
How do I use a speaking valve?

If your child is not on a ventilator and is able to breathe on their own:
1. If the mucous cannot be coughed out, then suctioned it out

2. Completely deflate the trach tube cuff
3. Remove the oxygen and humidity, if you have it on
To put the valve on:
1. Gently hold on to the edges of the trach tube flange and put the speaking valve onto the
trach tube
2. Twist the valve gently to make sure it is on the trach tube properly.The valve may
sometimes pop off. If this happens just replace it and be sure the connection is tight
To remove the valve:
1. Gently hold the flange and twist the valve off

If your child is on a ventilator and cannot breathe on their own:
1. If the mucous can’t be coughed out, then suction it out

2. Completely deflate the trach tube cuff (Put the cuff ‘down’)
3. Place the valve in-line with the ventilator tubing in the following way. Have your nurse or
respiratory therapist fill in the steps you should follow below:
a. _______________________________________
b. _______________________________________
c. _______________________________________
Page 30
4. Change the ventilator settings to:

FiO 2 or O 2 litre flow: ____________________ Tidal Volume: _____________________
Pressure Control: _______________________________________________________
Alarms: Low Pressure; test to be sure that the Low Pressure Alarm is working with the
valve in-place
5. To remove the valve, take the valve out of the ventilator circuit
6. If your child is on a ventilator return the settings to:
FiO 2 or O 2 litre flow: ____________________Tidal Volume: _____________________
Alarms: _______________________________________________________________
Other: ________________________________________________________________
7. When the speaking valve is removed, it is safe to inflate the cuff again
How do I clean my child’s speaking valve?

Clean the speaking valve every day using a mild soap and warm water. Rinse well. Allow to air
dry. When dry, store in sealed plastic container when not using.
Some cleaning products will damage the valve.
Do not use the following:

Hot water or harsh chemicals
Hydrogen Peroxide, bleach
Alcohol
Cleaning brushes
When can I get a new valve?

If you take care of these valves they will last a long time. Before replacing a valve with a new
one first wash and dry it carefully. If the valve is still sticky, noisy or begins to vibrate it needs to
be replaced. Talk to your respiratory therapist for more information.
Page 31
Trach Kit
 Trach tube of current size
 Trach tube that is half a size smaller than the current one
 Obturator
 Trach ties
 Water soluble lubricant
 Normal saline nebules
 Trach gauzes
 Scissors
 Suction unit
 Suction catheters
 Suction tubing
 Oximeter with probe
 Manual Resuscitator Bag
Tracheal Suctioning
Suctioning removes mucous from the windpipe and the trach, keeping the airway open. A suction
catheter is a tube that is used to take out mucous from the lungs and mouth.
The suction pressure will be:
 For babies: 60-80 mmHg (8-10 kPa)

 For older children: Up to 120 mmHg (<16 kPa)
Ask your healthcare professional to write down the suction

unit pressure: ______________________________________
Size of suction catheters to be used: ___________________ fr
Page 32
How to Suction
IMPORTANT! Check your suction equipment every day;

it must always be ready-for-use.
1. You will need:

 Suction machine – electrical or portable
 Suction tubing
 Distilled water (flushing solution)
 Clean container for flushing solution
 Disposable suction catheters of correct size
 Clean disposable gloves
 Mask
 Manual resuscitation bag with flex hose and trach adapter, if needed
 Extra inner cannula if needed
 Obturator
 Hand sterilizer
 Suction unit plug and charger, if needed
 Plastic bag for disposal of materials
2. Wash hands well

3. Fill the container with sterile distilled water
4. Attach the suction catheter to the connecting tubing of the suction machine
5. Turn on the suction machine and be sure there is good suction
6. Make sure the person you will be suctioning is in comfortable position. Their head should be
above their shoulders
7. Put on clean gloves being careful not to touch anything except the catheter
8. Push the thumb control through the paper backing on the package, and attach it to the
suction tubing
IMPORTANT! Use a clean suction catheter for each suction session.
Page 33
9. Withdraw the catheter from package slowly. Hold the catheter with your gloved hand 10 to
15 cm (4 to 6 inches) from the tip. Be careful not to have the catheter touch anything
10. Remove the ventilator, trach cork or speaking valve. from trach tube. If necessary, bag the
child with a manual resuscitator
11. Dip the catheter tip into flushing solution and suction a bit of fluid into the catheter to make
sure it works
12. Insert the catheter into trach tube only as far as you were told to go
Note: There are three ways to suction: Deep suctioning,Tube Suctioning and Tip
Suctioning. Ask your healthcare professional to show you how to suction these three ways.
Deep Suctioning
Put the catheter in until you feel something stopping you. Pull the catheter out a bit then
gently use the suction.
Tube Suctioning
The catheter is only put just past the end of the trach tube. It is not put all the way into the
lungs.
Tip Suctioning
The catheter tip is used to suction just at the opening of the trach tube.
IMPORTANT! Do not push or force the catheter.
13. You are now ready to apply the suction. Cover the thumb hole on the catheter and slowly
take the catheter out while twisting, or ‘rolling’ it between your fingers. You can pull the
catheter straight out or roll it back and forth between your fingers. It all depends on what
works best to remove the mucous. It takes practice to find what works best to remove the
mucous
IMPORTANT! Do not cover the thumb hole on the catheter until

you are ready to suction. Suction only when you are removing the
catheter.
Page 34
IMPORTANT! The suction catheter should not be in the trach for

more than 5 seconds.
14. Look at the mucous being suctioned out. Take note of the amount, the colour, the thickness
and the smell
15. Rinse the catheter out by dipping the tip into sterile distilled water and suction water
through the catheter until it is clear. You can use the same catheter to suction a few times,
as long as it is kept clean. However, if the catheter becomes blocked with mucous, remove it
and use a new one
16. Repeat steps 12 to 15 if needed. Ways to know if you need to suction again
 Ask if they feel “okay” or if they want to be suctioned again
 If you hear “gurgling” when they are breathing, then you need to suctioned again
Note: Suctioning can cause your child to feel very short of breath. So take breaks between
suction attempts. You may need to place the child back on ventilator for a while or give
some manual breaths with the resuscitation bag.
17. When done, replace the trach cork, speaking valve, or ventilator, if needed
18. Coil or wrap the suction catheter around the fingers and palm of one hand, then pull the
cuff of the glove over the top of the coiled catheter to completely cover it. Throw out the
gloves and dirty catheter. Throw out the suction catheter after each suction session.
Dispose of glove / catheter and cup
19. Turn off the suction unit
20. Empty and clean the suction drainage bottles and containers, if needed
21. Wash hands well
22. Be sure the suction equipment and supplies are ready for the next use. You never know
when you need to suction your child. Have all the equipment ready in case you need it
quickly
Page 35
When should I suction my child?

Many children need to be suctioned at least once a day, such as first thing in the morning or
before going to bed.
Your child needs to be suctioned when:
 They can coughing a lot and are not able to cough up the mucous
 They are having trouble breathing or their breathing sounds harsh
 The ventilator airway pressures are higher than normal
 You see mucous in the trach tube or in the ventilator tubing
Why does my child feel so short of breath when they are being suctioned?
Oxygen is removed from the airway when someone is being suctioned. Try to keep the suction
time to less than 5 seconds. This will help. Allow your child to take a few breaths between
suction attempts, to give your child a break.
Use a manual resuscitator bag before and after suctioning. This often helps move the mucous
up the airway so it is easier to suction or cough up. This may also help with the shortness of
breath that occurs when being suctioned.
Why is blood coming up the suction tube?

This may be happening because the catheter is pushed too hard into the airway. Sometimes it
happens if the suction catheter is too large. You can prevent bleeding by using the right size
catheter and not forcing the catheter down the airway.
Suctioning on the go:

Before going out make sure the portable suction unit is fully charged and you have all your
supplies.
Portable suction supplies:
 Suction catheters
 Connecting tubing
 Gloves
 Masks
 Hand sterilizer
 Distilled water, if desired
Page 36
 Spare inner cannula, if applicable

 Manual resuscitator
 Trach Kit
Other Helpful Tips

 The same catheter may be used during each suction attempt as long as it has remained
clean
 The same suction catheter should not be used for more than one suction session
 If the catheter becomes plugged, throw it out. Replace with another sterile catheter
 Some individuals may have to be manually ventilated (bagged) before and after
suctioning. This may help move mucous higher in the airway. This may also help with
breathing
 Replace cork/speaking valve and/or the heat and moisture exchanger when needed
 Suctioning is a clean procedure so it does not require the use of sterile gloves. Clean
gloves are used to act as a protective barrier so that secretions or organisms cannot be
transferred to the caregiver
Changing the Trach Tube

Some children change their trach tube once a month, others change it more often. Some will
change it if it becomes plugged or falls out by accident. The following are steps everyone in the
family needs to know. In case of an emergency, you need to be prepared and know what to do.
Everyone in the family should know what to do if the trach were to become plugged, or falls out by
accident. Do a practice-drill at home, so you can remain calm if these situations arise.
For a trach change, it is best if you have a second person to help you.
1. You will need:

 Clean or new trach tube with obturator; same size as the one that is currently in
 One size smaller trach tube – in case of an emergency where you cannot get the new
same size tube in
 Trach ties
 Supplies to clean the stoma
 Syringe, if the tube is cuffed
 Scissors
 Sterile distilled water
 Manual resuscitation bag and mask
Page 37
 Water soluble lubricant

 Suction machine and suction catheter
2. Wash your hands well and put on clean gloves

3. Check the new trach tube:
 Remove the trach tube from the package. Look at the new tube. If you notice any cracks
or breaks get a new tube
 If there is a cuff on the tube, check that it is working by inflating it and deflating it
 Inflate the cuff with air or water, as ordered by your doctor. If you notice a leak, get
another tube. If there are no problems, deflate the cuff completely
4. To keep the tube as clean as possible, touch only at the flange

5. Put the obturator into trach tube
6. Lubricate the end of the trach tube with a water soluble lubricant
7. Make sure the child is comfortable and lying on their back with their neck tilted slightly
backward. To do this, some people find it helpful to put a rolled towel under their shoulders
8. Do stoma care, if needed
10. Have the second person hold the trach tube at the flange. Remove the old trach ties. Take
care the trach tube does not fall out accidentally
11. If the child has a cuffed tube, deflate the cuff completely
12. Take out the old trach tube but try not to pull it straight out. Use a motion that follows the
curve of the trach tube
13. Guide the new trach tube into the stoma. Again, try to using a motion the follows the curve
of the trach tube
14. As soon as the new trach tube is in, remove the obturator
15. If the child is on a ventilator and has a cuffed tube, inflate the cuff
16. Place back on ventilator, or oxygen, if needed
17. Tie the trach ties and put on a clean dressing
18. Wash your hands
Page 38
What should I do if I cannot get the trach tube in?

1. Moisten the trach tube with sterile distilled water and try again
2. Make sure you are using the obturator and that the cuff is completely deflated
3. Make sure the neck is extended. You may need to reposition the child
4. If the child can breathe and is not in distress:
 Ask the child to take a big breath in. Guide the tube in as they breathe in
 Try to put in a smaller size trach tube in
5. Put the obturator into the stoma and gently pull down on the skin around the opening. This
should open the stoma a little more giving you room to put in the smaller trach tube
6. If the smaller tube will not go in and the child is having trouble breathing:
 Put the face mask on the manual resuscitator bag and place the mask over the nose and
mouth to ventilate. You will need to cover the stoma
 Have the second person call 911
The trach tube is out a little, but has not completely fallen out.
What do I do?
1. Deflate the cuff on the trach tube (if it has one)
2. Gently push the tube back in
3. Adjust the ties so the trach tube will not fall out
What do I do if the trach tube is plugged?

1. If the child is on a ventilator, the high pressure alarm will probably go off
2. Check to see if your child is having trouble breathing
3. If so, try suctioning. If the suction catheter does not go down the trach very far then it may
mean that the tube is plugged
4. If your child is having trouble breathing you will need to act fast. Remove the trach tube and
insert a new one
Page 39
Mechanical Ventilation
What is Mechanical Ventilation?

Your child may need a ventilator to move air in and out of their lungs because they can not breathe
well enough on their own. The ventilator can do all of the breathing (total support) or just partly
help your child’s own breathing effort (partial support). Most ventilators can give extra pressure
(PEEP pressure) to keep the lungs open so the air sacs do not collapse. Mechanical Ventilation can
be done using a ventilator and a trach tube, a ventilator and a mask, or a ventilator and a
mouthpiece.
Total Support
Those children who need the ventilator to do all their breathing would be on total support. A
trach tube is often used for those who need the ventilator to do all their breathing. People on
‘total support’ are not able to use a mask.
Partial Support
This is when the person is able to breathe on their own in-between the breaths delivered by the
ventilator. The ventilator does not have to deliver the full breath, if the person has some
breathing effort of their own.
Why is Mechanical Ventilation Needed?

Certain lung diseases change how the respiratory system works. Mechanical ventilators are used
when the:
 Brain cannot send signals to the lungs to breathe

 Lung is too stiff to expand fully
 Lung tissue is damaged causing breathing problems
 Muscles for breathing are not strong enough to move air in and out of the lungs
 Heart has been damaged and causes the lungs to work very hard
Page 40
Ventilator Settings
Below is a list of the most common ventilator settings. Your child’s ventilator settings will depend
on your ventilator type and mode.
Modes of Ventilation
The ventilator mode is how the ventilator delivers the breath.
Common ventilator modes are:
AC or C - Assist/Control or Control
IMV - Intermittent Mandatory Ventilation
SIMV - Synchronized Mandatory Intermittent Ventilation
CPAP- Continuous Positive Airway Pressure
PS - Pressure Support
When Pressure Support is working, the machine will deliver a set pressure when the child
breathes a breath on their own. It helps to boost the breath, so it is larger than they might
do on their own.
PC - Pressure Control
This sets the highest pressure to be delivered during a breath. This pressure is held for the
whole ‘breathing in’ time.
Page 41
Ventilator Rate
 Also known as Breath Rate and Respiratory Rate
 The number of breaths the ventilator delivers in one minute
Tidal Volume
 The amount of air the ventilator gives with each breath
Inspiratory Time
 The time it takes for the ventilator to give one breath
Inspiratory Flow Rate

 How fast the air travels during one breath
I: E Ratio (Inspiratory to Expiratory Ratio)

 The length of time it takes to breathe in compared to the time it takes to breathe out
 This is often expressed as a ratio
Peak Inspiratory Pressure (PIP)

 This shows the amount of pressure it takes to fill up the lungs when your child
breathes in
 The number shown may be slightly different with each breath
 Each person has a normal PIP
 The amount of pressure is displayed on the control panel of the ventilator, either as a
number on a screen or on a gauge
PEEP (Positive End Expiratory Pressure)

 This is the pressure the ventilator holds at the end each breath. PEEP helps to keep the
air sacs open so they do not collapse
Page 42
Sensitivity or Breathing Effort

 This control shows how much effort is needed to start a new breath from the
ventilator
Low Pressure Alarm

 This is a safety alarm that goes off when the ventilator does not reach the pressure
needed to give the full breath
 This usually means there is a leak somewhere in the tubing or that the ventilator
tubing has come off the patient’s trach tube. For a more information on low pressure
alarms, see the Troubleshooting section
High Pressure Alarm

 This is a safety alarm that goes off when the ventilator reaches the high pressure
setting
 This usually happens when:
B There is a blockage in the airway, often caused by too much mucous. Your child
might need to be suctioned
B Your child is wheezing, coughing or hiccupping
B There is a kink in the ventilator tubing
Oxygen
 If your doctor wants to give more oxygen, it may be added into the ventilator tubing
Your ventilator is a: ___________________________________________

The ventilator settings are: _____________________________________
Page 43
Ventilator Power Sources

Ventilators operate on electricity. There are three sources of electricity that are available to run the
ventilator: Alternating Current (A/C), External D/C battery and Internal D/C battery.
Alternating Current (A/C)

Most of the time your child’s ventilator will be plugged into your home wall outlet which is 120
volts of alternating current (A/C). Always use wall outlet power if you are planning to stay in one
place.
Internal Direct Current (D/C)

This is the battery inside the ventilator. It is used when there is a sudden drop in electricity to
power the ventilator. This may happen when the ventilator is unplugged accidently, or during a
power failure. A fully charged battery should keep the ventilator working for about 30-60
minutes.
This battery should not be used often. This battery is a safety feature and is only to be used in
an emergency. Keep the ventilator plugged into a wall outlet so the battery will always be
charged.
The Internal D/C battery is:
 Built into the ventilator

 For short term emergency power only
 On when the ventilator is on
 On when you unplug the ventilator from the wall or an external D/C battery
 Recharged when the ventilator is plugged in to a wall outlet
 Able to power the ventilator for 30-60 minutes, if it is fully charged
 To be discharged and recharged every month
Note: Depending on the ventilator, this battery may not recharge when the ventilator is
plugged into a D/C external battery. Check with your respiratory therapist.
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External Direct Current (D/C)

If a power failure were to last longer than 30-60 minutes, the battery inside your ventilator will
not last. So you need to have another way to power the ventilator, if this were to happen.
The Ventilator Equipment Pool (VEP) provides an external D/C battery for emergencies such as a
power outage. The battery is a standard 12 volt battery that would provide power to the
ventilator for 5 - 12 hrs.
IMPORTANT! This battery should not be used for portability, such

as with a wheelchair. They are for emergency backup power only.
How do I hook up the external battery to the ventilator?

1. Check to make sure the battery is fully charged. If it needs charging, do so first. Never
charge the battery while the battery is connected to the ventilator
2. Place the battery in a safe place away from the ventilator’s inlet filter (on the back of the
ventilator panel). Do not put the battery on top of ventilator
3. Plug the battery cable into the proper connection on the ventilator
4. Plug the battery cable into the battery
IMPORTANT! Some internal ventilator batteries may not recharge

when the ventilator is plugged into an external D/C battery.
How do I remove the external battery from the ventilator?

1. Unhook the battery cable from the battery
2. Unhook the battery cable from the ventilator
3. Make sure ventilator is plugged into the wall outlet (A/C power source)
4. Recharge the battery in a well ventilated area
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I would like to use my child’s ventilator with their wheelchair. What battery should
I use?
 A battery is needed when you use your child’s ventilator with their wheelchair. You will
need to buy another battery for this purpose
 Do not use the external battery that VEP has given you. That one is for emergency use
only. VEP does not supply batteries for wheelchair use
When do I need to recharge the external battery?

 Recharge the battery after every use in a well ventilated area
 Old batteries will lose their charge quickly so check the battery charge every week
 Discharge and recharge the battery monthly
How do I recharge the external battery?

1. Charge the battery in a well ventilated area
2. Do not charge the battery when it is hooked up to the ventilator
3. Use a 12 volt battery charger to recharge the battery
4. Connect the battery to the charger
5. Connect the charger to the wall outlet (A/C power)
6. Let the battery charge. Note: It will take one hour of recharge time for every hour that it
was used
7. When the battery is 80% charged, the yellow light will flash
8. When the battery is 90% charged the green light will come on. When the green light is on it
means the charge is complete
9. Leave the battery hooked up to the charger for another 3 hours after the green light comes
on
10. When the battery is fully charged, unplug the charger from the wall outlet first, before
unhooking the charger from the battery
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Back of ventilator External D/C battery 12 volt battery charger
Figure 30: Ventilator & Battery

Photo courtesy of Ventilator Equipment Pool
General Tips: Ventilator Management

 Place the ventilator on a night stand or a table away from drapes or other things that could
block the air flow to the inlet filter opening
 Spills will damage the ventilator and cause it to not work properly. Never place food or
liquids on top of the ventilator
 Use the protective doors, covers or lock out features on the ventilator. They protect the
settings from being changed by mistake
 Make sure the humidifier is lower than your child’s head
 Make sure the alarm port is not blocked by objects. If it is blocked, it may not be heard if it
goes off
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Daily
 Make sure the ventilator is plugged into a 3 - pronged wall outlet (A/C power source)
 Turn the ventilator on and check that the proper lights and sounds come on. Your ventilator
manual will tell you what to look for
 Check the ventilator settings to make sure that they are set correctly
 Check the respiratory rate. To do this your child cannot be connected to the ventilator. Hold
a glove tightly over the flex tube connector where it would attach to your child. Count the
number of breaths for one minute (60 seconds). It should be the same as the set breath rate
on the machine
 Test the Ventilator Circuit by doing a ‘Low Pressure Test’ and a ‘High Pressure Test’
Weekly
 Wipe down the ventilator with a damp cloth
 Clean and change the Ventilator Circuit
 Clean the Portable Suction machine
 Check that the external battery is charge
Monthly
 Change the bacteria filter in the breathing circuit
 Change or clean the inlet filters on the ventilator. These must be replaced/cleaned as
needed
 Discharge and recharge the external battery
Annually, or as needed
 Preventive maintenance is recommended by the manufacturer. Some ventilators need to be
serviced every 1-2 years, or after a certain number of hours of use
 The Ventilator Equipment Pool will contact you to arrange service on your machine
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The Ventilator Circuit

Below is a picture of a ventilator circuit. Your ventilator circuit may look a little different than this
picture. Circuits currently provided through the Ventilator Equipment Pool. Please see specific
user’s manual for circuit details.
A.Exhalation valve B. Ventilator circuit tubing
C. Pressure line D. Exhalation valve line
E. Outlet filter (not shown)
Figure 31: Ventilator Circuit

Courtesy of Ventilator Equipment Pool
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A The exhalation valve: is a balloon that closes when someone breathes in and opens when they
breathe out. The flex tube attaches to one end and the ventilator circuit tubing to the other end.
B The ventilator circuit tubing: is a 6 foot hose that attaches to the exhalation port at one end and
to the outlet port on the ventilator on the other end.
C The pressure line: is a small tube that is connected to two pressure ports; one on the ventilator
and the other on the exhalation valve.
D The exhalation valve line: is connected to the exhalation valve and the exhalation valve port on
the ventilator.
E The outlet filter: this filters gas coming from the ventilator, going into the ventilator circuit tubing
(not shown in the picture above)
Figure 32: LTV 950 Ventilator

Reproduced with permission of CareFusion www.CareFusion.com
Figure 32 shows the LTV 950 ventilator. Your child’s ventilator may look different than the
picture shown here.
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How do I clean and change the ventilator circuit?

