Weaning Protocol - PowerPoint

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					                     Weaning Protocol
      (Aim to start early, so you have the whole day)
                        Reduce or stop sedation                  Monitor
                                                                 patient’s O2
                   Mode - BIPAP/SIMV/ASB/Evita 2 or              sats
                           BIPAP/ASB/Evita 4                     Resp rate
                          FiO2 ≤ 45% PEEP ≤5cm                   TV 5ml/kg
                                                                 Is pt stable?
             Reduce rate by 2 breaths - monitor patients         Any
                                                                 concerns

                     Tolerated? See criteria
                                                                 review with
                                                                 Anaesthetist

             YES                         NO
  Reduce rate by 2 breaths -
       Monitor patient
                                     Reverse most recent
                                  NO change and monitor
 Are ABG within normal limits for
          the patient?
                                             patient
Is pt stable and tolerating changes

                    YES               NO
  Reduce rate by 2 breaths -
monitor pt, is change tolerated?                  Time and speed of
                                                  reducing rate depends
                    YES               NO          on the patient. If not
   Continue to reduce rate by 2                   tolerated well, go slower.
     breaths till on 6 breaths                    If patient wakes up
Is pt stable and tolerating change?               quickly, hasn’t been
                                                  ventilated long and is
                                                  coping well, it may be
    Consider CPAP/ASB via
                                                  possible to increase the
   ventilator - See CPAP/ASB
                                                  speed of weaning - liase
             protocol
                                                  with Senior Nurse.
   Rachel Imeson
   Review Date:
   February 2004
            CPAP ASB Weaning Protocol
        Is patient stable and tolerating CPAP/ASB after 1 hour?
                               YES                           NO
   Reduce ASB by 2 at intervals
   (depending on pt) till ASB is on 10
                                                     Reverse most recent
                                                     change and monitor
   Is patient stable and tolerating                  patient
   changes?
   Are ABGs within normal limits?                                NO

                                          YES
            CPAP 5cm                       OR                        T piece trial/or
                                                                     trachy mask
                               (review with Anaesthetist as it
                                depends on patient and how
                                  they have weaned - if no
    Tolerated?                 problems, T piece trial will be
                                     more appropriate.)
                                                                     Tolerated?

   YES               NO                                      YES                NO
CPAP 5cm        Reverse most                         Assess with             Reverse most
overnight       recent change                        Anaesthetist            recent
                                                                             change(consider
T piece trial   Rest Patient                                                 CPAP)
                                                    Extubate
in am
                                                    patient (or if
                                                    tracheostomy)
                Once rested, try again
                increasing time on CPAP
                as tolerated until patient
                is ready for T piece trial          NB: If Tracheostomy in, make
                or consider CPAP 2.5cm              plans to deflate cuff, decannulate &
                before T piece trial.               remove with anaesthetist.
     Rachel Imeson
     Review Date:
     February 2004
                           Definitions
            Tolerated – observations to monitor
Look at patient, do they look unsettled/tired/stressed?
Is respiratory rate below 35bpm & above 8bpm?
Are O2 saturations above 90%? (or as appropriate for patient)
Are ABGs acceptable for the patient?
Is PaO2 / FiO2 ratio >27.5kpc?
Is TV 5ml