Clean the ventilator circuit, resuscitation bag, humidifier and suction canister at least once a
week.
1. You will need:

 Pail for soaking
 Water
 White vinegar
 Clean towel
 Storage bag
2. Take apart the ventilator circuit. This includes the tubing, connectors and humidifier
reservoir jar, if used. Refer to your Patient Circuit Assembly Instructions
IMPORTANT! The ventilator will not work properly if water gets

into the pressure sensor line or exhalation valve.
3. Wash tubing and connectors in warm soapy water

4. Rinse with tap water to remove the soap
5. Make a solution of 1 part vinegar to 3 parts water in the pail. Soak humidifier jar, tubing,
and connectors in the vinegar solution for 30 minutes. Make sure that all the parts are in
the solution
6. Drain and rinse well. Place connectors and humidifier jar on a clean towel to air dry. Hang
the hoses to dry. Allow all parts to air dry completely before putting back together
7. Look carefully at the tubing and equipment for breaks or cracks. Check that everything is
clean. Replace anything that is broken or cannot be cleaned properly
8. Put the ventilator circuit together, so it is ready to use. If it is to be stored, cover the circuit
with a clean towel or store it in a clean plastic bag
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Testing the Ventilator Circuit

1. Inspect the Circuit:
 Make sure that all connections are tight
 Make sure the humidifier and exhalation valve are put together properly
 Check that the sensor lines are all connected
2. Do the “Disconnect Test” (Low Pressure Test):
 Make sure the low pressure alarm setting is set correctly
 Turn on the ventilator with the circuit connected
 Do not connect the circuit. Wait to see if the low alarm goes off
3. If the alarm does not sound, check the alarm setting to make sure it is set correctly
4. If it still is not alarming:
 Check the exhalation valve
 Try another circuit or use another ventilator, if you have one. You may need to use a
manual resuscitation bag to ventilate the person
 Then contact the Ventilator Equipment Pool (VEP) right away if it is still not alarming
5. Do the “High Pressure Test”. The purpose of this test is to check that there are no holes or
leaks in the tubing or connections
 Glove one hand
 Block the end of the trach adapter with your gloved hand and wait for the ventilator to
give a breath
 A high pressure alarm should sound after 1 - 3 breaths
 If there is no alarm check the high pressure alarm setting to make sure it is set correctly.
Also check all the connections to make sure they are tight and secure
 If still not alarming, try another circuit or use another ventilator if available
IMPORTANT! Use a manual resuscitation bag to ventilate your

child. Call the Ventilator Equipment Pool (VEP) if your ventilator
continues to not work.
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Ventilator Safety and Troubleshooting

Below is some information to help you troubleshoot some common problems that may occur. For
more information read the user manual supplied with your ventilator. Also read the “Problems and
Emergency Manual”.
What do I do if an alarm is sounding?

When a ventilator alarms you will see a warning light come on and hear a warning sound.
Alarms are to alert you to a safety concern. When an alarm goes off you need to pay attention
to it right away!
IMPORTANT! Do not change the alarm settings!
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Ventilator Troubleshooting Guide

Ventilator IN OP There is a problem with how the Turn the main power switch on the
ventilator is working ventilator off and then on again.
You will see a If the IN OP alarm is still alarming, do
warning light and not use this ventilator
hear a warning  Switch to another ventilator, if
sound. available
 Use manual resuscitator bag
 Call VEP right away
High Pressure 1. Mucous is blocking the airway 1. Suction to remove mucous.

2. Wheezing or bronchospasm 2. Give inhaled medicine
You will see a 3. There is a respiratory infection 3. Contact your child’s healthcare
warning light and professional
hear a warning 4. Alarm setting is not set correctly 4. Change alarm to proper setting
sound. 5. Damaged Exhalation Balloon 5. Replace exhalation valve or
(valve) change the circuit.
6. Kink in the tubing 6. Straighten the tubing
7. Water in tubing 7. Drain water
8. Coughing, swallowing or 8. If coughing, try suctioning
hiccupping
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Low 1. Visual and auditory 1. Look and feel for any leaks. Do
Pressure/Apnea the “Disconnect Test”
2. Leaks in the ventilator circuit 2. Recheck circuit and test
You will see a (exhalation valve, humidifier,
warning light and pressure line, holes in tubing)
hear a warning 3. Water in the pressure line 3. Drain water
sound. 4. The ventilator has come off the 4. Connect the ventilator to trach
patient’s trach tube
5. Leak around your child’s trach 5. Reposition the patient and/or
and/or cuff tube. May need a trach tube
change.Verify the volume in the
trach cuff-deflate and reinflate
6. Alarm set incorrectly 6. Set the correct alarm setting

7. Incorrect circuit 7. Change circuit
8. Loose trach ties 8. Tighten trach ties
9. Loose inner cannula 9. Change inner cannula or change
trach tube
Setting 1. Settings are incorrect. 1. Correct the settings
2. Dirty inlet filter 2. Replace filter
Power Switch Over 1. Power source has changed from 1. Make sure the ventilator is
AC (wall outlet) to internal or plugged in and there is power
external power source. and press the reset button
2. Power source has changed from
external to internal
Low Power Internal battery has drained and Operate ventilator on AC power for at
needs to be recharged least three hours
Always follow the instructions found in the ventilator manual.
IMPORTANT! When a ventilator alarms, look at your child to see

how they are doing. If they are not doing well, use a manual
resuscitation bag to ventilate them.
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Other Equipment
Using and Cleaning the Portable Suction Unit
Figure 33: Portable Suction Machine

Reproduced with permission from Hamilton Health Sciences Centre
These units are portable so if you are going somewhere, make sure the machine’s battery is fully
charged and that you have all your supplies (see “Suctioning on the Go”, page 36).
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How do you set the suction pressure?

The suction pressure is preset by your healthcare professional. To check the suction pressure,
first turn on the unit. Then cover the open end of the connective tubing with your finger and
look at the number on the gauge.
How do I charge the battery?

Plug the portable suction machine into AC power (home wall outlet) when it is not in use. When
using the machine on AC power, the on/off light will come on. When using the machine from
the battery power the on/off switch does not light up.
How do I clean the suction unit?
Daily
The canister should be emptied daily into the toilet. Wash it with soapy water and rinse well.
Leave a little water in the bottom of the canister as it will stop mucous from sticking to the
bottom.
Weekly
Clean the suction canister at least once a week.
1. You will need:

 White vinegar
 Water
 Two pails:
B One for warm soapy water
B One for vinegar (1 part) and water (3 parts) mix
 Clean towel
2. Remove the short tubing from the lid. Unfasten the canister and remove the lid from the
suction unit. Empty the contents into the toilet
3. Wash all parts in warm soapy water
4. Rinse with tap water to remove soap
5. Sink the pieces in one part vinegar to three parts water for 30 minutes. Rinse well and
remove the extra water. Place parts on a dry towel to air dry
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6. Put the tubing and canister back together. Look for any cracks and tears. Throw away and
replace any broken or cracked parts
7. Wipe the machine down with a damp cloth
8. Change the connecting tubing weekly or when soiled
9. Wash hand well
Monthly
Look at the filter and change it when it looks dirty or at least once every 2 months.
The Manual Rescusitation Bag

The resuscitation (re-suss-i-TAY-shun) bag is a
football-shaped bag that can help give breaths
to a child who needs help breathing or is unable
to take breaths on their own. When the bag is
squeezed, the air leaves the bag and goes into
the child’s lungs. The air they breathe out goes
out of the lungs and through a valve in the
Figure 34: Laerdal Bag
resuscitation bag. Manual resuscitations bags Photo Courtesy of Hamilton Health Sciences, used with
are also called “bags”, “ambu bags” or “manual permission of Laerdal Medical Canada Ltd www.laerdal.ca
ventilators”.
The manual resuscitator bag may look different from the picture.
When do I need to use a Manual Resuscitator Bag?

 When your child is having trouble breathing
 When there is a problem with the ventilator
 With chest physiotherapy, if needed
 Before and after suctioning, if needed
Page 58
How to use the Manual Resuscitator Bag

1. You will need:
 Adaptor for the trach tube
 Flex hose/tube
 Oxygen tubing, if needed
2. Take your child off the ventilator

3. Connect the resuscitator bag to your child’s trach tube
4. Squeeze the bag gently – try to deliver about 1/3 - 1/2 the volume of the resuscitator bag.
Squeezing the bag should take about 1 second
5. Look at your child to make sure:

 The chest is rising
 They are comfortable, are awake and aware of what is happening
 They are not turning blue
6. As soon as you finish squeezing the bag completely, release the bag to let your child breathe
out. Make sure you give your child enough time to breathe out before squeezing the bag
again
7. Squeeze the resuscitator bag in a regular pattern, about once every 4 - 5 seconds. Ask “Is
this enough air? Do you want more?” Adjust how much and how fast and how much you are
giving based on your child’s needs and comfort level
IMPORTANT! Never squeeze too hard on the manual resuscitator bag,

as it could damage the lungs. Do not squeeze the bag too fast. If your
child is not responding while suctioning, then call 911 right away.
Page 59
How do I care for a Manual Resuscitator Bag?

A leak in the resuscitator bag will stop the right amount of air from filling the lungs. In order for
the bag to work well it must be leak free. Every day you must do these two simple tests to make
sure there are no leaks in the manual resuscitator bag.
Test # 1
1. Wash hands well and put on gloves

3. With your other hand squeeze the resuscitator bag; you should feel the pressure in the bag
against your hand
4. If you hear or feel a leak then tighten all the connections
5. After checking all the connections, test again for leaks by repeating steps 2 & 3.
If it does not leak continue to Test #2
6. If it still leaks, you will have to replace your manual resuscitator bag. Call your respiratory
healthcare professionals
Test # 2
1. Squeeze the resuscitator bag to empty it

3. Release the resuscitator bag while keeping the outlet covered with your gloved hand
4. The resuscitator bag should fill up freely. If it does not, then the inlet valve maybe sticking
5. If the bag does not refill, unscrew the inlet valve assembly (pieces 6, 7 and 8 in picture) and
gently loosen the valve. Then put it back together
6. Do the test over again to make sure the resuscitator bag fills freely. If it still does not fill freely,
you will have to get another manual resuscitator bag. Call your respiratory healthcare
professionals
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How do I clean the manual resuscitator bag?

1. Clean the bag at least once a month, or when it is dirty
2. Take apart all the pieces of the resuscitator bag
3. Fill sink/pail with warm soapy water
4. Put all the pieces in the soapy water making sure all pieces are covered for 20 minutes
5. Rinse the pieces well
6. Fill sink/pail with 1 part vinegar to 3 parts water. Soak for 20 minutes
7. Rinse well
8. Place on clean towel to dry
9. Reassemble pieces of resuscitator and do both the leak and pressure tests
The pieces go together in order from 1 to 8 from photo below.
Figure 35: Manual Resuscutator Bag

Photo Courtesy of Hamilton Health Sciences, used with permission of
Laerdal Medical Canada Ltd www.laerdal.ca
IMPORTANT! Anyone who needs a ventilator to breathe, will need

a manual resuscitation bag. Those with a trach but do not need a
ventilator to breathe, may also need a manual resuscitation bag.
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Humidifiers
Humidification means to make moist or wet. Proper humidification helps keep the mucous thin and
easy to cough up. There are two common types of humidifiers; the Heat and Moisture Exchanger
(HME) and the pass-over humidifier.
What is a Heat and Moisture Exchanger (HME)?

An HME is a filter-like sponge that is put onto the trach tube and stays there while your child
breathes. It traps the heat and moisturize from the air that is breathed out from the lungs.
On the next breath in, the air passes through the HME and becomes warm and moist.
HMEs are sometimes called an ‘artificial nose’.
IMPORTANT! Never dampen the HME with water.
Figure 36: Illustration of an Heat Moist Exchanger

Reproduced with permission from West Park Healthcare Centre
Long-Term Ventilation,Centre of Excellence
When do I need to change the HME?

Change the HME:
 Every day, if your child is always using one

 Every second day, if your child is using it only at night time
 When it becomes dirty
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What is a Pass-Over Humidifier?

Air from the ventilator passes over heated water, becoming warm and moist before going to the
lungs.
Outlet port
Heater plate Inlet port
Heater control On/Off Switch
Figure 37: Fisher Paykel MR 410 Humidifier

Reproduced with permission from Fisher & Paykel Health Care Inc
There are a many types of pass-over humidifiers. All work in the same way, but the parts may
look different. A common brand is The Fisher-Paykel humidifier. To learn more about how to
care for your child’s unit, read the user manual that comes with your child’s equipment.
Page 63
All units have:
 Three pronged wall plug for electricity

 Reservoir unit to hold the water
 Heater control that controls water temperature
 Heating plate that heats the water to the temperature that is dialled in
IMPORTANT! Only use sterile distilled water. Sterile distilled water

is very clean and free of germs.
Changing the Temperature

 The numbers on the heating control are “guides” for changing the temperature of the
water
 The temperature will depend on your child’s comfort level and your healthcare
professional’s instructions
 It takes a little time for the unit to warm up
 The water temperature can change depending on the room temperature, heaters,
fans, or blankets
How do I fill the reservoir unit with water?

The humidifier works best when you keep the water in the reservoir unit between the ‘refill’
and the ‘full’ line. Keep the water level in the reservoir at the highest water level mark.
Although the water between the lines will last for a number of hours, you will have to fill or refill
the humidifier often. Once the level is at the low water level mark, throw out any water left in
the reservoir.
Ensure that you change the water every day and that the humidifier is in a safe place so it will
not get tipped over.
IMPORTANT! Never drain water from the ventilator tubing back

into the reservoir. Always drain the water from the ventilator
tubing into a separate container.
Page 64
If the ventilator is not in use

2. Use a funnel or a measuring cup
3. Disconnect the humidifier tubing and throw out the water
4. Rinse well and refill with sterile distilled water (fill to the ‘full line’ marking)
5. Reconnect the circuit tubing to the reservoir port opening
If your child is on the ventilator

You will need to know how long your child can stay off the ventilator, while breathing on their
own, before doing this next step. You will need to complete all the steps in the time they are off
the ventilator and breathing on their own. Ensure you have a manual resuscitation bag on hand,
in case they need to be given some breaths while off the ventilator.

2. You will need to change the circuit to ‘go around’ the humidifier. You can do this by following
these steps:
 Take off the short hose going to the humidifier from the ventilator outlet port
 Separate your child’s tubing from the humidifier port
 Connect your child’s tubing directly to the ventilator outlet port. Make sure there is no
water in the circuit
3. Throw out any water that is in the reservoir unit and rinse well
4. Fill the reservoir unit by using a funnel or measuring cup and fill with sterile distilled water to
the “fill line” marking
5. Disconnect your child’s tubing from the ventilator outlet port and reconnect it to the
humidifier port
6. Re-connect the short humidifier tubing to the ventilator outlet port
Page 65
There is water in the tubing, what should I do?

Sometimes when the air leaves the humidifier it cools in the tubing and water will collect in the
ventilator tubing. Water in the circuit can:
 Cause problems ventilating your child

 Cause germs to grow in the tubing which can lead to a lung infection
To remove the water from the circuit:

2. If the circuit has a “water trap”, let the water inside the tubing run down into the water
trap. Then empty the water trap collector. Note: you do not have to unhook the ventilator
circuit when emptying the “water trap” collector
3. Disconnect the ventilator tubing from your child at the trach site
4. Empty the short flex hose tubing by stretching it out and letting any water drain into a
container
5. Remove the ventilator tubing from the humidifier outlet and drain it away from the
exhalation valve
6. Drain the flex hose away from the exhalation manifold
7. Do not shake water from the tubing as it may spread germs
8. Attach the short flex hose to the patient's trach tube
Page 66
Inhaled Medicine
The use of inhalers or “puffers” is
Canister
one way to give medicine. Often
only a small amount is needed.
Because the medicine is breathed
into the lungs, it does not take long
AeroVent®
to work.
Chamber
Puffers can be given to someone
on a ventilator, by using a special
chamber such as the AeroVent®. Figure 38: Puffer Cannister and Aerovent Chamber
Reproduced with permission from Trudell Medical International
How do I give a puffer to someone on a ventilator?

1. Make sure that your are using the most current puffer ordered by your doctor
2. Check the expiry dates
3. Check that there is medicine in the canister. Shake the canister slowly close to your ear to
feel if it is full
4. Place the chamber into the inspiratory side of the ventilator circuit. If you have an HME on,
take it off
5. Shake the canister 10 times
6. Attach the puffer canister to the chamber adaptor (AeroVent®)
7. Press down on the canister once, just as your child begins to breathe in
8. Remove the canister. Replace the cap on the inlet port, to stop any leaks
9. Wait 30 seconds. If another puff is needed, repeat steps 5-8
Clean the chamber once a week, or when you clean the ventilator circuit.
Also inspect the puffer adaptor for cracking and leaks.
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Other Issues
Assistive Devices Program (ADP) Funding for Respiratory Supplies

How do I get funding for a ventilator and other supplies?
Anyone getting a ventilator and related supplies has to apply to ADP for funding assistance.
While your child is in the hospital getting ready to go home, you and your child’s doctor will be
asked to complete an ADP form to see if you qualify for funding.
To be approved for funding you must:
 Be an Ontario resident
 Have a valid Ontario Health Card
 Have a physical disability for at least 6 months
 Have the proper ADP forms completed by your doctor
B A sample ADP form can be found in Appendix A in this Manual
B The ADP forms need to be filled out every 3 years to renew the funding
The Assistive Device Program will pay for 100% of the cost of your child’s ventilators and some
of the accessories. ADP will pay 75% of the cost of your child’s respiratory care supplies, such as:
 Custom-made masks
 Commercial masks
 Ventilator circuit supplies
 Suction units
 A manual resuscitation bag
 Disposable trach supplies
There is a limit on the amount of supplies that will be covered. To find out more about what is
covered and what is not, you can read the ADP Respiratory Manual or talk to your respiratory
therapist.
The Ventilator Equipment Pool (VEP) supplies your child’s ventilator and ventilator circuits,
battery, battery cable and humidifier. The VEP is located in Kingston Ontario. You will not need
to go there to get your equipment. It will be sent to your home.
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ADP is a part of the Ontario Ministry of Health & Long Term Care (MOHLTC) which is part of the
Ontario government. Your ADP bill will be sent to the MOHLTC who will pay for your child’s
equipment. You will need to pay the remaining cost, which is 25% of the total for respiratory
supplies.
What other funding sources are there?

If you cannot afford to pay the remaining 25%, there are also some other options.
Try the following agencies.
Insurance Companies
 Extended Health Care (EHC) Insurance through workplace or privately

e.g. Ontario Blue Cross
Government assistance programs
 Ontario Disability Support Program (ODSP)

 Ontario Works
 Assistance for Children with Severe Disabilities (ACSD)
If you are interested in finding out more about other funding sources, contact your CCAC case
worker, social worker or physician who will help you find out what is best for you.
Page 69

What is the Ventilator Equipment Pool (VEP)?
The VEP is a central place where the ventilators are kept. VEP is part of Assistive Devices
Program (ADP). The VEP supplies your child’s ventilator and related equipment for those who
are approved by ADP.
Getting your Ventilator

Once ADP approves your request they inform VEP. VEP will then send you the equipment that
your doctor has ordered.
Ventilator Circuits
VEP will send you two ventilator circuits for every ventilator you are approved for. You will get 2
new circuits every 2 years.
The equipment is to be returned to VEP if you:
 No longer need it
 Are not approved for funding
 Are admitted to hospital and are not coming home for quite a while
 Are living in Long Term Care
The VEP does not give ventilators for use in long term care facilities. Patients entering these
facilities must tell VEP that their status has changed.
Who will service and repair the ventilator?

The ventilator will need regular service. Service and repairs are done by the VEP at no cost to
you. It is important to make sure that your ventilator receives the service when it should. Read
the manual that came with the ventilator for more information.
VEP will not pay for equipment that is lost, stolen or damaged through neglect or abuse.
 When it is time for service, the VEP will call and to make arrangements to pick up the
ventilator
 The replacement ventilator will be sent from Kingston and it will become your new
ventilator. You will keep this ‘new’ ventilator until the next time your ventilator needs
to be sent back for service
Page 70
 Make sure the ventilator settings and alarm limits are set properly, before using the
new ventilator
I am having problems with my child’s ventilator. Who do I call?

If you are having problems with your child’s ventilator first look at the manual and the trouble
shooting section in this book. Your home care company may be able to help you to find out
what the problem might be. If you are still having problems with the ventilator, then contact
your equipment provider.
Call your home care company if you have problems with your child’s ventilator circuit, such as
the tubing and connectors.
IMPORTANT! Call your ventilator equipment provider if you are

having trouble with your child’s ventilator.
My ventilator equipment provider is:

 VEP
VEP phone number is 1-800-633-8977 or 1-613-548-6156.
Follow the prompts on the message for service after business
hours. A respiratory therapist is available 24 hours a day.
 My ventilator supply provider’s name is:

_____________________________________________________
Phone number is: ______________________________________
Page 71
References
Department of Critical Care Nursing. (2002). Passy-Muir® trach speaking valve. Ohio: The Ohio State
Department of Critical Care Nursing. (2007). Tracheostomy suctioning. Ohio: The Ohio State
Department of Inpatient Nursing. (2005). Changing trachesotomy ties. Ohio: The Ohio State
Department of Inpatient Nursing. (2005). Reinsertion of a tracheostomy tube. Ohio: The Ohio State
Department of Inpatient Nursing. (2005). Tracheostomy care. Disposable inner cannula. Ohio: The
Department of Inpatient Nursing. (2005). Tracheostomy tubes. Ohio: The Ohio State University
Medical Center.
Department of Inpatient Nursing. (2007). Traceostomy care with non-disposable inner cannula.
Division of Nursing: The James Cancer Hospital and Solove Research Institute. (2004). Trach cuffs.
Young, C.S. (1984) Recommended guidelines for suction. Physiotherapy 70: 106-108
Page 72
Pulmonary
Clearance
Techniques
Pulmonary Clearance
Techniques
Notes
Pulmonary Clearance
Techniques
Pulmonary
Clearance
Techniques
Pulmonary Clearance Techniques Patients/Clients & Caregivers
Introduction
A strong cough is important so you can remove mucous from your lungs. If you have weak
muscles you may not be able to cough out your mucous. Perhaps you cannot take a deep
breath in. Perhaps you cannot breathe out with enough force to bring up the mucous. For a
strong cough you need two things:
 To be able to completely fill your lungs and

 To be able to breathe out forcefully
There are ways to help you if your muscles are too weak. This section lists several methods
and exercises to help you cough. If you use these exercises daily, you will be able move the
mucous up from the airway into your throat or mouth, where it can be suctioned out.
Pulmonary Clearance Techniques may improve:
 The amount of air you can breathe into and out of the lungs
 Coughing and speaking
 The amount of oxygen getting to the body
Pulmonary Clearance Techniques may prevent:
 The air sacs from collapsing

 Lung infections
Common Techniques
 Breath Stacking
 Assisted Cough Technique
 Postive Expiratory Pressure (PEP)
 Cough Assist Device
All these techniques have one thing in common. They all need someone to help you.
Page 1
Breath Stacking
Breath stacking is a breathing exercise that can help people who have breathing problems
due to muscle weakness or poor chest movement.
You will need 2 manual resuscitation bags. You need one in case of emergencies where you
need to use it to manually ventilate. The second one will be changed to become your Breath
Stacking Bag. The bag used for breath stacking prevents the person from breathing out. The
bag used for breath stacking should be clearly marked “Not for resuscitation”
Making a Breath Stacking Bag

 One-way valve
 Extension tube
 Either a mask or mouthpiece
 Nose clips
How is breath stacking done?

1. Have the person sit comfortably. They can lean back a bit, but they should not be
slouching
2. Put on nose clips
3. Look at the person being bagged and try to squeeze the bag as the person breathes in
4. Have the person take a deep breath in
5. Have them place their lips around the mouthpiece or hold the mask on their face
6. Have the person breathe in the air as the bag is squeezed
7. Ask them to try to to keep breathing in more air, as the bag is squeezed a second time
8. They should fill their lungs as full as possible and feel a stretch across the front of
their chest.
9. Have them hold the air in as long as possible before letting it go out. Use the air they
are breathing out to cough.
10. Regular breath stacking is good to do even if it is not used with an assisted cough. You
may find that breath stacking with an assisted cough is only needed once a day.
Page 2
When breath stacking is done right, it should not result in:
 dizziness
 chest discomfort
 chest pain
IMPORTANT! If you encounter dizziness, chest discomfort or

chest pain, stop the breath stacking exercise and rest.
How often should breath stacking be done?

Each time you do this exercise, do it 3 to 5 times. Breath stacking should not be done more
than every ten minutes. Breath stacking should be done 3 to 5 times a day.
Page 3
Assisted Cough Method

Having someone push on your abdomen (belly) just when you are trying to cough out is called
the Assisted Cough method. If you are not able to have someone push on your abdomen,
then they could push on your rib cage as you try to cough.
IMPORTANT! If you are sitting when this is done be sure that

the chair will not tip over.
When should assisted cough be done?

Doing breath stacking and assisted cough method on a full stomach may cause you to vomit.
To prevent this from happening do it:
 Before eating a meal

 2 hrs after eating a meal
 Bedtime
Helpful Hints for Children

Children 2 to 6 years of age are often not able to take a deep breath in while you insert the
mouthpiece or put the mask on. Ask them to pretend to blow out candles. This will help them
to empty their lungs. Try to catch them on their next breath-in and say “take a deep breath,
and another one, and another one”. Make eye contact with them the whole time. Then tell
them to “cough” or “breathe out” when they exhale.
Page 4
Cough Assist Device

The Cough Assist Device helps you get rid of mucous by trying to create a stronger cough. You
hold a mask on the face and the machine delivers a slow pressure increase when you breathe
in. Then it is followed by a rapid ‘suction’ effect. The slow breath-in followed by a quick
breath out, creates a cough.
Figure 1: Cough Assist Device.

http://www.coughassist.com/default.asp
Reproduced with permission of Philips Respironetics
You can use either a mask or a mouthpiece with the Cough Assist Device. Small children and
people with muscle weakness will have trouble keeping a seal on a mouthpiece, so will need
to use a mask. When using a mask you will need a good seal. If using a mask, be sure you
have good head and neck support, such as against a head rest on a wheelchair.
How do I give a Cough Assist Treatment?

1. You need two people to do the Assisted Cough technique
2. Have the patient sit comfortably with good head and neck support. They can be in
bed, with their head partially supported.
3. Check that the suction unit is working and ready
4. Check that the pressure settings on the Cough Assist Device are what was ordered
B Turn on the unit
B Seal the mask with your hand while you operate the Cough Assist Device
B Look at the pressure settings on both the IN and EX side
Page 5
5. Make eye contact with the patient

B Have the patient breathe out fully, then place the mask on their face just as they
begin to breathe in -OR-
B Have the patient breathe in and hold their breath as you place the mask on their
face
6. Move the lever to IN side and hold while you call out clearly “IN, IN, IN”
7. Quickly switch lever to EX side and call out “Cough, Cough, Cough”
8. Remove mask right away
Young Children
Children need some time to become familiar with the sounds of the device. Let them play
with the mask and push the buttons so they can hear the sounds. When they are comfortable
with the sounds, let them try one assisted breath. Be patient. It will take some time for them
to be comfortable with the exercise.
Other Pulmonary Clearance Techniques
Chest Physiotherapy
Chest physiotherapy is a physical technique of removing secretions with the use of clapping,
percussion, vibrations and/or postural drainage. Talk to your healthcare professional to learn
more about this technique.
Positive expiratory pressure devices (PEP)

The PEP device is a small hand-held device where you breathe out against a pressure.
Page 6
Clinical References
Miske LJ, Hickey EM, Kolb SM, Weiner DJ, Panitch HB. Use of the mechanical in-exsufflator in
pediatric patients with neuromuscular disease and impaired cough. Chest. 2004;125:
1406-1412.
Finder J. Overview of airway clearance technologies. July 2006. Available at:

http://www.rtmagazine.com/issues/articles/2006-07_06.asp. Accessed August 12, 2007.
Bach JR. Mechanical insufflation/exsufflation: has it come of age? A commentary. Eur Respir J.
2003;21:385-386.
Finder JD, Birnkrant D, Farber CJ, et al. Respiratory care of the patient with Duchenne
muscular dystrophy: ATS consensus statement. Am J Respir Crit Care Med. 2004;170:456-465.
Chatwin M, Ross E, Hart N, Nickol AH, Polkey MI, Simonds AK. Cough augmentation with
mechanical insufflation/exsufflation in patients with neuromuscular weakness. Eur Respir J.
2003;21:502-508.
Tzeng AC, Bach JR. Prevention of pulmonary morbidity for patients with neuromuscular
disease. Chest. 2000:118;1390-1396.
McCool DF, Rosen MJ. Nonpharmocologic airway clearance therapies: AACP evidence-based
clinical practice guidelines. Chest. 2006; 129:250-259.
Winck JC, Goncalves MR, Lourenco C, Viana P, Almeida J, Bach JR. Effects of mechanical
insufflation-exsufflation on respiratory parameters for patients with chronic airway secretion
encumbrance. Chest. 2004;126:774-780.
Resources
Ottawa Rehabilitation Center, www.rehab.on.ca
Page 7
Notes
Page 8
Routine Tasks
What to do
and when to do it
My Education
Checklist
and
Learning Log
Oximeter
Teaching
Checklist
Notes
Routine Tasks
What to do
and when to do it
Routine Tasks Patients/Clients & Caregivers
Task Daily Weekly Monthly

Stoma care 
Trach care 
Clean reusable inner cannula or replace disposable inner 
cannula
Clean speaking valves 
Clean suction canister – warm soapy water 
Change HME: if it is used all the time 
Ventilator plugged in 
Test ventilator alarms 
Check ventilator settings 
Test the ventilator circuit 
Test the manual resuscitator bag, if used often 
Make sterile distilled water Every 2-3
days
Test the manual resuscitator bag – if not used frequently 
Clean suction canister in vinegar and water 
Change HME: if being used only at night time 
Wipe down suction machine 
Change suction tubing 
Clean and test manual resuscitation bag 
Clean ventilator circuit 
Clean puffer chamber 
Clean humidifier 
Unplug ventilator and wipe with a damp cloth 
Check and order supplies 
Change bacterial filter in breathing circuit 
Clean or replace inlet filters (see manual) 
Discharge and recharge ventilator internal battery 
Discharge and recharge the D/C External battery 
Change suction filter Every 2nd
month
Ventilator preventative maintenance by VEP or other As required by equipment
equipment provider provider
Update the ventilator equipment pool with any changes As changes occur
Page 1
Routine Tasks Patients/Clients & Caregivers
Notes
Page 2
My Education
Checklist
and
Learning Log
My Education Checklist and Learning Log Patients/Clients & Caregivers
Introduction to Checklist
Below is a list of learning goals. It is important that all caregivers take part in learning how to care
for someone who is ventilated. You will learn from many different healthcare professionals. This
checklist is a guide to make sure that everything you need to know is covered. At any time, if you
feel you need to redo something, or are unsure of something, just ask. Your healthcare
professionals are eager to help you.
Individual’s Name: ___________________________________________________
Learning Objectives
At the completion of the training, the participant will be able to…
Individual Care Date Initials Caregiver

Initials
1. Describe in general terms normal anatomy and
physiology of the respiratory system:
B How we breathe
B Humidification
B Upper airway anatomy and placement of a
tracheostomy
B What is different with a tracheostomy
B Location and role of vocal cords
B Explain why an individual with a trach tube
might not be able to speak
2. Describe how changing body position or eating a
meal can affect breathing
3. Demonstrate safe technique for:
B Bathing
B Feeding/Eating
B Dressing
4. Explain the importance of drinking water and using
a humidifier to manage secretions
5. Describe why heart rate or breathing rate may
change with activity or illness
Page 1
6. Describe possible signs and symptoms of a chest

infection and the steps to take if there is an
infection
7. Explain the importance of proper hand hygiene
and how the use of gloves and a mask can prevent
the spread of infection
8. Explain the purpose of breath stacking
9. Describe what equipment is needed for
breathstacking
10. Demonstrate how to do the breathstacking
technique
11. Describe the plan for follow-up care
12. Explain the role of the family physician in the care
of the individual
Home Equipment Date Initials Caregiver

Initials
1. Identify the hazards and safety implications for
someone with a trach due to a loss of the
protective mechanisms of the upper airway
2. Identify home environment hazards
3. Determine if there are sufficient number of
grounded plugs
Inhaled Medication Date Initials Caregiver

Initials
1. Explain the function, dose and frequency of
individual-specific Metered Dose Inhalers
(MDI)/puffers
2. Demonstrate/explain how to give an MDI/puffer
with the ventilator
Page 2
Humidification System Date Initials Caregiver

Initials
1. Explain the importance of humidification
2. Demonstrate when and how to use an heated
moister exchanger (HME)
3. Demonstrate how to use and clean a passover
humidifier
Tracheostomy Care Date Initials Caregiver

Initials
1. Define tracheostomy
2. Explain why an individual might need a
tracheostomy
3. Name the parts of the tracheostomy tube
4. Describe stoma care
5. Describe how to prevent and manage skin
breakdown
6. Describe how to recognize and treat skin problems
around stoma (e.g. granulomas) and neck
7. Demonstrate how to clean the stoma and describe
what equipment is needed
8. Demonstrate correct inflation and deflation of a
cuffed tracheostomy tube
9. Explain the purpose of an inner cannula
10. Demonstrate how to insert or remove an inner
cannula
11. Explain how a trach tube could become blocked
and how to clear it
12. Describe how to clean and take care of the trach
equipment
13. Demonstrate how to change the tracheostomy ties
or holder
14. Main role: Changes outer cannula, holds cannula
in place until helper is finished securing the trach
ties, assesses and maintains airway
Page 3
15. Helper role: removes ties, cleans neck and stoma,

positions and holds person for tube change,
suctions (tip or measured), secures ties when tube
is change
16. Describe and demonstrate the emergency
replacement of the trach tube
17. Trach Tube Change:
 Demonstrates Helper role on patient
B Practice # 1
B Practice # 2
B Practice # 3
 Demonstrates Main role on patient
B Practice # 1
B Practice # 2
B Practice # 3
 Demonstrates Solo trach change competently
B Practice # 1
B Practice # 2
B Practice # 3
Speaking Valves and Other Adjuncts Date Initials Caregiver

Initials
1. Describe how a speaking valve works and when to
use it
2. Describe how to clean and take care of the
speaking valve
3. Explain the importance of cuff deflation before
using a speaking valve, if applicable
4. Trach Mask
5. Oxygen therapy
6. Explain the need for a specialty trach tube and
how to order one
Page 4
Oximeter Date Initials Caregiver

Initials
1. Explain what parameters the oximeter measures
including the waveform, and perfusion index
2. Demonstrate how to get a good saturation and
heart rate reading
3. Demonstrate correct application of probe
4. Explain when to use oximeter; asleep and/or
unattended
5. Identify oximeter assessment abilities
6. Demonstrate how to set correct alarm settings;
low and high settings for saturation and Heart
Rate (HR)
7. Describe when and how often to change probe,
every 4 hours and as needed (PRN)
8. Systematic troubleshooting (refer to user guide)
9. Explain the battery power requirements
10. Explain the routine monitor maintenance
Suctioning Date Initials Caregiver

Initials
1. Explain why an individual might need suctioning
2. Identify the appropriate interventions for
secretions that are: dry and thick, yellow or green,
blood tinged
3. Explain the purpose of suctioning
4. Identify the characteristics of secretions: colour,
consistency, amount, and odour and why it is
important
5. Demonstrate how to correctly set up the suction
equipment
6. Explain why it is important to use two gloves when
suctioning
7. Demonstrate clean suctioning technique including
asking the individual for direction before and
during suctioning
Page 5
8. Explain why suctioning should be done only when

needed, trying to avoid over suctioning or
frequent suctioning
9. Explain what to do if blood is suctioned from the
trachea, and explain what difference it might make
if the individual takes blood thinners
10. Explain how to troubleshoot the suction unit
11. Describe correct disposal of dirty suction
equipment including suction catheters and gloves
12. Demonstrate how to:
B Tip suction
B Tube suction
B Deep suction
13. Demonstrate how to stock the portable suction
bag for use outside the home
Manual Ventilation Date Initials Caregiver

Initials
1. Demonstrate how to properly connect and
disconnect an individual from a ventilator
2. Demonstrate when and how to use the manual
resuscitation bag
3. Demonstrate how to test the manual resuscitation
bag for proper functioning
4. Demonstrate how to properly clean the manual
resuscitation bag
5. Demonstrate how to add oxygen when using the
manual resuscitation bag
Page 6
Ventilator Care Date Initials Caregiver

Initials
1. Describe the purpose of a ventilator and when an
individual might need one
2. Demonstrate what needs the check-out procedure
when starting the ventilator at the bedside: high
and low pressure testing
3. Demonstrate what needs to be turned on and
checked when starting the ventilator on the
wheelchair
4. Demonstrate how to change the water in the
humidifier, and describe what kind of water is
used in the humidifier
5. Explain what needs to be plugged in when the
wheelchair ventilator is not in use
6. Demonstrate how and when to make ventilator
setting changes, including oxygen
7. Demonstrate how to check the ventilator high and
low pressure alarms
8. Describe the kind of situations that make the
low-pressure alarm sound and what to do for the
individual
high-pressure alarm sound and what to do for the
individual
power switch over alarm sound and what to do for
the individual
ventilator inoperative alarm sound and what to do
for the individual
12. Describe all ventilator alarms including high and
low pressure alarms
13. Describe what to do when there is a ventilator
IN OP alarm
14. Demonstrate how to assemble and disassemble
the ventilator circuit
Page 7
15. Demonstrate changing the ventilator circuit and

checking the ventilator after changing the circuit
16. Describe how to use a PEEP valve (if applicable)
17. Demonstrate how to assemble and disassemble
the PEEP valve (if applicable)
18. Demonstrate how to clean the ventilator circuit
19. Describe how and when to clean the ventilator
circuit and change the filters
20. Demonstrate how to check the external and
internal battery
21. Discuss how long a battery should last
22. Discuss how often to check and discharge the
battery
23. Demonstrate how to charge and discharge the
battery
Page 8
Emergency Management Date Initials Caregiver

Initials
1. Describe the emergency plan, i.e. when to call 911
2. Describe the role of the home care company in an
emergency
3. Describe the role of the acute care hospital in an
emergency or power failure situation
4. Describe the role of Hydro and the Fire
Department in an emergency
5. Explain the emergency preparedness plan,
including the procedure during a power failure
6. Explain what to do if the individual has an
obstructed air passage, such as how to clear the
airway
7. Explain how to identify and manage someone in
respiratory distress
8. Describe/demonstrate correct actions for each of
the following situations:
B Accidental decannulation
B Mucous Plug
B Trauma to stoma area
9. Identify and indicate how to contact local
emergency resources
10. Identify what information needs to be conveyed to
emergency personnel
11. Ensure family is provided with emergency contact
list
12. Caregivers are trained in CPR
13. Demonstrate manual ventilation of a
tracheostomy
14. Demonstrate how to ventilate should the trach
come out and you can’t replace it
Page 9
Funding and Equipment Supply Date Initials Caregiver

Initials
1. Explain the role of Assistive Devices Program (ADP)
in funding the equipment and supplies
2. Explain the role of the Ventilator Equipment Pool
(VEP) and how to contact them
3. List the equipment provided by the VEP
4. List equipment not provided by the VEP
5. Explain the role of the home care company and
how and when to contact them
6. List the supplies that come from the home care
company, how to place an order and explain
funding
7. List the supplies not covered by ADP that the
individual is responsible for
8. Describe how to safely store equipment
9. Describe when to discard equipment (please refer
to guidelines in the Ventilation & Tracheostomy
Care section)
Healthcare Provider
Signature Initials
Name/Designation
Page 10
Best Time for Education Sessions

Check off morning (M), afternoon (A) or evening (E) in the chart below for the best time for our
education sessions.
Caregiver Relationship to Su Mo Tu We Th Fr Sa
Patient
Additional Comments
Page 11
I understand that, although I may complete this education checklist, I am not being certified to
do any of the acts described. Any actions that I take following this training will be done under
the direction and responsibility of the patient or their authorized agent.
Caregiver Signature: _________________________________ Date: _______________________
Facility Name: ___________________________________________________________________
Address: _______________________________________________________________________
Instructor Signature: _________________________________ Date: _______________________
Facility Name: ___________________________________________________________________
Address: _______________________________________________________________________
Page 12
Oximeter
Teaching
Checklist
Oximeter Teaching Checklist Patients/Clients & Caregivers
This is a checklist for the healthcare professional to use when reviewing the oximetry
equipment with the caregiver. Verify receipt of the equipment, probes, the reference manual
and user guide.
1. Ensure all probes and cables are working 4. Review and explain:
by testing them on either yourself or  Power indicator light
patient. Ensure caregiver performs the  Battery indicator (four shaded
same test on the child segments = fully charged)
 Heart rate volume
2. Review and explain parameters:  Alarm volume
 Spo2  Backlight
 Heart rate  Lock function
 Waveform  Alarm silence button – one for two min
 Perfusion Index silence; three quick will silence
indefinitely – press once to reset to
3. Review and explain alarms (must be
normal function
ordered by physician):
 Low Saturation 5. Review battery power:
 High Saturation (if a patient is not on  Needs 3.5 hours to completely charge
oxygen this can be turned off as internal battery
ordered by physician)  Battery life – 24 hours if completely
 Low Heart Rate charged (if backlight is on the internal
 High Heart Rate battery lasts 12 hours)
 Explain that adjusting alarms must have
a physician’s order 6. Troubleshooting:
 Demonstrate how to adjust alarms  Review the troubleshooting guide in
(in case physician orders it to be made the technical reference manual
at home) page 3-1
7. Contact information to tell family/

caregiver:
 Contact Ventilator Equipment Pool
(VEP)
 Explain to the caregiver when
equipment is no longer needed and
physician has discontinued use,
caregiver to contact VEP to return
_________________________________ _______________________________
Caregiver Signature and Date RRT Signature and Date
Page 1
Oximeter Teaching Checklist Patients/Clients & Caregivers
Notes
Page 2
Troubleshooting
Troubleshooting
Guide
Troubleshooting
Troubleshooting
Notes
Troubleshooting
Troubleshooting
Guide
Troubleshooting Guide Patients/Clients & Caregivers
Problems and Solutions

When caring for patients on long term ventilation, you need to be aware of problems that
may arise. The problems may be related to what is happening with the patient or what is
happening with the ventilator.
Problems Related to the Patient

Whenever there is a problem, the first thing you need to do is look at the patient to see if
they are having any breathing problems. Patients will try to tell you if they are having trouble
breathing, are in pain, or need something. Every person is different, but common ways of
getting your attention include:
 Clicking their tongues

 Making unusual sounds
 Triggering an emergency bell or a ventilator alarm
If the patient is having trouble breathing they may look:
 Short of breath
 Pale, dusky or blue
 Scared or frightened
Consider using a baby monitor alarm, so others can hear if there is a problem.
IMPORTANT! If the patient cannot speak or communicate,

then they are not getting any air. If this happens, manually
ventilate using the resuscitation bag. A patient with a
speaking valve who cannot talk usually means they are not
getting any air.
What do I do if the patient is in distress?
1. Try to find out what the problem is by asking the patient “What is the problem?” or
“Are you getting enough air?” or “Do you need to be suctioned?”
2. Manually ventilate using a resuscitation bag
3. Use oxygen with the resuscitation bag, if needed
Page 1
4. If the patient has nodded yes to “Do you need to be suctioned?” then suction them
immediately
5. Call out for help to anyone who can hear you, such as a family member. Phone 911 or
your regional emergency number for an ambulance
6. Keep on manually ventilating the patient until help arrives
7. Stay with the patient. Tell the patient what is happening, and that help is on the way
8. Once emergency support has arrived explain the problem to the attendants
The following table lists problems and some steps to take to solve them. If you at any
time do not feel that you are able to correct the problem, do not wait to call for help.
Problem What to do
B Blocked Airway  Suction to remove mucous or food

B Choking on food  Manually ventilate using the resuscitation bag
B Mucous in the airway  If there is an inner cannula, change it
Patient is “not getting enough  Manually ventilate using the resuscitation bag
air”  Suction to remove anything that may be blocking the
airway
 Tighten all ventilator tubing connections
 Check that there is no leak in the system
 Make sure the humidifier hose is connected
 Make sure the ventilator settings are set correctly
 Check to see if there is a trach tube cuff leak
 If oxygen is being used, check that the oxygen supply is set
up correctly
 If patient is short of breath right after activity, allow them
to settle or rest a little to see if there is improvement
 The patient may need their bronchodilator (puffer); if it is
part of the care plan, then give the dose now
 If you have an oximeter, check the reading
 If there is a cuffed trach tube, make sure the cuff is properly
inflated
Page 2
Problem What to do
Problem with the Trach Tube  Make sure the ventilator tubing is not pulling on the trach
tube
 Reposition the patient so the tube is not being pulled on
 Reposition the head and neck
 If on the ventilator, and you hear air coming from around
the trach, you may have a trach tube cuff leak
 Check that the inner cannula is not blocked and is locked in
place
 Check that the trach ties are tied securely, but not too tight
 May need a trach tube change
Possible infection:  If you have an action plan that the doctor has given you,
B Stoma is red, swollen or follow that
painful to touch  Call the doctor or healthcare professional right away
B Mucous is yellow or green
B There is more mucous
B You need to suction more
often
B Needs more puffer
medicine
B Has a fever or chills
B Is not feeling well and is
really tired
B Oximeter reading, if you
have one, is low
The patient is very anxious  Instill 2-5 mls of normal saline into trach and apply manual
resuscitator or ventilator for a few breaths
 Use Breath Stacking and Cough Assist techniques to move
any mucous up the airway
 Try to remain calm and tell them what you are doing to
solve the problem
 Have patient do relaxation exercises
 If necessary, give medication as ordered
Page 3
Problem What to do
There is a lot of mucous and it  Suction

is difficult to suction it all out 1. Lubricate the suction catheter with water and try
suctioning again
2. Use manual resuscitation bag to deliver 3-5 breaths
3. Change the inner cannula, if there is one
4. Suction
5. Repeat steps 1-4, if needed
 Use Pulmonary Clearance Techniques – such as Breath
Stacking. This will help move the mucous up so it can be
suctioned out
 Moving often will help a patient cough up their mucous.
You can turn the patient every 1-2 hours or have them sit in
a chair several times a day
 If you have learned how, change the trach tube
 Call 911 if airway is still blocked
The trach tube has fallen out  Try to put the trach tube back in. Only try this once. If this
and the patient is not having does not work, get a new trach tube to insert
any trouble breathing 1. Completely deflate the cuff of the new trach tube
2. Lubricate the trach tube with water soluble lubricant
3. Insert obturator into the new trach tube
4. Slide new trach tube into stoma, but do not force
5. Remove the obturator
6. Insert the inner cannula, if there is one
7. Reinflate cuff, if there is one
8. Try to ventilate with a manual resuscitation bag
9. Check that the chest is rising and falling with each
breath
10. Place patient back on the ventilator
11. Check patient to make sure they are okay
 If you are not able to re-insert the trach tube:
1. Use a manual resuscitation bag with mask and
ventilate the patient
2. CALL 911
3. Contact your doctor and your respiratory therapist
Page 4
Problem What to do
The patient is in pain  Determine the type and location of the pain. For example;
is the pain with coughing, swallowing or only on breathing
in?
 Try to reposition the patient
 Give pain medicine, if ordered
 If there is chest tightness, then give inhaled medicine
(puffer), if ordered
The trach tube has fallen out  Attempt to re-insert trach tube ONCE (see above)
and the patient is having  CALL 911
trouble breathing  If you cannot reinsert a trach tube of same size: try
inserting either a tube that is one size smaller or a cuffless
tube
 Put a mask on the manual resuscitator bag
 If the patient needs oxygen: remove oxygen supply from
ventilator and connect to the manual resuscitation bag
 Place the mask over the patient’s mouth and nose and give
manual breaths. Have a second person cover the stoma
while you manually ventilate
IMPORTANT! Always use a manual resuscitation bag to give

breaths while you are troubleshooting.
Page 5
Problems and Solutions – The Ventilator
IMPORTANT! When a ventilator alarms, always look at the

patient first, not the ventilator. Look to make sure that the
chest is moving up and down. Make eye contact with the
patient and ask “Are you okay?”
Ventilators will alert you to a safety problem with a visual or an audible alarm. Some
situations will trigger a visual or an audible alarm. Serious situations will trigger both audible
and visual alarms together. You need to learn what the alarms mean on your ventilator.
Whatever the warning signal is, follow these steps:
1. Never leave the patient alone until the problem has been fixed
2. Use a manual resuscitation bag to ventilate the patient while you are trying to fix a
ventilator problem
3. Find out which alarm went off
4. Correct any problems, if you find any
5. Replace any broken equipment
6. Change the ventilator circuit, if needed. You should always have a spare ventilator circuit
set up, ready for use
7. Any equipment that failed is called ‘defective’. Do not use defective equipment. If your
ventilator is defective, manually ventilate the patient. If there is no other ventilator
available then call for an ambulance to take the patient to the nearest hospital
8. Once the patient is stable and taken care of, call the VEP to report the problem. The
telephone number for VEP is 1-800-633-8977. A respiratory therapist is on hand 24 hours
a day to help with ventilator issues and problems. Follow the prompts on the message for
service after business hours
9. For other replacement disposable supplies, contact the home care company
The following table lists specific problems and what you can do to solve them. Please see
manufacturer’s instructions for a complete list of alarms for your ventilator.
Page 6
Alarm Possible cause What to do
High Pressure  Mucous plugs or mucous  Suction to remove mucous

 Coughing, swallowing or  If coughing, may need puffer or
hiccupping suctioning
 Bronchospasm  Give inhaled medicine, if ordered
 Changes in patient’s breathing  Contact the appropriate
pattern. Patient is not healthcare provider
responding to medicine or
suctioning
 Alarm set incorrectly  Change alarm to proper setting
Low Pressure/  Leaks in the ventilator circuit  Look and feel for any leaks:
Apnea exhalation valve, humidifier,
pressure line, and tubing for
leaks
 Water in pressure line  Drain water
 Patient is disconnected from  Reconnect patient to ventilator
ventilator
 Leaks around trach or trach tube  Reposition patient and, or the
cuff trach tube. Try to deflate/
reinflate the cuff
 Alarm set incorrectly  Reset alarm to proper setting
 Dirty inlet filter  Replace filter
Setting  Settings are incorrect  Reset settings

 Ventilator malfunction  Manually ventilate patient and
call the equipment provider
Power Switch  Power source has changed from  Ensure ventilator is plugged in
Over AC to internal or external power and there is power
source  If switching to or from an
 Power source has changed from external battery, then press the
external to internal reset button to cancel the
audible and visual alarm
Low Power  Internal battery is discharged  Plug in and operate ventilator on

AC power for at least three
hours. If no power is available
then manually ventilate
Page 7
Notes
Page 8
Emergency
Contacts and
Planning
Emergency
Preparedness Guide
for People with Disabilities /
Special Needs
Emeergency Contacts
Useful Web www.ontario.ca/emo
& Planning
Resources
Notes
Emergency Contacts
& Planning
Emergency
Contacts and
Planning
Emergency Contacts and Planning Patients/Clients & Caregivers
All About You
Your Contact Information

First Name: _________________________________________________________________
Middle Name: _______________________________________________________________
Last (Family) Name: __________________________________________________________
Street Address: ______________________________________________________________
City: ______________________________ Postal Code: ______________________________
Home Phone: _______________________ Cell Phone: ______________________________
Fax: ______________________________ Email: ___________________________________
Date of Birth: ___________________________
Allergies: ___________________________________________________________________
Your Ventilator Settings

These settings have been determined by your doctor and healthcare professionals team. Do
not change the settings without first talking with your doctor and healthcare professionals.
Make: ______________________________ Model: ________________________________
Mode: ______________________________
Volume: ____________________________ Breath Rate: ____________________________
Low Minute Volume: __________________Pressure: ______________________________
IMPORTANT! You need to have a complete list of your

ventilator settings, even those settings that do not appear on
the front panel of the ventilator.
Page 1
If you use a speaking valve, first deflate the cuff. Then change the ventilator settings to:
Volume: _____________________________ Breath Rate: ____________________________
Inspiratory Time (I:E ratio): _____________________________________________________
Breath Effort (sensitivity): ______________________________________________________
Low Alarm: ___________________________ High Alarm: ____________________________
Keep track of ventilator setting changes

Ventilator Setting Change Reason for Change Date Changed
Your Trach Tube

Make: ______________________________ Model: _______________________________
Type/Serial #: ________________________ Size: _________________________________
Ordering information: _______________________________________________________
Page 2
Keep track of when the trach tube was changed

Date of Tube Tube Tube Location Who
Change Make/Model Size Type changed it?
Keep track of medicine taken

Drug Name What it does How much or how When to take
many
Page 3
Special Instructions
Page 4
Your Personal Support Network

Your personal support networks are people who know about your healthcare needs and can
be called upon to help you in an emergency.
Family Doctor
Name: ________________________________________________________________
Phone: ____________________
Other Doctor Specialty: __________________________________________________
Name: ________________________________________________________________
Phone: ____________________
Home Healthcare Professional Specialty: _____________________________________
Name: _________________________________________________________________
Phone: ____________________
Home Healthcare Professional Specialty: _____________________________________
Name: _________________________________________________________________
Phone: ____________________
Equipment Supplier
Name: _________________________________________________________________
Phone: ____________________
Page 5
Family Friend
Name: _____________________________________________________________
Phone: ____________________
Family Friend
Name: _____________________________________________________________
Phone: ____________________
Other Contact Specialty: Ventilator Equipment Pool
Name: _____________________________________________________________
Phone: ____________________
Other Contact Specialty: Home Care Company
Name: _____________________________________________________________
Phone: ____________________
Page 6
Your Personal Emergency Plan

Developing a personal plan can help you to cope during an emergency. Completing the
information below will help you to develop a good plan.
What to do if there is a power failure?

Use your external D/C battery, given to you by the Ventilator Equipment Pool (VEP), for
emergency use. A full charged battery should last 5-12 hours.
 Go somewhere where there is power. Somewhere close to your home. This could be a
hospital, a hotel, a fire or ambulance hall. These places usually have power even during a
power outage
 Call family or friends to see if their power is out. If they still have power, you could go
there. Make sure there is at least one person on your contact list that lives close by and
understands your needs
 Plan on how you might escape from your home. Getting out of your home quickly and
safely can be difficult, so you need a plan. For example, if you live in a high rise
apartment, it may not have adequate back up power for a long power outage. It may not
be easy to get out of the building when the elevators are not working. So you need to
have a plan
You need two external D/C batteries, if you want to be mobile with your ventilator. One
battery to use when you are mobile, and the other battery in case of a power failure. The
backup battery from the VEP is not to be used with your wheelchair. You need to buy another
D/C external battery if you want to use your ventilator while you are mobile.
If you are having trouble paying for a second battery, consider going to Assistance for
Children with Sever Disabilities (ACSD) or Ontario Disability Support Program (ODSP),
insurance, or various service clubs to ask for help. Sometimes they can help with funding.
Consider where you could go if there was a prolonged power outage: List friends, family,
hospital or fire station address here.
Page 7
Family/Friend: _____________________________________________________________
Street Address: ____________________________________________________________
City: ______________________________ Postal Code: ___________________________
Contact Person: _____________________ Home Phone: __________________________
Cell Phone: _________________________
Out-of-Town Family/Friend: __________________________________________________
Street Address: ____________________________________________________________
City: ______________________________ Postal Code: ___________________________
Contact Person: _____________________ Home Phone: __________________________
Cell Phone: _________________________
Page 8
Long-term Emergency Refuge

If the power outage is long term you will have to leave your home and stay somewhere else
for a while. Make plans on where you will go if this happens.
Street Address: _____________________________________________________________
City: _______________________________ Postal Code: ___________________________
Contact Person: ______________________ Home Phone: __________________________
Cell Phone: ________________________
How will I get there?

Have a transportation plan ready in case you need to leave home quickly.
Contact Person: ________________________ Home Phone: ________________________
Cell Phone: ____________________________
Travel Bag Checklist

In an emergency you will have to leave your home quickly. Have a travel bag packed with
everything you would need to take with you in an emergency. The contents of your travel bag
should include:
 Spare trach tubes: current trach tube size and another one that is one size smaller
 Ventilator settings
 Spare ventilator circuit and HMEs
 Your Contact List
B Healthcare team names and phone numbers
B Personal support network names and phone numbers
B VEP phone number
B Equipment supplier name and phone number
B Oxygen supplier name and phone number
 List of medicines and inhalers (puffers)
 Resuscitation bag and mask
 Portable suction unit and supplies
 D/C Battery
Page 9
Fire Precautions
Fire Extinguishers
 Have two fire extinguishers in the home
 Your fire extinguishers need to be checked once a year
Smoke Detectors
 Have one smoke detector on every level in your home
 Change the batteries in your smoke detectors twice a year. Many people change their
smoke alarm batteries twice a year; when they change their clocks in the spring and the
fall. Write the date you changed the batteries, on the smoke detector
 Post a “No Smoking/Flame” sign, if oxygen is in use
Emergency Supplies
An emergency situation may occur that requires you to stay in your home for a long period of
time. So it is wise to have some emergency supplies. Have enough supplies for a week.
According to the “Emergency Preparedness Guide for People with Disabilities/Special Needs”
from Emergency Management Ontario. Here is what they suggest:
 Respiratory travel bag

 Enough medications
 MedicAlert® bracelet or identification
 Bottled water
 Food (non-perishable)
 Manual can opener
 Flashlight(s) & batteries
 Battery operated radio & batteries or crank radio
 Spare batteries
 Candles and matches/lighter
 Important papers (identification)
 Clothing and footwear
 Blankets or sleeping bags
 Toilet paper and other personal items
 Telephone that can work during a power disruption
 Extra car keys and cash
Page 10
 Whistle (to attract attention, if needed)

 Playing cards
 First-aid kit
 Backpack or duffle bag
This Guide may found at the web site www.emergencymanagementontario.ca. Make sure
that your supplies do not become too old to use. For example, keep your medicine up to
date. Buy bottled water and food with a long expiry date. You should also check your
flashlight(s) and replace the batteries from time to time.
Page 11
Notes
Page 12
Emergency
Preparedness
Guide
Acknowledgement of
Source
The following document, titled “Emergency Preparedness Guide for People with
Disabilities/Special Needs” has been provided by Emergency Management Ontario.
The following acknowledges the original copyright claimed by the Queen’s Printer of Ontario:
© Queen’s Printer for Ontario, 2007. Reproduced with permission.
The document is being reproduced here with permission from Emergency Management
Ontario in the form originally made available.
Emergency
Preparedness Guide
for People with Disabilities /
Special Needs
www.ontario.ca/emo
Acknowledgements
This Emergency Preparedness Guide for People with Disabilities and/or Special Needs
was prepared by the Government of Ontario’s Emergency Management Ontario in
partnership with the Accessibility Directorate of Ontario.
In order to produce a guide that promotes the values and protects the integrity,
independence and safety of all Ontarians, the following organizations were consulted
for their subject matter expertise and special insights, for which we are most
appreciative:
Canadian Diabetes Association
Canadian MedicAlert® Foundation
■
Canadian Paraplegic Association (Ontario)
■
Canadian Red Cross
■
Centre for Independent Living in Toronto (CILT) Inc.
■
CNIB
■
Foreign Affairs and International Trade Canada
■
Learning Disabilities Association of Ontario
■
Ministry of Community and Social Services Emergency Management Unit
■
Ministry of Government Services
■
Multiple Sclerosis Society of Canada, Toronto Chapter and Ontario Division
■
National (USA) Organization on Disability Headquarters
■
Office of the Fire Marshal – Ontario Head Office
■
Ontario March of Dimes (Provincial Office)
■
Ontario Seniors’ Secretariat
■
Ontario SPCA (Ontario Society for the Prevention of Cruelty to Animals)
■
SOS Emergency Response Technologies
■
St. Demetrius Development Corporation
■
The Canadian Hearing Society
■
Toronto Rehabilitation Institute
■
■
Special appreciation is also extended to all the people that volunteered their time
to pose for the pictures throughout this guide.
Ministry of Community Safety Ministry of Community
Emergency Management Ontario Accessibility Directorate of Ontario
and Correctional Services and Social Services
www.ontario.ca/emo www.mcss.gov.on.ca
Since not every emergency situation is similar or predictable, every person should rely on and use
their best judgement when offering assistance to others in an emergency, without putting their own
or other people's safety at risk.
© Queen’s Printer for Ontario 2007
All material created in this guide is protected by Crown Copyright, which is held by the Queen's Printer for Ontario. No materials can be reproduced
or copied in part or in whole without the expressed written permission of the Ministry of Community Safety and Correctional Services.
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Emergency Survival Kit Checklist . . . . . . . . . . . . . . . . 3
Service Animal Emergency Kit Checklist . . . . . . . . . . . 4
Important Considerations . . . . . . . . . . . . . . . . . . . . . . 5
Categories
Mobility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
NonVisible Disabilities . . . . . . . . . . . . . . . . 14
Seniors with Special Needs . . . . . . . . . . . . . . 16
Highrise Safety . . . . . . . . . . . . . . . . . . . . . . . 18
Travel Considerations . . . . . . . . . . . . . . . . . . 20
For More Information . . . . . . . . . . . . . . . . . . . . . . . . . 22
1
Introduction
Emergencies can occur suddenly and without any advance warning.
Although Ontario has effective emergency management legislation
and programs, individuals and families play a vital role in preparing
for times of crisis when emergency services and other government
resources may be strained. It is important that individuals and
families prepare to be selfreliant for at least three (3) days
immediately after or during an emergency. This guide provides special emergency
preparedness considerations and advice for the estimated 1.5 million Ontarians with
disabilities and/or special needs, including seniors with special needs.
Prepare Now
Emergency preparedness includes developing and practising a family emergency
response plan and the preparation of an emergency survival kit.
For those living with a physical, visual, auditory and/or other nonvisible disability,
emergency preparedness should also involve incorporating special accommodations
into their family emergency response plan. To best prepare for an emergency
according to one’s special needs, please refer to the appropriate category in this
guide for a list of suggested emergency survival kit items and contingency planning
considerations.
For more information on emergency management arrangements in your area contact your
municipal Emergency Management Coordinator through your local government office.
Using this Guide
This guide covers topics relevant to the emergency preparedness needs of people
with visible and/or nonvisible disabilities and seniors with special needs.
• Disabilities/special needs are identified as separate categories according to colour
and a symbol shown on the top right hand corner of each page.
• Each category provides information on how individuals should prepare for an
emergency given their special needs, how the public can best assist a person with
a disability and additional suggested survival kit items.
• The last page is an additional contact information resource for the reader.
• Copies of this guide are available in both English and French, and in alternative
formats upon request. Please contact:
General Tel: 4163143723 General Tel: 4163260207
Emergency Management Ontario Accessibility Directorate of Ontario
Tollfree Phone: 18773143723 Tollfree Phone: 18885205828
TTY: 4163260148
Tollfree TTY: 18883356611
2
Emergency Survival Kit Checklist
This Emergency Survival Kit checklist outlines the basic items every individual
should keep in an easytoreach place to help them be selfreliant for at least
three (3) days immediately after or during an emergency. Since emergency
supply requirements vary for individuals with different disabilities, please refer
to the appropriate category in this guide for additional suggested survival kit
items.
Prepare Now,
Emergency Survival Checklist
Learn How…
❍ Flashlight and batteries ❍ Manual can opener
❍ Radio and batteries or crank radio ❍ Clothing and footwear
❍ Spare batteries (for radio, ❍ Blankets or sleeping bags
flashlight, assistive devices, etc.) ❍ Toilet paper and other
❍ Firstaid kit personal items
❍ Telephone that can work during ❍ Medication
a power disruption ❍ MedicAlert® bracelet or
❍ Candles and matches/lighter identification
❍ Extra car keys and cash ❍ Backpack/duffle bag
❍ Important papers (identification) ❍ Whistle (to attract attention,
❍ Nonperishable food and bottled if needed)
water ❍ Playing cards
3
Service Animal Emergency Kit Checklist
This Service Animal Emergency Kit checklist outlines the basic items every
person with a service animal should have prepared in advance to keep their
service animals comfortable during the stress of an emergency situation.
It is advisable to keep all items in a transportable bag that is easy to access
should evacuating the home become necessary. Also, remember to check the
kit twice a year (an easy way to remember is to do it when you check your
smoke alarms biannually) to ensure freshness of food, water and medication,
and to restock any supplies you may have “borrowed” from the kit.
Service Animal Emergency Kit Checklist
❍ Minimum 3day supply of ❍ Muzzle (if required)
bottled water and pet food ❍ Blanket and favourite toy
❍ Portable water and food bowls ❍ Plastic bags
❍ Paper towels and can opener ❍ Uptodate ID tag with your
❍ Medications with a list
phone number and the
identifying reason (e.g., medical
name/phone number of your
condition), dosage, frequency
veterinarian (microchipping is
and contact information of
also recommended)
prescribing veterinarian
❍ Current photo of your service
❍ Medical records including animal in case they get lost or
vaccinations separated from you
❍ Leash/harness ❍ Copy of licence (if required)
Pet Owners:
While service animals are accepted at shelters in an emergency, family pets
are not. Hence, it is advisable for pet owners to prepare a similar emergency
kit for each family pet according to the needs of each different animal
(e.g., cat, rabbit, bird, etc.). In the case of cats, include a cat carrier, little
pan, litter, scooper and plastic bags. It is also recommended for pet owners
to have prior arrangements made with family or friends to take care of their
animal, should evacuating the home be necessary during an emergency.
For additional information on pets and emergencies, please visit the
Emergency Management Ontario website at www.ontario.ca/emo.
4
Important Considerations
Remember…
The emergency survival kit items listed in this guide are only a
suggestion and may or may not apply to every emergency situation and/or
a person’s special needs. Therefore you should decide which
essential items to include for yourself and your family members.
During an emergency you may have no electrical power.
During an emergency you may need to go to an emergency evacuation
shelter. It is recommended that you and your family have a designated
contact person that resides outside of your immediate community. This way,
in the event of an evacuation, family members can easily notify each other
by calling their designated contact person.
Pack and store all emergency survival items (including medications, medical
supplies and/or assistive devices) in an easytoaccess and easyto
transport container should you need to evacuate.
Select a network of individuals at work and at home that will be able
to assist you during an emergency. (Make sure you inform your network of
where you keep your emergency survival kit.)
Prepare a list of any food or drug allergies you might have and all the
medications you are taking. You may want to provide this list to your
designated network and also keep a copy in your emergency survival kit, on
your person, at home, your workplace and in your car (if applicable).
On your list of medications, specify the reason for each medicine that you
are taking (e.g., medical condition being treated) including the generic
name, dosage, frequency, and the name and contact information of the
prescribing physician.
If you have children with a disability or special needs, prepare a similar list
for each of your children and provide it to their caregiver, school, emergency
contact members, etc.
If you have an allergy, chronic medical condition, or special medical need
you may want to consider owning and wearing a MedicAlert® bracelet or
identification as part of your emergency preparedness plan.
For more information visit: www.medicalert.ca.
5
Remember…
Regularly check expiration dates on all medications, bottled water, and
canned/packaged food in your emergency survival kit. It is best to replace
food and bottled water at least once a year.
Prepare a contact information list of all your emergency contact persons and
provide a copy to your designated network at work and/or home. Also keep a
copy in your survival kit, on your person, at home, at your workplace and in
your car (if applicable).
Provide written instructions for your network on how best to assist
you and your service animal (if applicable) during an emergency.
Label all of your special needs equipment and attach laminated instruction
cards on how to use, retrieve and/or move each assistive device during an
emergency.
Since your medications, assistive devices, etc. may change over time, it is
advisable for you to regularly assess your needs and incorporate any changes
to your emergency survival kit supplies and your family emergency plan.
If your personal needs require regular attendant care and/or life sustaining
apparatus, arrange with your network to check on you immediately if an
emergency occurs or if local officials issue an evacuation order.
Carry a personal alarm that emits a loud noise to draw attention to
your whereabouts.
If you rely on any life sustaining equipment/apparatus, develop an
emergency backup plan that will ensure the equipment/apparatus works
in the event of a power outage.
Install working smoke alarms on every floor of your home and outside all
sleeping areas.
Test smoke alarms on a monthly basis by pushing the test button. Replace
smoke alarm batteries every six months and whenever the lowbattery
warning sounds.
Develop and practise a home fire escape plan or refer to your building’s fire safety
plan so that everyone in your home knows what to do in the event of a fire.
Practise your emergency plan with your network at least twice a year.
If during an emergency your support network cannot assist you for whatever
reason, ask other individuals around you to help you. Remember to inform
them of your special needs and how they can best offer any assistance to you.
6
Tips on Helping a Person with a Disability
“Ask First” if the person needs or wants your help – do not just assume
☛ that they do.
Allow the person to identify how best to assist them.
☛
Do not touch the person, their service animal and/or their assistive
☛ device/equipment without their permission.
☛ Follow instructions posted on special needs equipment and/or assistive
device during an emergency.
Avoid attempts to lift, support or assist in moving someone unless you
☛ are familiar with safe techniques.
Never administer any food or liquids to an unconscious or unresponsive
☛ person.
☛ Be aware that some people who have disabilities may request that you
use latexfree gloves to reduce spread of viral infection to them.
☛ Ask the person with special needs if areas of their body have reduced
sensation and if they need you to check those areas for injuries after a
disaster.
7
Mobility
• If you use a wheelchair
or scooter, request that
an emergency
evacuation chair be
stored near a stairwell
on the same floor that
you work or live on, so
that your network can
readily use it to help
you safely evacuate
the building.
• In your instruction list
Mobility limitations may make it difficult for a person for your network,
to use stairs or to move quickly over long distances. identify areas of your
These can include reliance on mobility devices such as body that have reduced
a wheelchair, scooter, walker, crutches or a walking sensation so these
cane. In addition, people with a heart condition or areas can be checked
various respiratory difficulties can experience certain for injuries after an
levels of mobility limitations. emergency, if you
cannot check them
Your Emergency Plan: yourself.
• Ask your network This will help your • Check with your local

to practise moving network become more municipal office to
your special needs comfortable handling or find out if emergency
equipment during using your special evacuation shelters
your emergency needs equipment during in your area are
practice plan. an emergency. wheelchair accessible.
Additional Items
Emergency Survival Kit
■ Tire patch kit.
Dos & Don’ts ■ Can of sealinair product (to
repair flat tires on your wheelchair
or scooter).
Assisting People with Disabilities
✔ Use latexfree gloves when ■ Supply of inner tubes.
providing personal care whenever ■ Pair of heavy gloves (to protect
possible. (People with spinal cord your hands while wheeling or
injury have a greater risk of making way over glass or other
developing an infectious disease sharp debris).
during an emergency. Gloves ■ Latexfree gloves (for anyone
help control secondary medical providing personal care to you).
conditions that can easily arise if ■ Spare deepcycle battery for
personal care is disrupted during motorized wheelchair or scooter.
an emergency.) ■ A lightweight manual wheelchair for
✔ Ensure that the person’s wheelchair backup to a motorized wheelchair
goes with the person. (if feasible).
■ Spare catheters (if applicable).
✘ Do not push or pull a person’s
■ An emergency backup plan that
wheelchair without their permission.
will ensure any life sustaining
equipment/apparatus is operable in
the event of a power outage.
■ Any other contingency supplies
unique to your special needs.
Vision
Your Emergency Plan:
• Have a long cane
available to readily
manoeuvre around
debris on the floor or
furniture that may
have shifted after an
emergency.
• Mark all emergency
supplies in advance
with fluorescent tape,
large print or in braille.
• Mark gas, water and
electric shutoff valves
in advance with
fluorescent tape,
large print or in braille.
• Familiarize yourself in
advance with all escape
Vision loss can include a broad range of conditions routes and locations of
ranging from complete blindness to partial or low emergency doors/exits
vision that cannot be corrected with lenses or surgery. on each floor of any
A person’s ability to read signs or move through building where you
unfamiliar environments during an emergency may be work, live and/or visit.
challenged, creating a feeling of being lost and/or
being dependent on others for guidance.
10
Additional Items
■ Extra white cane, preferably a
Dos & Don’ts
cane that is longer in length.
■ Talking or braille clock.
✔ Always ask first if you can be of ■ Largeprint timepiece with extra
any assistance to them. batteries.
■ Extra vision aids such as an
✔ For people who are deafblind, use
electronic travel aid, monocular,
your finger to draw an “X” on their
binocular or magnifier.
back to let them know you are
■ Extra pair of prescription glasses –
there to help during an emergency.
if you wear them.
✔ To communicate with a deafblind ■ Any reading devices/assistive
person, try tracing letters with your
technology to access information/
finger on the palm of their hand.
portable CCTV devices.
✔ To guide the person, offer them ■ Any other contingency supplies
your arm instead of taking theirs unique to your special needs.
and walk at their pace. Keep half a
step ahead of them. ✘ Do not assume the person cannot see
✔ If the person has a service dog, you, or that they need your help.
ask them where you should walk to ✘ Never grab or touch a person with
avoid distracting the animal. vision loss.
✔ Provide advance warning of ✘ Do not touch, make eye contact or
upcoming stairs, curbs, major distract the person’s service dog as
obstacles, or changes in direction. this can seriously endanger the owner.
✔ Watch for overhangs or protrusions ✘ Do not shout at a person with vision
the person could walk into. loss. Speak clearly and provide
specific and precise directions.
✘ Avoid the term “over there”. Instead,
describe locating positions such as,
“to your right/left/straight ahead/
behind you”, or by relaying clock face
positions. (For example: 12 o’clock)
11
Hearing
A person can be deaf, deafened or hard of hearing.
The distinction between these terms is based on the
individual’s language and means of communicating
rather than the degree of hearing loss.
In an emergency, the method in which emergency
warnings are issued becomes critical to how a person
with hearing loss is able to respond and follow
instructions to safety.
• If your network is • Obtain a pager that
unavailable during an is connected to an
emergency, seek the emergency paging
assistance of others to system at your
whom you can workplace and/or the • Replace batteries in
communicate your building that you live in. batteryoperated smoke
hearing loss by spoken • Install a smoke alarms every six
language, moving detection system that months and whenever
your lips without includes smoke alarms the lowbattery warning
making a sound, and accessory flashing sounds.
pointing to your ear, strobe lights or • Keep a laminated card
using a gesture, or if vibrators to gain your on your person and in
applicable, pointing to attention if the alarms your survival kit that
your hearing aid. sound. identifies you as deaf
• Keep a pencil and paper • Test smoke alarms on or hard of hearing and
handy for written a monthly basis by explains how to
communication. pushing the test button. communicate with you.
12
Additional Items
■ Extra writing pads and pencils for
Dos & Don’ts communication.
■ Flashlight, whistle or noisemaker.
■ Preprinted key phrases you would
✔ Get the person’s attention via a
use during an emergency.
visual cue or a gentle touch on
their arm before speaking to them. ■ Assistive devices unique to your
✔ Face the person and make eye needs (e.g., hearing aid, pager,
contact when speaking to them as personal amplifier, etc.).
they may rely on speechreading.
■ Portable visual notification devices
✔ Communicate in close proximity. that allow you to know if a person
✔ Speak clearly and naturally. is knocking on the door, ringing
✔ Use gestures to help explain the the doorbell, or calling on the
meaning of what you are trying to telephone.
communicate to the person.
■ Extra batteries for assistive devices.
✔ Write a message if there is time
and keep a pencil and paper handy. ■ A CommuniCard (produced by
✘ Avoid approaching the person from The Canadian Hearing Society)
behind. that explains your hearing loss and
✘ Refrain from shouting or speaking also helps identify how rescuers
unnaturally slowly. or assisters can communicate with
you during an emergency.
✘ Do not make loud noises as hearing
aids amplify sounds and can create ■ Any other contingency supplies
a physical shock to the user. unique to your special needs.
Note: Typically people who are
deafened or hard of hearing will need
information presented in a text format.
13
NonVisible Disabilities
• Consider owning and
wearing a MedicAlert®
bracelet or identification
because it will help
notify emergency
responders about your
nonvisible disabilities.
For more information
visit: www.medicalert.ca.
• Request a panic push
button to be installed in
the building you work
Nonvisible disabilities can include communication, and/or live in, so that
cognitive, sensory, mental health, learning or in the event of an
intellectual disabilities in which an individual’s ability emergency you can
to respond to an emergency is restricted. They can notify others of your
also range from allergies, epilepsy, hemophilia, whereabouts and that
diabetes, thyroid condition, multiple sclerosis, you need special
pulmonary or heart disease and/or dependency on assistance.
dialysis, sanitary or urinary supplies. Individuals with • People with Multiple
nonvisible disabilities may have difficulty performing Sclerosis: Symptoms
some tasks without appearing to have a disability. are often made worse
by heat and humidity.
Your Emergency Plan: Be prepared to keep
• Prepare an easyto • Inform your designated cool and dry.
understand list of support network of • People with Diabetes:
instructions or where you store your Keep frozen water
information for yourself medication. bottles or ice packs in
that you think you may • Keep a pencil and paper your freezer. Have an
need in an emergency. or portable electronic insulated bag or cooled
• Keep an emergency recording device handy thermos ready to store
contact list on your to write down or record your insulin, should
person of key people any new instructions there be a power
that are aware of your provided to you in an outage or you need
special needs. emergency. to evacuate.
14
Additional Items
■ Supply of food items appropriate to
Dos & Don’ts your disability or dietary restrictions.
■ List of instructions that you can
easily follow in an emergency.
✔ Allow the person to describe what ■ Personal list and minimum three days
help they need from you. supply of all needed medications,
✔ Find effective means of medical supplies and special
communication (e.g., provide drawn equipment (e.g., ventilator for asthma,
or written instructions. When giving nitrolingual spray for heart condition,
directions use landmarks instead of Epinephrine pen against allergic
terms “go left” or ”turn right”). reaction/anaphylactic shock, etc.).
✔ Be patient, flexible and maintain eye ■ Detailed list of all prescription
medications.
contact when speaking to the person.
■ MedicAlert® identification.
✔ Repeat instructions (if needed).
✔ Ask the person about their medication unique to your special needs.
and if they need any help taking it.
(Never offer medicines not
For Example: People with Diabetes
prescribed by their physician.) ■ Extra supply of insulin or oral agent.
✔ Keep people with multiple sclerosis ■ Extra supply of syringes, needles
cool and dry to avoid making their and insulin pens (if used).
symptoms worse. ■ Small container for storing used
syringes/needles (if applicable).
✘ Avoid shouting or speaking quickly.
■ Blood glucose testing kit, spare
Instead, speak clearly but not so
batteries and record book.
slowly as to offend the person.
■ Supply of blood glucose and urine
✘ Do not restrain a person having a ketone testing strips.
convulsion. Instead, roll them on
■ Fastacting insulin for high blood
their side to keep their airway clear glucose (if applicable).
and place something soft (e.g., your ■ Fastacting sugar for low blood
jacket) under their head to protect it glucose.
from injury. Once the convulsion ■ Extra food to cover delayed meals.
passes and they become conscious, ■ Ice packs and thermal bag to store
help them into a resting position. insulin (if applicable).
15
Seniors with Special Needs
social workers, etc., at
your place of residence
(if applicable), including
the hours they keep.
• Familiarize yourself with
all escape routes and
location of emergency
doors/exits in your
home.
• Know the location of
emergency buttons.
Since an emergency situation or an evacuation can be
(Many seniors’ buildings
a frightening and confusing time, it is important that
have emergency
seniors, especially those with special needs, know the
buttons located in
steps to take in an emergency. This includes seniors
bedrooms and
contacting their local municipal office to find out about
washrooms that have
programs and services available in their community
a direct link to 911
that will help them during an emergency and assist
or the building’s
them to return to their regular routine.
superintendent.)
Your Emergency Plan: • If asked to evacuate,
• Create an emergency superintendent, etc. bring with you any
contact list with names Keep a copy of this list equipment or assistive
and telephone numbers in your survival kit and devices you may need
of your physicians, case on your person. immediately.
worker, contact for your • Write down the names • Always wear your
seniors group, and phone numbers of MedicAlert®
neighbours, building onsite doctors, nurses, identification.
16
Additional Items
Dos & Don’ts your disability or dietary restrictions.
■ Assistive devices needed such as
canes, walkers, lightweight manual
✔ Check on neighbours who are seniors
wheelchair, hearing aids, breathing
with special needs to find out if they
apparatus, blood glucose monitoring
need your help during an emergency
device, etc.
or evacuation.
■ Prescription eyewear and footwear
✔ Allow the person to describe what
(if required).
help they need and how it can be
■ Extra supply of medications and
provided to them.
vitamin supplements.
✔ Be patient, listen actively.
■ Personal disabilityrelated list of all
✔ If the person appears anxious or your needed medical supplies and
agitated, speak calmly and provide
special equipment.
assurance that you are there to help.
■ Copies of all medication
✔ If evacuation is necessary, offer a prescriptions.
ride to seniors who do not have
■ Extra dentures (if required) and
access to a vehicle.
cleaner.
✔ If time permits, offer to carry the ■ Latexfree gloves (to give to anyone
person’s emergency survival kit to
providing personal care to you).
your car, along with any equipment
or assistive devices they will need.
✔ Follow instructions posted on special
needs equipment and/or assistive For Seniors with Diabetes:
devices during an emergency. Please refer to previous “Other
■
NonVisible Disabilities” category.
✘ Refrain from shouting or speaking
unnaturally slowly.
✘ Avoid being dismissive of the person’s
concerns or requests.
17
Highrise Safety
Highrise buildings present unique challenges when
evacuation is necessary during an emergency.
Residents should make themselves aware of:
✔ Building superintendent’s name and phone number.
✔ Who sits on the Building Safety Committee.
✔ Who the floor monitors are.
✔ Who conducts evacuation drills, and how often.
✔ Location of fire extinguishers, automated external
defibrillator units, and oxygen tank.
✔ Location of emergency evacuation device(s).
• Advise your building that are wheelchair • If you rely on any life
manager/superintendent accessible (if applicable). sustaining equipment/
of your special needs • Request that an apparatus, develop an
and/or requirements emergency evacuation emergency backup
during an emergency. chair be installed on the plan that will ensure
• Familiarize yourself floor you live or work the equipment/
with your building’s on, preferably close to apparatus is operable
evacuation plan. the stairwell in the event of a power
• Know where all (if applicable). outage.
escape routes and • If you live in a • Obtain large printed
location of emergency highrise building, create signs from the building
doors/exits are on a ‘buddy’ system with manager that you can
each floor. your neighbours and place in your window
• Know the location of regularly practise your in the event of an
emergency buttons in emergency response emergency, indicating
the building and exits plan with them. that you need assistance.
18
Additional Items
■ Personal alarm that emits a loud
Dos & Don’ts noise to draw attention to your
whereabouts.
■ Supply of food items appropriate
✔ Check on neighbours and/or to your dietary restrictions.
coworkers with special needs to find
out if they need your help during an ■ Supply of medications and assistive
emergency or evacuation. devices appropriate to your
✔ Listen actively to what the disability.
individual with special needs is ■ Supply of plastic bags for storing
saying. garbage/personal waste.
✔ During an emergency evacuation
■ Names and contact information of
(if time permits), offer to carry the
your neighbours, superintendent
person’s emergency survival kit
and property/building manager.
for them along with any special
equipment or assistive devices ■ Laminated copy of your building’s
they will need. evacuation plan and diagram of
✔ Review previous categories in this guide escape routes and location of
on how to assist people with specific emergency doors/exits on each
disabilities and/or special needs. floor.
✘ In general, avoid attempts to lift,
support or assist in moving a person
down the stairs, unless you are
familiar with safe techniques.
19
Travel Considerations
Whether travelling locally or internationally, people with
disabilities and seniors with special needs should take
extra time to research and plan their trip to make their
travel experience safe and enjoyable. This includes
preparing in advance, an emergency plan and
“ReadyGoBag” with emergency survival items.
Your Emergency Plan: booklet Bon Voyage, • Inform your travel

• Before travelling, visit But..., that contains companion(s) on how
the Foreign Affairs and contact information for to assist you in an
your destination's emergency.
Canadian office and • If travelling alone,
International Trade
Canada website at
www.voyage.gc.ca Emergency Operations establish a network
where you can register Centre. You can order it (e.g., hotel staff) that
and find other helpful free of charge at can assist you during
travel information www.voyage.gc.ca. an emergency.
safety tips. • Divide your medications • If you have difficulty
• Discuss your particular and medical supplies using stairs request a
accommodation needs between your carryon room on a lower floor.
with your travel agent. and checkin baggage, • Review the hotel
• Discuss your trip with keeping them in their emergency exit plan.
your doctor to prepare original labelled • If needing to evacuate,
contingency plans in containers. Bring copies bring your emergency
case of illness. of your prescriptions “ReadyGoBag” and
• Obtain necessary travel with you. any assistive devices
medical insurance. • Always wear your you may need.
• Carry a copy of the MedicAlert® bracelet.
20
Additional Items
Dos & Don’ts your dietary restrictions.
■ Supply of medications/assistive
devices appropriate to your disability
✔ Check on fellow travellers with
(e.g., Glucagen injection if you manage
visible disabilities or special needs
your diabetes with insulin and you are
to find out if they need your help
travelling to a remote location that
during an emergency or evacuation.
does not have ambulance service).
✔ Listen actively to what the individual
■ Laminated personal information card
with special needs is saying and how
that you keep on your person at all
they might need your help.
times when travelling. (Card identifies
✔ If they speak in a foreign language
your special needs, lists all
that you do not understand, try to
medications you are taking, any food/
communicate using gestures.
drug allergies you might have, your
✔ During an emergency evacuation treating physician’s name and contact
(if time permits), offer to carry the
information, and your next of kin.)
person’s emergency survival kit
■ Copy of your travel medical insurance
for them along with any special
and other important travel documents.
equipment or assistive devices
■ A personal alarm that emits a loud
they will need.
noise to draw attention to your
✔ Review previous categories in this whereabouts.
guide on how to assist people with
■ Small container that can store or
specific disabilities or special needs.
disintegrate syringes or needles
✘ Do not let the person be separated safely (if applicable).
from their wheelchair or mobility aids. ■ Antinausea and antidiarrhea pills
and pain medication.
■ Sunblock.
■ Insect repellent.
■ Dictionary to help you communicate
in a foreign language.
■ Any other contingency supplies unique
to your disability or special needs.
21
For More Information
Specific Disabilities and Special Needs
Canadian Diabetes Association Multiple Sclerosis Society of Canada – Ontario Seniors’ Secretariat
Tel: 4163633373
Toronto Chapter and Ontario Division Tel: 4163267076 (Seniors’ INFOline)
Tollfree Phone: 18002268464
Tel: 4169226065 Tollfree Phone: 18889101999
Fax: 4164087117
Tollfree Phone: 18669226065 Tollfree TTY: 18003875559
www.diabetes.ca Fax: 4169227538 Fax: 4163267078
www.mssociety.ca www.ontarioseniors.ca
Canadian Paraplegic Association Ontario
Tel: 4164225644
Ontario March of Dimes
Tel: 4164253463
Tollfree Phone: 18002633463 Emergency Preparedness
Fax: 4164225943
Fax: 4164251920
www.dimes.on.ca Emergency Management Ontario
www.cpaont.org
Tel: 4163143723
Ontario SPCA (Ontario Society for the Tollfree Phone: 18773143723
Canadian Red Cross Prevention of Cruelty to Animals) Fax: 4163143758
Tel: 9058901000
Tel: 9058987122 www.ontario.ca/emo
Fax: 9058901008
Tollfree Phone: 1888ONTSPCA
www.redcross.ca (6687722)
Fax: 9058538643 For Information on MedicAlert®
Centre for Independent Living in Toronto Email: [email protected]
(CILT) Inc. www.ontariospca.ca Bracelets or Identification
Tel: 4165992458
TTY: 4165995077
The Canadian Hearing Society Canadian MedicAlert® Foundation
24hr Newsline: 4165994898
Tel: 4169282500 Tel: 4166960142
Fax: 4165993555
TTY: 4169640023 Tollfree Fax: 18003928422
www.cilt.ca
Tollfree TTY: 18773473429 www.medicalert.ca
Fax: 4169282523
CNIB www.chs.ca
Tel: 4164862500
Toronto Rehabilitation Institute For Travel Advice and
Tel: 4165973422
Registration Service when
TTY: 4164808645
Fax: 4165971977
Travelling Abroad
Fax: 4164807700
www.torontorehab.com
www.cnib.ca
Foreign Affairs and International Trade
Accessibility Initiatives Canada
Learning Disabilities Association of
Tel: 6139446788
Ontario Accessibility Directorate of Ontario TTY: 6139441310
Tel: 4169294311
Tel: 4163260207 In Canada and USA:
Fax: 4169293905
www.ldao.ca TTY: 4163260148 Tollfree TTY: 18003943472
Tollfree TTY: 18883356611 www.voyage.gc.ca

Fax: 4163269725
www.mcss.gov.on.ca
Local Emergency Management Contact: This guide is courtesy of:
© Queen’s Printer for Ontario, 2007 © Imprimeur de la Reine pour l'Ontario 2007
ISBN 9781424923809 ISBN 9781424923861
10M 01/07 10M 01/07
Disponible en français Available in English
Useful Web
Resources
Useful Web Resources Patients/Clients & Caregivers
Respiratory Related Sites

West Park Healthcare Centre
Includes online e-learning modules, example:
B Respiratory Anatomy and Physiology
B Tracheal Suctioning and Manual Ventilation
B Tracheostomy Tubes and Stoma Care
B Introduction to Long Term Mechanical Ventilation (Invasive)
http://www.ltvcoe.com
The Institute for Rehabilitation Research and Development (The Rehabilitation Centre
Ottawa)
Includes “Respiratory Protocols for SCI and Neuromuscular Diseases”:
B Anatomy and Physiology
B Clinical Pathway
B Interventions (LVR with bag, MI-E, ventilator, and GPB)
B CoughAssist™ - New Generation of MI-E
B Mechanical Insufflation/Exsufflation Policy
B Lung Volume Recruitment with Resuscitation Bag Policy
http://www.irrd.ca/education/

http://www.ontvep.ca/
The Ministry of Health & Long-Term Care, Assistive Devices Program, Respiratory Devices
Category Administration Manual (June 2007)
http://www.health.gov.on.ca/english/providers/pub/adp/resp_manual_20070627.pdf
Aaron’s Tracheostomy Page

A web site that provides information about tracheostomy
http://www.tracheostomy.com/
Page 1
Information on Diseases
ALS Society of Canada
http://www.als.ca
Chronic Obstructive Airway Disease (COPD)-Canadian Lung Association

http://lung.ca/diseases-maladies/copd-mpoc_e.php
Cystic Fibrosis
http://www.cysticfibrosis.ca
Multiple Sclerosis Society of Canada

http://www.mssociety.ca/en/default.htm
Muscular Dystrophy of Canada

http://www.muscle.ca
Ontario March of Dimes/March of Dimes Canada

http://www.marchofdimes.ca/dimes
Post Polio Health International

http://www.post-polio.org
Spinal Muscular Atrophy

http://www.smafoundation.org
Page 2
Government Listings and Publications

Assistive Devices Program (Ontario Ministry of Health & Long Term Care)
http://www.health.gov.on.ca/english/public/program/adp/adp_mn.html
ADP Respiratory Manual

http://www.health.gov.on.ca/english/providers/program/adp/product_manuals/respiratory_
devices.pdf
How to Hand Wash

http://www.health.gov.on.ca/en/ms/handhygiene/video/hand_wash.aspx
Best Practices for Hand Hygiene in all Healthcare Settings

http://www.health.gov.on.ca/english/providers/program/infectious/diseases/best_prac/bp_
hh_20080501.pdf
Health Canada: Health Products and Food Branch

http://www.hc-sc.gc.ca/index-eng.php
Ontario’s Community Care Access Centres

http://www.health.gov.on.ca/english/public/contact/ccac/ccac_mn.html
Page 3
Associations/Agencies
Canadian Paraplegic Association Ontario
http://www.cpaont.org
Canadian Sleep Society

http://www.css.to
College of Physicians and Surgeons of Ontario

http://www.cpso.on.ca
College of Respiratory Therapists of Ontario

http://www.crto.on.ca
Canadian Society of Respiratory Therapists

http://www.csrt.com
International Ventilator Users Network

http://www.ventusers.org
Ontario Hospital Association

http://www.oha.com
Respiratory Therapy Society of Ontario

http://www.rtso.ca/
The BC Association for Individualized Technology and Supports for People with Disabilities:
Home of the Provincial Respiratory Outreach Program (PROP)
http://www.bcits.org/default.htm
The Canadian Lung Association

http://www.lung.ca
The Ontario Lung Association

http://www.on.lung.ca
Page 4
Home/Long Term Ventilation Education

AARC Clinical Practice Guideline
Long-Term Invasive Mechanical Ventilation in the Home – 2007 Revision & Update
http://www.rcjournal.com/cpgs/pdf/08.07.1056.pdf

Providing Patient and Caregiver Training
http://www.rcjournal.com/cpgs/pcgtcpg.html

Training the Health-Care Professional for the Role of Patient and Caregiver Education
http://www.rcjournal.com/cpgs/thcpcpg.html

Pulse Oximetry
http://www.rcjournal.com/cpgs/pulsecpg.html
Battery University is an on-line resource that provides practical battery knowledge

http://www.batteryuniversity.com
Emergency Management Ontario: Emergency Preparedness Guide for People with

Disabilities/Special Needs
http://www.emergencymanagementontario.ca/stellent/idcplg/webdav/Contribution%20Fold
ers/emo/documents/Disability%20Guide_Eng.pdf
http://www.getprepared.ca
IVUN-Home Ventilator Guide

http://www.ventusers.org/edu/HomeVentGuide.pdf
The Institute for Rehabilitation Research and Development: The Rehabilitation Centre,
Ottawa: Respiratory Protocols for Spinal Cord Injuries and Neuromuscular Disease
http://www.irrd.ca/education/default.asp
The Toronto East General Hospital Progressive Weaning Centre

Provincial Centre of Excellence
http://www.tegh.on.ca/bins/content_page.asp?cid=3-2850&lang=1&pre=view
Page 5
West Park Healthcare Centre Long-Term Ventilation Centre of Excellence: On-line e-learning
modules
http://www.ltvcoe.com/index.html
Chronic Ventilation Strategy Task Force: Final Report, June 30, 2006
http://www.health.gov.on.ca/english/providers/program/critical_care/docs/report_cvtg.pdf
Page 6
Vendors
The Porta-Lung
http://portalung.com/index.htm
Breathing Pacemakers: Avery Biomedical

http://www.averylabs.com/index.html
Diaphragm Pacing System: Synapse Biomedical

http://www.synapsebiomedical.com/products/neurx.shtml
Cough Assist Device

http://www.coughassist.com
Respironics
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Page 7
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Page 8
Glossary of Terms
Introduction &
Appendix A
Appendix B
Appendix C
Professionals
Healthcare
Patients/Clients
& Caregivers
Appendices
Glossary of Terms
Introduction &
Appendix A
Appendix B
Quick Reference Guide to LTV® 900, 950 & 1000 Series
Ventilators
Professionals
Healthcare
Appendix C
Patients/Clients
& Caregivers
Appendices
Appendix A
Equipment/Supply Authorization
Form (Sample)
£;;
. >
. Ontarl·o
Ministry of Health
and Long-Term Care
Assistive Devices Branch
7th floor, 5700 Yonge Street
NORTH YORK ON M2M 4K5
Toll Free 1 800 268-6021
TOO (Toll Free) 1 800 387-5559
1ioronto Area 416327"-8804
Fax 416 327-8192
EA 11378242
Equipment/Supply
Please read Instructions prior to completion. Pre,ss hard, you are completing multiple copies. Authorization
~
Last name of applicant (please print)
I am receiving social assistance benefits, Dyes

If yes, check one only:
D Ontario Works (OW) D Ontario Disability Support Program (ODSP)
I certify that the above named personhas a long term

physi:aI cIsabity and/or Iness and medically I9qlIiras
the use d the equipmentfor OCher than the exdu!live
use d sports,sd100Ior wort<.
o o - ~~
o
Check if the client has accessed Change in medical condition (specify) _
ADP before for this device category
Growth/Atrophy
Description of item: BrandIModel or product equivalent

Product Vendor to complete
equivalent
category cat Qty, supplied Total cost ($)
I hereby certify that I have seen the above named person and that I have authorized the equipmenVsupplies
described in Section 3 above, based on my assessment of this individual's medical requirements,
Signature of ADP Registered Authorizer Area code Telephone no, Less amount paid by:
o Applicant
o Agent
Signature of ADP Registered Dispenser or Rehabilitation Assessor

Date (dimly)
I hereby certify that I am a resident of Ontario and In need of the equipment prescribed as In Section 3 above. I do not have similar equipment In
working order previously fLlnded by ADP and I understand the vendor or ADP may bill me for equipment obtained In contravention d the above.
I understand that I am free to go to any registered vendor In the community and that I may obtain the locetlons of these vendom from the above ADP
registered authorizers, or directly from tmt Asslstlve Devices Program.
I certify that the Information on this form Is true, correct and complete to the best of my knowledge. I understand the rules of eligibility for ADP and I
am eligible for the above supplies/equipment. I authorize the release of the above Information to the Ministry of Health, Its agents theADP registered
vendor I have chOHl1 and my Insurance company. '
I consent to the "Indirect collection" by ADP vendors on behalf of the Ministry of Health of the applicant's name, address, heath number and
EqulpmentlSupply Authorization number Where such Information Is reqUired by the Mlnl~try to process this claim.
I consent to the collection and disclosure of medical and non-medical Information by the Asslstlve Devices Branch (ADB) to the Workplace Safety &
Insurance Board (WSlB), and by the WSIB to the ADB, to determine my eligibility to receive funding assl.tancefrom the ADB.
Signature of applicant or agent
1-
Vendor's name I hereby certify that the information on this form is true, correct and
Gomplete to the be5t of my knowleQge llI1Q th~t the equipment
Isupplies as listed have been provided to the above person by
Authorization Form
Equipment/Supply
Appendix A
Appendix A
Equipment/Supply Authorization
Form (Sample)
Notes
Authorization Form
Equipment/Supply
Appendix A
£;;
. >
. Ontarl·o
Ministry of Health
and Long-Term Care
Assistive Devices Branch
7th floor, 5700 Yonge Street
NORTH YORK ON M2M 4K5
Toll Free 1 800 268-6021
TOO (Toll Free) 1 800 387-5559
1ioronto Area 416327"-8804
Fax 416 327-8192
EA 11378242
Equipment/Supply
Please read Instructions prior to completion. Pre,ss hard, you are completing multiple copies. Authorization
~
Last name of applicant (please print)
I am receiving social assistance benefits, Dyes

If yes, check one only:
D Ontario Works (OW) D Ontario Disability Support Program (ODSP)
I certify that the above named personhas a long term

physi:aI cIsabity and/or Iness and medically I9qlIiras
the use d the equipmentfor OCher than the exdu!live
use d sports,sd100Ior wort<.
o o - ~~
o
Check if the client has accessed Change in medical condition (specify) _
ADP before for this device category
Growth/Atrophy
Description of item: BrandIModel or product equivalent

Product Vendor to complete
equivalent
category cat Qty, supplied Total cost ($)
I hereby certify that I have seen the above named person and that I have authorized the equipmenVsupplies
described in Section 3 above, based on my assessment of this individual's medical requirements,
Signature of ADP Registered Authorizer Area code Telephone no, Less amount paid by:
o Applicant
o Agent
Signature of ADP Registered Dispenser or Rehabilitation Assessor

Date (dimly)
I hereby certify that I am a resident of Ontario and In need of the equipment prescribed as In Section 3 above. I do not have similar equipment In
working order previously fLlnded by ADP and I understand the vendor or ADP may bill me for equipment obtained In contravention d the above.
I understand that I am free to go to any registered vendor In the community and that I may obtain the locetlons of these vendom from the above ADP
registered authorizers, or directly from tmt Asslstlve Devices Program.
I certify that the Information on this form Is true, correct and complete to the best of my knowledge. I understand the rules of eligibility for ADP and I
am eligible for the above supplies/equipment. I authorize the release of the above Information to the Ministry of Health, Its agents theADP registered
vendor I have chOHl1 and my Insurance company. '
I consent to the "Indirect collection" by ADP vendors on behalf of the Ministry of Health of the applicant's name, address, heath number and
EqulpmentlSupply Authorization number Where such Information Is reqUired by the Mlnl~try to process this claim.
I consent to the collection and disclosure of medical and non-medical Information by the Asslstlve Devices Branch (ADB) to the Workplace Safety &
Insurance Board (WSlB), and by the WSIB to the ADB, to determine my eligibility to receive funding assl.tancefrom the ADB.
Signature of applicant or agent
1-
Vendor's name I hereby certify that the information on this form is true, correct and
Gomplete to the be5t of my knowleQge llI1Q th~t the equipment
Isupplies as listed have been provided to the above person by
Appendix B
Quick Reference Guide for
LTV® 900, 950 & 1000 Series Ventilators
LTV® Series Ventilators

(LTV® 900, 950, and 1000)
Quick Reference Guide
P/N 10674, Rev. H
LTV® 900, 950 & 1000

Quick Reference
Appendix B
Appendix B
LTV® 900, 950 & 1000 Series Ventilators
Notes
LTV® 900, 950 & 1000
Quick Reference
Appendix B
LTV® Series Ventilators
(LTV® 900, 950, and 1000)
Quick Reference Guide
P/N 10674, Rev. H

TABLE OF CONTENTS
Front and Side Panel Reference ................................................................................. 1

Front Panel Display and Description.......................................................................... 1
Side Panel Descriptions............................................................................................. 3
Turning the Ventilator On and Off .............................................................................. 5
Turning the Ventilator On .......................................................................................... 5
Turning the Ventilator Off .......................................................................................... 6
Ventilator Checkout Tests ........................................................................................... 7
Alarm Test ................................................................................................................. 8
Display Test............................................................................................................... 9
Control Test ............................................................................................................. 10
Leak Test................................................................................................................. 11
Vent Inop Alarm Test............................................................................................... 12
Set Defaults ............................................................................................................. 13
Exit .......................................................................................................................... 14
Variable Controls........................................................................................................ 15
Setting Up Modes of Ventilation ............................................................................... 17
Setting Up Control Mode ......................................................................................... 17
Setting Up Assist/Control Mode............................................................................... 19
Setting Up SIMV Mode ............................................................................................ 21
®
P/N 10674, Rev. H LTV Series Ventilators iii
Setting Up CPAP Mode ........................................................................................... 23

Setting Up NPPV Mode ........................................................................................... 25
Monitored Data ........................................................................................................... 27
Extended Features ..................................................................................................... 29
Using AC/DC Power ................................................................................................... 57
Using the AC Adapter.............................................................................................. 57
Using an External DC Power Source....................................................................... 58
Power Displays and Indicators ................................................................................. 59
Attaching a Breathing Circuit.................................................................................... 63
Oxygen Computer Chart............................................................................................ 65
Alarms ......................................................................................................................... 67
®
P/N 10674, Rev. H LTV Series Ventilators iv
FRONT AND SIDE PANEL REFERENCE
Front Panel Display and Description
®
P/N 10674, Rev. H LTV Series Ventilators 1
A - Mode and Breath Selection – Selects ventilation modes. Selects breath types.
B - Power – Turns ventilator “On” or to “Standby.”
C - Variable Control Settings – Sets ventilation characteristics, such as Tidal Volume
and Breath Rate.
D - Display Window – Displays Alarm Messages, Monitored Data, Extended Features
menu.
E - Airway Pressure Display – Displays real-time airway circuit pressure.
F - Patient Effort Indicator – LED is lit briefly each time a patient trigger is detected.
G - Power Source – Displays power source and charge levels.
H - Variable Alarm Settings – Sets variable alarm levels.
I- Alarm Silence/Reset – Silences audible alarms. Clears visual alarms.
J - Set Value Knob – Changes variable control settings. Navigates Extended
Features menu.
K - Special Controls – Activates special controls such as Manual Breath, Low
Pressure O2 Source, Insp/Exp Hold or Control Lock feature.
®
Side Panel Descriptions
®
A - 22mm Outlet Port – Patient Breathing Circuit outlet port.

B - Flow Xducer – Flow Transducer high pressure sensing port.
C - Flow Xducer – Flow Transducer low pressure sensing port.
D - Exh Valve – Exhalation Valve drive line port.
E - Alarm Sounder Port
F - Cooling Fan
G - DC Input – External DC power port (earlier version)
or DC power port pigtail connector (current version).
H - Patient Assist – Patient Assist Call jack.
I- Comm Port – Communications port.
J - O2 Inlet – Oxygen Inlet fitting.
K - Filter – Air Inlet.
®
TURNING THE VENTILATOR ON AND OFF
Turning the Ventilator On
To turn the LTV® ventilator on:
1) Connect the ventilator to an external power source:
• The AC power adapter may be used or the ventilator may be connected to an
external battery.
• If you do not connect the ventilator to an external power
source, it will operate from the internal battery.
2) Press and release the On/Standby button. The ventilator will
commence operation:
• The On/Standby LED is lit and the Power On Self Tests (POST) are run.
During POST;
• The front panel displays are illuminated.
• Verify the audible alarm is activated for 1 second (only on ventilators with a
symbol on the back panel label).
• Verify a confirming audible chirp is activated (only on ventilators with a
symbol on the back panel label).
3) Once POST is successfully completed, the ventilator begins operating using the
stored control settings.
®
Turning the Ventilator Off

®
To turn the LTV ventilator off:
1) Disconnect the patient from the ventilator.

2) Press and hold the On/Standby button for 3 seconds. The ventilator
ceases operating, the audible alarm sounds continuously and the Vent
Inop LED is lit.
3) Press the Silence/Reset button to silence the audible alarm.
• Verify a confirming audible chirp is activated immediately after the
alarm is silenced (only on ventilators with a symbol on the back
panel label).
4) The ventilator continues to charge the internal battery as long as it is connected to
an external power source.
Note: The Vent Inop LED will remain lit for a minimum of 5 minutes and does not
affect battery life.
®
VENTILATOR CHECKOUT TESTS
WARNING - Disconnect the patient from the ventilator prior to running the Ventilator
Checkout tests and ventilate the patient using an alternative method. The
ventilator does not deliver gas during the Ventilator Checkout tests.
To enable the Ventilator Checkout menu:
1) Begin with the ventilator in Standby mode (off) and connected to a valid AC power
source.
• Verify that the External Power and Charge Status LEDs are illuminated.
2) Press and hold the Monitor Select button. While holding
the Select button, press the On/Standby button.
• REMOVE PTNT alarm message is displayed and an
audible alarm is sounded.
3) Clear the alarm by pressing the Silence/Reset button.
• Audible alarm is silenced and VENT CHECK is displayed.
4) Press the Select button to move to the first test.
• The first Ventilator Checkout Test, ALARM, is
displayed.
®
Alarm Test
The alarm Test is used to verify that the audible alarm is working correctly.
1) Press the Select button while ALARM is displayed.
2) Verify the audible alarm is sounded.
• If a Patient Assist Call System or Remote Alarm is connected via the
ventilator’s Patient Assist Port, verify the device also activates (audible/visual),
as specified by its manufacturer.
3) When the alarm has sounded for at least 2 seconds, press the
Select button again.
• The audible alarm is silenced and the next menu item is displayed.
4) For ventilators with an audio sound symbol ( ) on the back panel label, verify a
confirming audible chirp occurs after the alarm is silenced.
®
Ventilator Checkout Tests
Display Test
The display Test is used to verify that the ventilator displays are working correctly.
To run the Display Test:
1) Press the Select button while DISPLAY is displayed.
2) All segments of the 7-segment control displays, all dots of the dot-matrix window
displays and all LEDs are illuminated.
• The External Power and Charge Status LEDs are tested and verified when
the AC adapter is connected to the ventilator (see page 7).
• The Vent Inop LED is tested and verified during the Vent Inop Alarm Test (see
page 12).
3) To end the display test, press the Select button again and the
next menu item is displayed.
®
Control Test
The Control Test is used to verify that the ventilator buttons and controls are working
correctly.
To run the Control Test:
1) Press the Select button while CONTROL is displayed.
2) SELECT is displayed in the display windows.
3) To test each control, press the button. The name of the button is
displayed in the display window. To test the Set Value knob, turn it
clockwise and counterclockwise. The direction of rotation is
displayed in the display window.
4) To exit the control test, press the Select button again and the next
menu item is displayed.
®
Leak Test
The Leak Test is used to test the patient circuit for leaks. The patient circuit should be
tested with all accessories, such as humidifiers or water traps, in place.
To run the Leak Test:
1) Cap or otherwise occlude the patient circuit wye.
2) Press the Select button while LEAK is displayed.
• To perform the Leak Test, the ventilator closes the exhalation valve, sets the
flow valve to a near-closed state, elevates the turbine motor speed and elevates
the circuit pressure.
• At the conclusion of the test, the display shows LEAK xx.x pass or fail, where
xx.x is the measured leak.
3) To exit the Leak Test, press the Select button again and the next
menu item is displayed.
®
Vent Inop Alarm Test

The Vent Inop Alarm Test is used to verify that the Inop Alarm is working correctly.
To run the Vent Inop Alarm Test:
1) To run the Vent Inop Alarm Test, the ventilator must be on (running) for at least 60
seconds and the Ventilator Checkout menu must be enabled.
2) Turn the ventilator off by pressing and holding the On/Standby button for
a minimum of 3 seconds. DO NOT press the Silence/Reset button.
3) Observe the ventilator for 15 seconds.
• Listen for the alarm tone
• Watch the Vent Inop LED
4) For all ventilators, verify that both of the following conditions existed;
• The alarm tone sounded continuously for the full 15-second duration.
• The Vent Inop LED illuminated continuously for the full 15-second duration.
5) If a Patient Assist Call System or Remote Alarm is connected via the ventilator’s Patient
Assist Port, verify the device also activates (audible/visual), as
specified by its manufacturer.
6) Silence the alarm by pressing the Silence/Reset button.
7) For ventilators with an a audio sound symbol ( ) on the back panel
label, verify the following condition existed;
• A confirming audible chirp occurred after the alarm was silenced.
®
When the Ventilator Checkout Tests have been completed, proceed to Exit for instructions
to exit the vent check mode, or see below concerning the use of the Set Defaults option.
Set Defaults
The Set Defaults option is used to reset user settable Controls and Extended Features
settings to their factory-set default values (see the LTV® 1200 Series Ventilators Operator’s
Manual for factory-set default values).
To set the default values:
1) Turn the Set Values knob until EXIT is displayed and press the Select button.
• VENT CHECK is displayed
2) Turn the Set Values knob until VENT OP is displayed and press the Select button.
3) Turn the Set Values knob until DEFAULTS is displayed and press the Select button.
• SET DEFAULTS is displayed.
4) Press the Select button while SET DEFAULTS is displayed.
• Except for the Language selected and the Date/Time settings and format, all user
settable Controls and Extended Features options are reset to their factory-set default
values.
• A DEFAULTS SET alarm will be generated the next time the ventilator is powered up
in normal ventilation mode (see Alarms, DEFAULTS SET for additional information).
®
Exit
To return to any of the VENT CHECK tests, turn the Set Value knob until the desired
test is displayed.
To Exit:
1) Press the Select button while EXIT is displayed, and VENT CHECK
is displayed.
2) Turn the Set Value knob until EXIT is displayed again.
3) Press the Select button.
The Ventilator performs a Self Test (POST) and resumes normal operation.
®
VARIABLE CONTROLS
®
To set a variable control:

1) Select the control by pressing the associated button. The display for the selected
control will be displayed at normal brightness and all other control displays will be
dimmed.
2) Change the control value by rotating the Set Value Knob. Rotate
clockwise to increase and counter-clockwise to decrease the value.
3) The new control value goes into effect when the operator:
• Presses the selected button again, or
• Selects another control, or
• Presses the Control Lock button, or
• Waits 5 seconds
All controls will then return to their normal brightness.
®
SETTING UP MODES OF VENTILATION
Setting Up Control Mode
®
To set the ventilator up in Control mode:

1) Press the Select button twice to toggle the modes between Assist/Control and
SIMV/CPAP. Select the Assist/Control mode.
2) Press the Select button twice to toggle between Volume and Pressure ventilation.
®
Select Volume or Pressure, as desired. (Not available on the LTV 900.)
3) Set the Breath Rate.
4) If Volume ventilation is selected, set the Tidal Volume. The calculated peak flow
Vcalc is displayed in the window while Tidal Volume is being changed.
5) If Pressure ventilation is selected, set the Pressure Control. (Not available on the
LTV® 900.)
6) Set the Inspiratory Time. The calculated peak flow Vcalc is displayed in the window
while Inspiratory Time is being changed. Vcalc only applies to volume ventilation.
®
7) Set O2% (LTV 1000 only).
8) Set the Sensitivity to Off (dash “-“).
9) Set the High Pressure Limit alarm.
10) Set the Low Pressure alarm.
11) Set the Low Minute Volume alarm.
12) Set the PEEP control on the exhalation valve.
®
Setting Up Assist/Control Mode
®
To set the ventilator up in Assist/Control mode:

®
Select Volume or Pressure, as desired. (Not available on the LTV 900).
LTV® 900.)
®
7) Set O2%, (LTV 1000 only).
8) Set the Sensitivity to a setting from 1 to 9.
®
Setting Up SIMV Mode
®
To set the Ventilator up in SIMV mode:

SIMV/CPAP. Select the SIMV/CPAP mode.
2) Press the Select button to toggle between Volume and Pressure ventilation. Select
®
Volume or Pressure, as desired. (Not available on the LTV 900).
®
LTV 900.)
7) Set the Pressure Support, if desired.
8) Set O2% (LTV® 1000 only).
®
Setting Up CPAP Mode
®
To set the ventilator up in CPAP mode:

2) Press the Select button twice to toggle between Volume and Pressure ventilation for
Apnea backup. Select Volume or Pressure for Apnea backup. (Not available on the
LTV® 900).
3) Set the Breath Rate to Off (dashes “- -“).
4) If Volume ventilation is selected, set the Tidal Volume for Apnea backup. The calculated
peak flow Vcalc is displayed in the window while Tidal Volume is being changed.
5) If Pressure ventilation is selected, set the Pressure Control for Apnea backup. (Not
available on the LTV® 900.)
6) Set the Inspiratory Time for Apnea backup. The calculated peak flow Vcalc is displayed
in the window while Inspiratory Time is being changed. Vcalc only applies to volume
ventilation.
7) Set the Pressure Support, if desired. NOTE: Although Tidal Volume, Pressure
8) Set O2% (LTV® 1000 only). Control and Insp Time are dimmed,
9) Set the Sensitivity to a setting from 1 to 9. they should be set to clinically
appropriate levels as the ventilator uses
10) Set the High Pressure Limit alarm. these settings for Apnea back-up
11) Set the Low Pressure alarm for Apnea backup. ventilation.
®
Setting Up NPPV Mode
®
To set the Ventilator up in NPPV mode:

1) Set the ventilator controls for Control, Assist/Control, SIMV, or CPAP mode, as
described in the preceding section.
2) Set the ventilator controls for Volume or Pressure ventilation, as described in the
preceding section.
3) Set all other ventilation parameters, as described in the previous section.
5) Enter Extended Features by pressing and holding the Monitor Select button for 3
seconds.
6) Turn the Set Value knob until VENT OP is displayed.
7) Press the Monitor Select button.
8) Turn the Set Value knob until NPPV Mode is displayed.
9) Press the Monitor Select button.
10) Turn the Set Value knob until NPPV On is displayed.
11) Press Monitor Select button.
12) The NPPV LED will be illuminated.
13) Exit the Extended Features menus by turning the Set Value knob until Exit is
displayed, and pressing Select button until monitored data is displayed in the
window.
®
MONITORED DATA
The monitored data displays may be automatically scrolled or manually scrolled. To

cycle through the available monitored data automatically from a halted scan, press the
Monitor Select button twice. Pressing the Select button once while scan is active shall
halt scanning and the currently display monitor shall remain in the display window. Each
time you press the button once; the next data item in the list will be displayed. To
resume scan, press the scan button twice. The monitored data is displayed in the
following order.
Display Description
PIP Displays the Peak Inspiratory Pressure measured during the
inspiratory phase. PIP is not updated for spontaneous breaths.
MAP Displays a running average of the airway pressure for the last 60
seconds.
PEEP Displays the pressure in the airway circuit at the end of exhalation.
f Displays the breaths per minute and includes all breath types.
Vte Displays the exhaled tidal volume as measured at the patient wye.
®
Display Description
VE Displays the exhaled tidal volume for the last 60 seconds as calculated
from the last 8 breaths.
I:E Displays the ratio between measured inspiratory time and measured
exhalation time. Both normal and inverse I:E Ratios are displayed.
Vcalc Is based on the Tidal Volume and Inspiratory Time settings. Displayed
when selected and whenever Tidal Volume or Inspiratory Time is
selected for change.
®
EXTENDED FEATURES
Navigating the Extended Features Menus:
To enter the Extended Features menu (in normal ventilation mode),
press and hold the Monitor Select button for three seconds.
To view the next item in a menu, turn the Set Value knob
clockwise.
To view the previous item, turn the Set Value knob counterclockwise.
To enter a menu item or select a setting, press the

Select button.
To exit a menu, turn the Set Value knob until the EXIT option is
displayed, then press the Select button or press Control Lock.
®
®
EXTENDED FEATURES
Alarm Operations
Alarm Volume
After accessing Extended Features, ALARM OP is displayed. Press the Select button
and ALARM VOL is displayed.
2) VOL xx dBA is displayed, where xx is the currently set volume.
3) Turn the Set Value knob until the desired setting is displayed.
®
Alarm Operations
Apnea Interval
and ALARM VOL is displayed. Turn the Set Value knob until APNEA INT is displayed.
2) APNEA xx sec is displayed, where xx is the currently set Apnea interval.
®
EXTENDED FEATURES
Alarm Operations
High Pressure Alarm Delay
This menu item is used to select immediate or delayed audible notification for High
Pressure alarms.
and ALARM VOL is displayed. Turn the Set Value knob until HP DELAY is displayed.
2) Turn the Set Value knob until the desired setting is displayed,
NO DELAY, DELAY 1 BRTH, or DELAY 2 BRTH.
®
Alarm Operations
Low Peak Pressure Alarm
This item is used to select the type of breaths that the Low Pressure Alarm applies to.
and ALARM VOL is displayed. Turn the Set Value knob until LPP ALARM is displayed.
ALL BREATHS, VC/PC ONLY.
®
EXTENDED FEATURES
Alarm Operations
1
High PEEP Alarm
This menu item is used to set a high PEEP alarm value. When the current PEEP value
exceeds the set high PEEP alarm value, an audible alarm will be sounded and a
flashing HIGH PEEP message will be displayed.
and ALARM VOL is displayed. Turn the Set Value knob until HIGH PEEP is displayed.
HI PEEP OFF or PEEP xx cmH2O.
1
The HIGH PEEP alarm is only available on ventilators with software version 3.15 or
higher installed.
®
Alarm Operations
PNT Assist 2
This menu item is used to configure the patient Assist Port output signal to be
generated for use with remote alarm systems.
and ALARM VOL is displayed. Turn the Set Value knob until PNT ASSIST is displayed.
NORMAL or PULSE.
2
The PNT ASSIST option is only available on ventilators with software version 3.15 or
higher installed.
®
EXTENDED FEATURES
Alarm Operations
Exit
To return to the top of the ALARM OP menu:
1) Turn the Set Value knob until EXIT is displayed.
2) Press the Select button while EXIT is displayed
®
Ventilator Operations
Variable Rise Time
The variable Rise Time option is used to select the rise time profile for Pressure Control
and Pressure Support breaths. The rise time profiles are numbered 1 through 9, where
1 is the fastest rise time and 9 is the slowest rise time.
After accessing Extended Features, ALARM OP is displayed. Turn the Set Value knob
until VENT OP is displayed. Press the Select button, and RISE TIME is displayed.
2) PROFILE x is displayed, where x is the currently set value.
3) Turn the Set Value knob until the desired Rise Time Profile is displayed.
®
EXTENDED FEATURES
Variable Flow Termination
The Variable Flow Termination is used to select the percentage of peak flow used for cycling
Pressure Support breaths. Pressure Support breaths are cycled from inspiration to
exhalation when the flow reaches the set percentage of the peak flow, or when flow goes
below 2 lpm.
When Pressure Control Flow Termination is enabled, the Variable Flow Termination setting
is used for flow termination of Pressure Control breaths as well.
After accessing Extended Features, ALARM OP is displayed. Turn the Set Value knob until
VENT OP is displayed. Press the Select button.
1) Turn the Set Value knob until FLOW TERM is displayed.
3) % OF PEAK xx is displayed, where xx is the current Flow Termination setting.
4) Turn the Set Value knob until the desired Flow Termination percentage
is displayed.
®
Variable Time Termination
The Variable Time Termination is used to select maximum inspiratory time for cycling
Pressure Support breaths. Pressure Support breaths are cycled from inspiration to
exhalation, if this time is reached before the flow reaches the set percentage of the
peak flow. When a breath is cycled based on the time setting, the Pressure Support
display is flashed briefly.
until VENT OP is displayed. Press the Select button.
1) Turn the Set Value knob until TIME TERM is displayed.
3) TERM x.x sec is displayed, where xx is the current Time Termination setting.
4) Turn the Set Value knob until the desired Time Termination is
displayed.
®
EXTENDED FEATURES
Pressure Control Flow Termination
The Pressure Control Flow Termination option is used to enable or disable flow
termination for Pressure Control breaths.
When this option is on, Pressure Control breaths are cycled at the set percentage of
peak flow, if it is reached before the set Inspiratory Time elapses. The percentage of
peak flow is set in the Variable Flow Termination option.
1) Turn the Set Value knob until PC FLOW TERM is displayed.

3) PC FLOW ON or PC FLOW OFF is displayed.

4) Turn the Set Value knob until the desired state is displayed.
®
Leak Compensation
Use the Leak Compensation option to enable or disable tracking of the Baseline Flow to
improve triggering when a circuit leak is present.
When Leak Compensation is on, the system is gradually adjusted to maintain set
sensitivity, if the leak is stable and there is no auto cycling.
1) Turn the Set Value knob until LEAK COMP is displayed.

3) LEAK COMP ON or LEAK COMP OFF is displayed.

®
EXTENDED FEATURES
NPPV Mode
1) Turn the Set Value knob until the NPPV MODE is displayed.
3) NPPV MODE ON or NPPV MODE OFF is displayed.

®
Control Unlock
When the Easy method is selected, unlock the controls by pressing and releasing the
Control Lock button.
When the Hard method is selected, unlock the controls by pressing and holding the
Control Lock button for 3 seconds.
1) Turn the Set Value knob until CTRL UNLOCK is displayed.

3) UNLOCK EASY or UNLOCK HARD is displayed.

®
EXTENDED FEATURES
Language Selection
1) Turn the Set Value knob until LANGUAGE is displayed.
3) ENGLISH or the currently selected language is displayed.

4) Turn the Set Value knob until the desired language is displayed.
®
Software Versions
After accessing Extended Features, ALARM OP is displayed. Turn the
Set Value knob until VENT OP is displayed. Press the Select button.
Turn the Set Value knob until VER xx.xx.xx is displayed, where
xx.xx.xx is the current software version.
Usage Meter
After accessing Extended Features, ALARM OP is displayed. Turn the
Set Value knob until VENT OP is displayed. Press the Select button.
Turn the Set Value knob until USAGE xxxxx.x is displayed, where
xxxxx.x is the current number of hours the ventilator has been in
operation.
®
EXTENDED FEATURES
Communications Setting
The ventilator may be connected to printer, a graphics monitor, or a modem. The
Communications Setting option is used to select the communications protocol for data
transmission.
1) Turn the Set Value knob until COM SETTING is displayed.
3) MONITOR or the currently selected protocol is displayed.

4) Turn the Set Value knob until the desired protocol is displayed.
®
Set Date
1) Turn the Set Value knob until SET DATE is displayed.

3) The current date is displayed in the currently selected date format.
4) Press the Control Lock button to exit, or continue to modify the Date.
To modify the Date:
1) Press the Select button, YEAR xxxx is displayed.
2) Turn the Set Value knob until the desired year is displayed.
3) Press the Select button, MONTH xx is displayed.
4) Turn the Set Value knob until the desired month is displayed.
5) Press the Select button, DAY xx is displayed.
6) Turn the Set Value knob until the desired day is displayed.
7) Press the Select button to accept the new date.
®
EXTENDED FEATURES
Set Time
1) Turn the Set Value knob until SET TIME is displayed.
3) The current time is displayed.

4) Press the Control Lock button to exit, or
To modify the Time:
1) Press the Select button, HOUR xx is displayed.
2) Turn the Set Value knob until the desired hour is displayed.
3) Press the Select button, MIN xx is displayed.
4) Turn the Set Value knob until the desired minute is displayed.
5) Press the Select button to accept the new time. The seconds are automatically
reset to 00.
®
Date Format
The Date Format option is used to select the display format for the current date.
1) Turn the Set Value knob until DATE FORMAT is displayed.
3) MM/DD/YYYY or the currently selected date format is displayed.
4) Turn the Set Value knob until the desired format is displayed.
®
EXTENDED FEATURES
PIP LED
1) Turn the Set Value knob until PIP LED is displayed.
3) PIP LED ON or PIP LED OFF is displayed.

®
Model Number / Serial Number
®
To view the LTV model number:
Turn the Set Value knob until LTV XXXX is displayed, where XXXX is
the model of the ventilator.
To view the LTV® serial number:

1) Press the Select button while LTV XXXX is displayed.
• The serial number is displayed on the left side of the display
area as XXXXXX, where XXXXXX is the serial number of the ventilator.
2) Press the Select button to return to the model number option.
To view LTM™ compatibility:
1) Press the Select button while LTV XXXX is displayed.
• LTM will be displayed if software and internal hardware in the
LTV® Ventilator are LTM™ compatible.
2) Press the Select button to return to the model number.
®
EXTENDED FEATURES
Valve Home Position
To view the valve home position:
Turn the Set Value knob until Vhome XXX is displayed, where XXX is the
home position for the flow valve installed in the ventilator.
Set Defaults
The Set Defaults option is only displayed and accessed through the VENT CHECK and
VENT MTNCE menus and is used to reset user settable Controls and Extended
Features settings to their factory-set default values. See Ventilator Checkout Tests,
Set Defaults for instructions on how to set default values and the LTV® Series
Ventilators Operator’s Manual for factory-set default values.
®
Exit
To return to the top of the VENT OP menu:
XDCR ZERO
This item is used to view the Transducer Autozero results and schedule the Transducer
Autozero to be run (please refer to the Operator’s Manual).
®
EXTENDED FEATURES
RT XDCR DATA
This menu displays the Real Time Transducer Data (please see the Service Manual for
more information).
EVENT TRACE
This menu displays the Events Codes stored by the ventilator (please see the Service
Manual for more information).
®
Exiting Extended Features
To return to Monitored Parameters:
3) Repeat Steps 1 and 2 until the Monitored Parameters are displayed.
®
USING AC/DC POWER
Using the AC Adapter
To run the ventilator from an external AC
power source.
1) Connect the power jack (straight or 90°)
from the AC adapter to the power port
(earlier version ventilators) or power port
pigtail connector (current version
ventilators) on the left side of the ventilator.
2) Connect the proper AC power cable (110
or 220 V plug) to the AC power adapter.
3) Connect the 110 or 220 V power cable to a suitable power source.
While the ventilator is plugged in, the internal battery is continuously charged.
CAUTION: Release Button – To avoid damaging the ventilator or the power connector,
press the release button on the connector before removing it from the ventilator power
port pigtail connector.
®
Using an External DC Power Source

To run the ventilator from an external DC power source.
1) Connect the power port of the external DC power adapter cable to the power port
on the left side of the ventilator (earlier version ventilators), or the power port pigtail
connector (current version ventilators).
2) Connect the DC jack to the DC power source.
®
POWER DISPLAYS AND INDICATORS
Indicators
Battery Level
The Battery Level indicator shows the level of available internal battery power while
running from the internal battery.
Approximate Battery Time

LED Color Battery Level
@ nominal settings
Green Internal battery level is acceptable 45 minutes
Amber Internal battery level is low 10 minutes
Red Internal battery level is critically low 5 minutes
Off Ventilator is running on AC or
External Battery
®
Indicators
Charge Status
When the ventilator is plugged into an External Power source, it automatically charges
the internal battery.
LED Color Charge Status

Flashing The ventilator is performing pre-charge qualification testing of the
Amber battery prior to starting the charge process. This happens when
external power is first applied to the ventilator. The qualification
process normally takes a few seconds but may take up to an hour
on a deeply discharged battery.
Green The internal battery is charged to full level.
Amber The battery has not reached a full charge level and is still charging.
Red The ventilator has detected a charge fault or internal battery fault.
The internal battery cannot be charged. Contact your Pulmonetic
Systems Certified Service Technician.
®
Indicators
External Power
The External Power indicator shows the level of external power while the ventilator is
operating from an external power source. When the ventilator is running from the
internal battery, the External Power indicator is off. When running from external power,
the indicator shows the following levels.
LED Color Power Level

Green External Power level is acceptable
Amber External Power level is low
External power may be provided by connecting the ventilator to an external battery or to
an external AC power source.
®
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®
ATTACHING A BREATHING CIRCUIT
How to attach a patient breathing circuit.
1) Connect the main breathing tube

to the 22 mm outlet port on the
right side of the ventilator.
2) Connect the two exhalation flow
transducer sense lines to the
ports marked Flow Xducer on the
right side of the ventilator. These
are non-interchangeable Luer
fittings.
3) Connect the Exhalation Valve
driver line to the port marked Exh
Valve on the right side of the
ventilator.
®
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®
OXYGEN COMPUTER CHART
®
Oxygen Computer Chart
To determine O2 Input Flow:

1) Find the desired FIO2 on the horizontal axis.
2) Project up to the minute volume.
3) Project horizontally to the left vertical axis and read the oxygen flow.
To determine O2 Concentration:
1) Find the O2 input flow on the vertical axis.
2) Project horizontally right to the minute volume.
3) Project vertically down to the horizontal axis and read the FIO2.
®
ALARMS
How to Silence and Reset Alarms
To silence an alarm, press the Silence Reset button.
To reset an alarm that has been corrected, press the Silence Reset button
again.
Alarm Cause Solution

APNEA XX bpm Occurs when the time since the last breath Reevaluate the
start exceeds the set Apnea Interval. When patient’s condition.
an Apnea alarm occurs, the ventilator will
enter Apnea Back up ventilation mode. Reevaluate ventilator
settings.
APNEA An Apnea alarm has occurred and cleared Reevaluate the

The ventilator is no longer in Apnea Back- patient’s condition.
up mode.
Reevaluate ventilator
settings.
®

BAT EMPTY Occurs when the ventilator is operating Attach the ventilator to
from the internal battery power and the external AC or DC
batter charge level is critically low. This power.
alarm can be temporarily silenced but
cannot be cleared.
BATTERY LOW Occurs when the ventilator is operating Attach the ventilator to
from internal battery power and the battery external AC or DC
charge level is low. power.
Reevaluate power
requirements.
DEFAULTS Occurs during POST when the ventilator Push the
detects an invalid setting stored in non- Silence/Reset button
volatile memory. twice to reset alarm.
settings.
DEFAULTS SET Occurs when the ventilator is first powered Push the
up after the SET DEFAULTS option has Silence/Reset button
been used to reset all controls and twice to reset alarm.
extended features settings to their factory- Reevaluate ventilator
set default values. settings.
®
Alarms

DISC/SENSE Occurs when the ventilator detects one of Check Patient Circuit
the following conditions: assembly for
• The patient circuit or proximal disconnects.
pressure sense line has become Check pressure
disconnected. sensing lines for
• The low side exhalation flow occlusions.
transducer sense line has become
disconnected.
• The proximal pressure sense line is
pinched or occluded.
HIGH O2 PRES Occurs when the average oxygen inlet Reduce O2 inlet
pressure exceeds the acceptable limit for pressure.
the type of oxygen source.
®

3
HIGH PEEP Occurs when the ventilator detects one of Reevaluate ventilator
the following conditions: settings.
• The patient circuit positive end Disassemble, clean
expiratory pressure (PEEP) exceeds and reassemble the
the High PEEP alarm setting. Patient Circuit,
• Patient Circuit, Exhalation valve Exhalation Valve and
and/or PEEP valve occluded. PEEP Valve.
HIGH PRES Occurs when the circuit pressure exceeds Reevaluate ventilator
the set High Pressure Limit setting. settings.
Inspect Patient Circuit
for occlusions or kinks.
Reevaluate patient.
HW Fault Occurs when the ventilator detects a If alarm reoccurs,
problem with the ventilator hardware. contact your Service
Rep or Pulmonetic
Systems.
3
The HIGH PEEP alarm is only available on ventilators with software version 3.15 or
higher installed.
®
Alarms

INOP A ventilator INOP occurs when: If an INOP alarm
• The ventilator is switched from On to occurs during
Standby. operation, remove
• The ventilator detects any condition ventilator from service
that is deemed to make the ventilator and contact your
unsafe. Service Rep.
LOCKED The LOCKED message is displayed when Press the Control Lock
a button is pressed while the controls are button.
locked. No audible alarm is given.
If locked alert
continues, press and
hold the Control Lock
button for three
seconds.
LOW MIN VOL Occurs when the exhaled minute volume is Examine Exhalation
less than the set Low Minute Volume. Valve body for
disconnects.
Reevaluate patient.
®

LOW O2 PRES Occurs when the average oxygen inlet Increase O2 inlet
pressure is less than the minimum pressure.
acceptable inlet pressure of 35 PSIG. If using O2 cylinder,
replace used cylinder
with a new one.
LOW PRES Occurs when the peak inspiratory pressure Examine Patient
for a machine or assist breath is less than Circuit for disconnect.
the Low Pressure setting. Reevaluate ventilator
settings.
Reevaluate patient.
NO CAL DATA, Occurs when the ventilator detects invalid Remove ventilator
NO CAL or missing calibration records on power up. from service, perform
Calibration procedure.
POWER LOST Occurs when the ventilator is operating on Evaluate power
external power and the voltage drops requirements.
below the useable level and switches to Attach ventilator to an
internal battery operation. external AC or DC
power source.
®
Alarms

POWER LOW Occurs when the ventilator is operating on Evaluate power
external power and the voltage drops to the requirements.
low level.
REMOVE PTNT Occurs when the ventilator is powered up Ensure patient is
in the Ventilator Checkout or Ventilator disconnected from
Maintenance modes. The ventilator is not ventilator and is being
delivering gas. ventilated by
alternative means.
RESET A RESET alarm occurs if the ventilator May be caused by
restarts following a condition other than Internal Battery
being shut down by pressing the depletion during
On/Standby button. operation 4 or ESD. If
the problem reoccurs,
remove from service
and contact your
Service Rep or
Pulmonetic Systems
4
Only available on ventilators with software version 3.13 or higher installed.
®

XDCR FAULT Occurs when a transducer autozero test Press Silence/Reset
fails. button twice to reset
alarm. If problem
occurs frequently,
remove from service
and contact your
Service Rep. or
Pulmonetic Systems.
®
Pulmonetic Systems®
17400 Medina Rd., Suite 100
Minneapolis, Minnesota 55447-1341
Tel: (763) 398-8500

(800) 754-1914
Fax: (763) 398-8400
www.Pulmonetic.com
Appendix C
LTV® 1200/1150 Series Ventilators
ASSISTANCE
Cardinal Health
Pulmonetic Systems
Customer Care: (800) 754-1914

(763) 398-8500
Fax: (763) 398-8403
Website: www.cardinalhealth.com/viasys
®
P/N 18409-001, Rev. A LTV 1200/1150 Ventilator ii
Quick Reference
LTV® 1200/1150
Appendix C
Appendix C
LTV® 1200/1150 Series Ventilators
Notes
Quick Reference
LTV® 1200/1150
Appendix C
ASSISTANCE
Cardinal Health
Pulmonetic Systems

(763) 398-8500
Fax: (763) 398-8403
Website: www.cardinalhealth.com/viasys
®
P/N 18409-001, Rev. A LTV 1200/1150 Ventilator ii
TABLE OF CONTENTS
Table of Contents:
Front and Side Panel Reference ................................................................................. 1

Front Panel Display and Description.......................................................................... 1
Side Panel Descriptions............................................................................................. 3
Turning the Ventilator On and Off .............................................................................. 5
Turning the Ventilator On .......................................................................................... 5
Turning the Ventilator Off .......................................................................................... 6
Variable Controls.......................................................................................................... 7
SETTING UP MODES OF VENTILATION..................................................................... 9
Setting Up Assist/Control Mode................................................................................. 9
Setting Up SIMV Mode ............................................................................................ 11
Setting Up CPAP Mode ........................................................................................... 13
Setting Up NPPV Mode ........................................................................................... 15
Monitored Data ........................................................................................................... 17
Extended Features ..................................................................................................... 19
SBT (Spontaneous Breathing Trial)......................................................................... 21
®
P/N 18409-001, Rev. A LTV 1200/1150 Ventilator iii
Using AC/DC Power ................................................................................................... 25

Using the AC Adapter.............................................................................................. 25
Using an External DC Power Source....................................................................... 26
Power Displays and Indicators ................................................................................. 27
Attaching a Breathing Circuit.................................................................................... 30
Oxygen Computer Chart............................................................................................ 31
Alarms ......................................................................................................................... 33
®
P/N 18409-001, Rev. A LTV 1200/1150 Ventilator iv
Front Panel Display and Description (LTV® 1200 shown)
®
P/N 18409-001, Rev. A LTV 1200/1150 Ventilator 1
A - Mode and Breath Selection – Selects ventilation modes, and selects breath
types.
B - On/Standby Button – Turns the ventilator “On” or to “Standby”.
C - Variable Control Settings – Sets and displays each ventilation characteristic.
D - Display Window – Displays Alarm Messages, Monitored Data, and Extended
Features menus.
E - Airway Pressure Display – Displays real-time airway circuit pressure.
F - Patient Effort Indicator – LED is lit briefly each time a patient trigger is detected.
G - Power Source – Displays power source and charge levels.
H - Variable Alarm Settings – Sets and displays variable alarm levels.
I- Alarm Silence/Reset – Silences audible alarms. Clears visual alarms.
J - Set Value Knob – Changes variable control settings. Navigates Extended
Features.
K - Special Controls – Activates special controls such as Manual Breath, Low
®
Pressure O2 Source (LTV 1200 only), Insp/Exp Hold and Control Lock feature.
L - PEEP – PEEP control setting and display.
®
Side Panel Descriptions
®
A - 22mm Outlet Port – Patient Breathing Circuit outlet port.

B - Flow Xducer – Flow Transducer high pressure sensing port.
C - Flow Xducer – Flow Transducer low pressure sensing port.
D - Exh Valve – Exhalation Valve drive line port.
E - Alarm Sounder Port
F - Cooling Fan
G - DC Input – DC power port pigtail connector.
H - Patient Assist – Patient Assist Call jack.
I- Comm Port – Communications port.
J - O2 Inlet – Oxygen Inlet fitting.
K - Filter – Air Inlet.
®
TURNING THE VENTILATOR ON AND OFF
Turning the Ventilator On
1) Push the On/Standby button.
If the Patient Query feature is enabled/on when the ventilator is
powered up, ventilation and alarm activation are suspended and the message SAME
PATIENT is displayed.
• To enable the suspended alarms and begin ventilation with the settings in use
during the last power cycle, press the Select button while SAME PATIENT is
displayed.
• To enable the suspended alarms and begin ventilation with Preset values
appropriate for a new patient, turn the Set Value knob until NEW PATIENT is
displayed and press the Select button. Then turn the Set Value knob until the
desired patient type is displayed (INFANT, PEDIATRIC or ADULT) and press the
® ®
Select button (see the LTV 1200 or LTV 1150 Operator’s Manual, Chapter 10,
for detailed settings and information).
If the Patient Query feature is disabled/off when the ventilator is powered up and
passes POST, it will begin ventilation (appropriate alarms enabled) using the settings in
use during the last power cycle.
®
Turning the Ventilator Off
To turn the ventilator off:

1) Disconnect the patient from the ventilator.
2) Press and hold the On/Standby button for 3 seconds. The ventilator
ceases operating, the audible alarm sounds continuously and the Vent
Inop LED is lit.
3) Press the Silence/Reset button to silence the audible alarm.
• Verify a confirming audible chirp is activated immediately after the
alarm is silenced.
4) The ventilator continues to charge the internal battery as long as it is connected to
an external power source.
Note: The Vent Inop LED will remain lit for a minimum of 5 minutes and does not
impact battery life.
®
VARIABLE CONTROLS
®
To set a variable control:

1) Select the control by pressing the associated button. The display for the selected
control will be displayed at normal brightness and all other control displays will be
dimmed.
2) Change the control value by rotating the Set Value Knob. Rotate
clockwise to increase and counter-clockwise to decrease the value.
3) The new control value goes into effect when the operator:
• Presses the selected button again, or
• Selects another control, or
• Presses the Control Lock button, or
• Waits 5 seconds
All controls will then return to their normal brightness.
®
Setting Up Assist/Control Mode
®
Setting Up the Ventilator in Assist/Control Mode:
Select Volume or Pressure, as desired.
5) If Pressure ventilation is selected, set the Pressure Control.
6) Set the Inspiratory Time. The calculated peak flow Vcalc is displayed in the
window while Inspiratory Time is being changed. Vcalc only applies to volume
ventilation.
®
9) Set the High Pres. Limit alarm.
11) Set the Low Min. Vol. alarm.
12) Adjust the PEEP control.
®
Setting Up SIMV Mode
®
To set the Ventilator up in SIMV mode:
2) Press the Select button to toggle between Volume and Pressure ventilation.
Select Volume or Pressure, as desired.
5) If Pressure ventilation is selected, set the Pressure Control.
6) Set the Inspiratory Time. The calculated peak flow Vcalc is displayed in the
window while Inspiratory Time is being changed. Vcalc only applies to volume
ventilation.
8) Set O2% (LTV® 1200 only).
®
Setting Up CPAP Mode
®
To set the ventilator up in CPAP mode:

2) Press the Select button twice to toggle between Volume and Pressure ventilation
for Apnea backup. Select Volume or Pressure for Apnea backup.
3) Set the Breath Rate to Off (dashes “- -“).
4) If Volume ventilation is selected, set the Tidal Volume for Apnea backup. The
calculated peak flow Vcalc is displayed in the window while Tidal Volume is being
changed.
5) If Pressure ventilation is selected, set the Pressure Control for Apnea backup.
6) Set the Inspiratory Time for Apnea backup. The calculated peak flow Vcalc is
displayed in the window while Inspiratory Time is being changed. Vcalc only
applies to volume ventilation.
8) Set O2% (LTV® 1200 only).
11) Set the Low Pressure alarm for Apnea backup.
®
Setting Up NPPV Mode
®
To set the Ventilator up in NPPV mode:
Set any desired Extended Features options and:

1) Push the Assist/Control, SIMV/CPAP mode button until the NPPV LED flashes.
Press the button once more to confirm. The NPPV LED continues to flash and
SET IPAP displays. The Pres. Support control display is bright and all other
controls dim.
2) Turn the Set Value knob to adjust the IPAP value (shown in Pres. Support LED
window). Press the Pres. Support button to confirm, SET EPAP will display. The
PEEP control display is bright and all other controls are dim.
3) Turn the Set Value knob to adjust the EPAP value (shown in the PEEP LED
window). Press the PEEP button to confirm.
4) The PEEP button push confirms NPPV operation and LED then turns solid.
®
®
MONITORED DATA
The monitored data displays may be automatically scrolled or manually scrolled. To
cycle through the available monitored data automatically from a halted scan, press the
Monitor Select button (left of display window) twice. Pressing the Select button once
while scan is active shall halt scanning and the currently display monitor shall remain in
the display window. Each time you press the button once; the next data item in the list
will be displayed. To resume scan, press the Select button twice within 0.3 seconds.
The monitored data is displayed in the following order:
Display Description
PIP Displays the Peak Inspiratory Pressure measured during the
inspiratory phase. PIP is not updated for spontaneous breaths.
MAP Displays a running average of the airway pressure for the last 60
seconds.
PEEP Displays the pressure in the airway circuit at the end of exhalation.
f Displays the breaths per minute and includes all breath types.
Vte Displays the exhaled tidal volume as measured at the patient wye.
VE Displays the exhaled tidal volume for the last 60 seconds as calculated
from the last 8 breaths.
®
Display Description
I:E Displays the ratio between measured inspiratory time and measured
exhalation time. Both normal and inverse I:E Ratios are displayed.
I:Ecalc Displays the ratio between the set Breath Rate and Inspiratory Time.
The display is updated in real-time while the Breath Rate setting is
being changed.
Vcalc Is based on the Tidal Volume and Inspiratory Time settings. Displayed
when selected and whenever Tidal Volume or Inspiratory Time is
selected for change.
SBT min Displays the time remaining until the number of minutes preset in the
SBT OP, MINUTES menu have elapsed. (Only displayed in the SBT
mode of ventilation.)
f/Vt f f/Vt is computed every time the Total Breath Rate (f) or Total Minute
Volume (VE) is calculated. (Only displayed when SBT mode is
selected.)
®
EXTENDED FEATURES
Navigating the Extended Features Menus:
To enter the Extended Features menu (in normal ventilation mode),

press and hold the Monitor Select button for three seconds.
To view the next item in a menu, turn the Set Value knob
clockwise.
To view the previous item, turn the Set Value knob counterclockwise.
To enter a menu item or select a setting, press the

Select button.
To exit a menu, turn the Set Value knob until the EXIT option is displayed, then press
the Select button or press Control Lock.
®
®
EXTENDED FEATURES
SBT (Spontaneous Breathing Trial)
Using the Spontaneous Breathing Trial option you can temporarily minimize ventilatory
support and perform clinical assessments of a patient’s dependence on, or ability to be
removed from positive pressure ventilation. SBT mode should be used only while
attended by a Respiratory Therapist or other properly trained and qualified personnel
(please refer to the LTV® 1200 or LTV® 1150 Operator’s Manual, Chapter 10, for more
information).
When the Spontaneous Breathing Trial mode is turned on (SBT ON selected);
• The ventilator switches to CPAP mode.

• Pressure Support and FiO2 control settings on the front panel are overridden
with the values preset in the SBT OP menus.
• The High Breath Rate alarm (HIGH f) in the ALARM OP menu is disabled (as
long as the SBT mode is on).
®
EXTENDED FEATURES
To modify the Spontaneous Breathing Trial settings:
1) Turn the Set Value knob until SBT START is displayed, push
the Select button, and SBT OFF or SBT ON is displayed.
Turn the Set Value knob until the desired setting is
displayed, and push the Select button.
• When SBT ON is selected, the Spontaneous Breathing Trial
ventilation mode is turned on using the current SBT menu settings. If the SBT
menu settings were not previously reset, the factory set default settings will be
used. All SBT menu settings are to be reviewed for applicability and/or
set as necessary, prior to selecting the SBT ON menu option.
• When the Spontaneous Breathing Trial ventilation mode is active and SBT
OFF is selected, the Spontaneous Breathing Trial ventilation mode is
terminated and ventilation returns to the previously set modes/settings.
®
2) SBT Menu Options
SBT OP
SBT START
PRES SUPPORT
PEEP
®
SBT FIO2 (LTV 1200 only)
MINUTES
HIGH f/Vt
LOW f/Vt
SBT HIGH f
SBT LOW f
DISPLAY f/Vt
EXIT
Turn the Set Value knob until desired SBT menu option is displayed, push the
Select button and the value setting is displayed.
Turn the Set Value knob until the desired setting is displayed, push the Select
button, and the desired value is set.
®
EXTENDED FEATURES
Exiting Extended Features
To return to Monitored Parameters:

3) Repeat Steps 1 and 2 until the Monitored Parameters are displayed.
®
USING AC/DC POWER
Using the AC Adapter
To run the ventilator from an external AC
power source.
1) Connect the power jack (straight or 90°)
from the AC adapter to the power port
pigtail connector on the left side of the
ventilator.
2) Connect the proper AC power cable (110
or 220 V plug) to the AC power adapter.
3) Connect the 110 or 220 V power cable to a
suitable power source.
While the ventilator is plugged in, the internal battery is continuously charged.
CAUTION: Release Button – To avoid damaging the ventilator or the power connector,
press the release button on the connector before removing it from the ventilator power
port pigtail connector.
®
Using an External DC Power Source

To run the ventilator from an external DC power source.
1) Connect the power port of the external DC power adapter cable to the power port
pigtail connector on the left side of the ventilator.
2) If applicable, connect the DC jack to the DC power source.
®
Indicators
Battery Level
The Battery Level indicator shows the level of available internal battery power while
running from the internal battery.
Approximate Battery Time

LED Color Battery Level
@ nominal settings
Green Internal battery level is acceptable 45 minutes
Amber Internal battery level is low 10 minutes
Red Internal battery level is critically low 5 minutes
Off Ventilator is running on AC or
External Battery
®
Indicators
Charge Status
When the ventilator is plugged into an External Power source, it automatically charges
the internal battery.
LED Color Charge Status

Flashing The ventilator is performing pre-charge qualification testing of the
Amber battery prior to starting the charge process. This happens when
external power is first applied to the ventilator. The qualification
process normally takes a few seconds but may take up to an hour
on a deeply discharged battery.
Green The internal battery is charged to full level.
Amber The battery has not reached a full charge level and is still charging.
Red The ventilator has detected a charge fault or internal battery fault.
The internal battery cannot be charged. Contact a Pulmonetic
Systems Certified Service Technician.
®
Indicators
External Power
The External Power indicator shows the level of external power while the ventilator is
operating from an external power source. When the ventilator is running from the
internal battery, the External Power indicator is off. When running from external power,
the indicator shows the following levels.
LED Color Power Level

Green External Power level is acceptable
Amber External Power level is low
External power may be provided by connecting the ventilator to an external battery or to

an external AC power source.
®
ATTACHING A BREATHING CIRCUIT

How to attach a Patient Breathing
Circuit.
1) Connect the main breathing tube
to the 22 mm outlet port on the
right side of the ventilator.
2) Connect the two exhalation flow
transducer sense lines to the
ports marked Flow Xducer on the
right side of the ventilator. These
are non-interchangeable Luer
fittings.
3) Connect the Exhalation Valve
driver line to the port marked Exh
Valve on the right side of the
ventilator.
®
OXYGEN COMPUTER CHART
®
Oxygen Computer Chart
To determine O2 Input Flow:

1) Find the desired FiO2 on the horizontal axis.
2) Project up to the minute volume.
3) Project horizontally to the left vertical axis and read the oxygen flow.
To determine O2 Concentration:
1) Find the O2 input flow on the vertical axis.
2) Project horizontally right to the minute volume.
3) Project vertically down to the horizontal axis and read the FiO2.
®
ALARMS
How to Silence and Reset Alarms
To silence an alarm, press the Silence Reset button.
To reset an alarm that has been corrected, press the Silence Reset button
again.

APNEA XX bpm Occurs when the time since the last breath Reevaluate the
start exceeds the set Apnea Interval. When patient’s condition.
an Apnea alarm occurs, the ventilator will
enter Apnea Back up ventilation mode. Reevaluate ventilator
settings.
APNEA An Apnea alarm has occurred and cleared Reevaluate the

The ventilator is no longer in Apnea Back- patient’s condition.
up mode.
settings.
®

BAT EMPTY Occurs when the ventilator is operating Attach the ventilator to
from the internal battery power and the external AC or DC
batter charge level is critically low. This power.
alarm can be temporarily silenced but
cannot be cleared.
BAT LOW Occurs when the ventilator is operating Attach the ventilator to
from internal battery power and the battery external AC or DC
charge level is low. power.
Reevaluate power
requirements.
DEFAULTS Occurs during POST when the ventilator Push the
detects an invalid setting stored in non- Silence/Reset button
volatile memory. twice to reset alarm.
settings.
DEFAULTS SET Occurs when the ventilator is first powered Push the
up after the SET DEFAULTS option has Silence/Reset button
been used to reset all controls and twice to reset alarm.
extended features settings to their factory- Reevaluate ventilator
set default values. settings.
®
Alarms

DISC/SENSE Occurs when the ventilator detects one of Check Patient Circuit
the following conditions: assembly for
• The patient circuit or proximal disconnects.
pressure sense line has become Check pressure
disconnected. sensing lines for
• The low side exhalation flow occlusions.
transducer sense line has become
disconnected.
• The proximal pressure sense line is
pinched or occluded.
HIGH f Occurs when the Total Breath Rate (f) Check Patient Circuit
exceeds the high breath rate and time assembly for leaks.
period alarm values. Check HIGH f alarm
values.
HIGH O2 PRES Occurs when the average oxygen inlet Reduce O2 inlet
(LTV® 1200 only) pressure exceeds the acceptable limit for pressure.
the type of oxygen source.
®

HIGH PEEP Occurs when the ventilator detects one of Reevaluate ventilator
the following conditions: settings.
• The patient circuit positive end Disassemble, clean
expiratory pressure (PEEP) exceeds and reassemble the
the High PEEP alarm setting. Patient Circuit,
• Patient Circuit, Exhalation valve Exhalation Valve and
and/or PEEP valve occluded. PEEP Valve.
HIGH PRES Occurs when the circuit pressure exceeds Reevaluate ventilator
the set High Pressure Limit setting. settings.
Inspect Patient Circuit
for occlusions or kinks.
Reevaluate patient.
HW Fault Occurs when the ventilator detects a If alarm reoccurs,
problem with the ventilator hardware. contact your Service
Rep or Pulmonetic
Systems.
®
Alarms

INOP A ventilator INOP occurs when: If an INOP alarm occurs
• The ventilator is switched from On to during operation,
Standby. remove ventilator from
• The ventilator detects any condition service and contact
that is deemed to make the ventilator your Service Rep.
unsafe.
LOCKED The LOCKED message is displayed when Press the Control
a button is pressed while the controls are Lock button.
locked. No audible alarm is given.
If locked alert
continues, press and
hold the Control Lock
button for three
seconds.
LOW MIN VOL Occurs when the exhaled minute volume Examine Exhalation
is less than the set Low Minute Volume. Valve body for
disconnects.
Reevaluate patient.
®

LOW O2 PRES Occurs when the average oxygen inlet Increase O2 inlet
(LTV® 1200 only) pressure is less than the minimum pressure.
acceptable inlet pressure of 35 PSIG. If using O2 cylinder,
replace used cylinder
with a new one.
LOW PEEP Occurs when the patient circuit Positive Reevaluate ventilator
End Expiratory Pressure (PEEP) is less settings.
than the Low PEEP alarm setting. Disassemble, clean
and reassemble the
Patient Circuit,
Exhalation Valve and
PEEP Valve.
LOW PRES Occurs when the peak inspiratory pressure Examine Patient
for a machine or assist breath is less than Circuit for disconnect.
the Low Pressure setting. Reevaluate ventilator
settings.
Reevaluate patient.
NO CAL DATA, Occurs when the ventilator detects invalid Remove ventilator
NO CAL or missing calibration records on power up. from service, perform
Calibration procedure.
®
Alarms

POWER LOST Occurs when the ventilator is operating on Evaluate power
external power and the voltage drops requirements.
below the useable level and switches to Attach ventilator to an
internal battery operation. external AC or DC
power source.
POWER LOW Occurs when the ventilator is operating on Evaluate power
external power and the voltage drops to the requirements.
low level.
REMOVE PTNT Occurs when the ventilator is powered up Ensure patient is
in the Ventilator Checkout or Ventilator disconnected from
Maintenance modes. The ventilator is not ventilator and is being
delivering gas. ventilated by
alternative means.
®

RESET A RESET alarm occurs if the ventilator May be caused by
restarts following a condition other than Internal Battery
being shut down by pressing the depletion or ESD. If
On/Standby button. the problem reoccurs,
remove from service
and contact your
Service Rep or
Pulmonetic Systems
SBT < f These alarms are only active in the
SBT > f Spontaneous Breathing Trial (SBT) mode
SBT < f/Vt of ventilation (see the LTV® 1200 or LTV®
SBT > f/Vt 1150 Operator’s Manual, Chapter 9, for
more information on each alarm setting).
SBT OFF
XDCR FAULT Occurs when a transducer autozero test Press Silence/Reset
fails. button twice to reset
alarm. If problem
occurs frequently,
remove from service
and contact your
Service Rep. or
Pulmonetic Systems.
®
Cardinal Health
Pulmonetic Systems

(763) 398-8500
Fax: (763) 398-8403
www.cardinalhealth.com/viasys
Notes
On the CD
33 Glossary of Terms 33 Oximeter Teaching Checklist
33 Identification and Preparation Tool 33 Troubleshooting Guide
33 Preparation for ICU Discharge 33 Emergency Contacts and Planning
33 Preparation for Hospital Discharge 33 Useful Web Resources
33 Home Ventilation & Tracheostomy Care 33 Emergency Preparedness Guide for People
(for Adults) with Disabilities/Special Needs
33 Non-Invasive Positive Pressure Ventilation 33 Assistive Devices Program Equipment/
(for Adults) Supply Authorization Form
33 Home Ventilation and Tracheostomy Care 33 Quick Reference Guide to LTV® 900, 950 &
(for Paediatrics) 1000 Series Ventilators
33 Pulmonary Clearance Techniques 33 Quick Reference Guide to LTV® 1200/1150
33 Routine Tasks Series Ventilators
33 My Education Checklist and Learning Log
Resource CD
Partners
Funding provided by
180 Dundas Street West, Suite 2103

Tel: 416-591-7800
Fax: 416-591-7890
Toll free: 1-800-261-0528
Web site: www.crto.on.ca

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Optimizing

A Training Manual for

Section #2: Healthcare Professionals

Section #3: Patients/Clients & Caregivers

Pulmonary Clearance Techniques Emergency Contacts and Planning

Section #4: Appendices

Assistive Devices Program

Section #1: Introduction & Glossary of Terms

Section #2: Healthcare Professionals

Discharge Identification & Preparation

Section #3: Patients/Clients & Caregivers

Non-Invasive Positive Pressure Oximeter Teaching Checklist

Pulmonary Clearance Techniques Emergency Contacts and Planning

Section #4: Appendices

Assistive Devices Program

Section #1: Introduction &

Introduction to the Manual

If a patient cannot be weaned off the ventilator they are

There is also a Troubleshooting Guide, as an additional reference. For those patients on

There are other tools and checklists to help you

A Cardiopulmonary resuscitation (CPR):

M Retractions: Pulling or jerky movement of

Trach Ties: Cotton twill or Velcro tapes used to

Section #2: Healthcare Professionals

Evaluation and Discharge Planning

Assessment of the Home Environment

Assessment includes geographic location, available space, and accessibility.

Caregivers must be motivated and able to learn the care routines.

 Patient is able and willing to supervise/direct care

Education and Training

This includes professional services, support systems, individual’s financial resources.

 Adequate financial resources and mechanisms for reimbursement identified prior to

A written management plan for respiratory, medical care, and emergencies.

First Team Meeting

Primary aims of this meeting are:

 Determine the short and long term goals

 Individual  Speech Language Pathologist

Primary aims of this meeting are:

 Determine if discharge to home or community facility is achievable

Primary aims of this meeting are:

 Monitor progress toward goals

Placement Considerations in the Home

Adequate Daily Care Coverage

Home Mechanical Ventilators

A VAI discharged to the community is provided with:

Other Respiratory Supplies

 Apnea cardiorespiratory monitors  Tracheostomy supplies

Other Medical Supplies

Individual, Home Care Providers and Family Education

A successful discharge requires a simplified and comprehensive transfer of care routines

Information provided in respiratory teaching packages typically should cover:

 Tracheostomy and ventilator care

The training should include, but is not limited to:

 Respiratory anatomy and physiology  Use of the manual resuscitator bag

Emergency Plan and Recommended Physician Coverage

The individual's wishes regarding resuscitative efforts should be addressed and be

The individual must have:

For those caregivers wishing for Cardiopulmonary Resucsitation (CPR) certification,

Communication and Transfer of Information to Community Providers

Decrease Invasive Monitoring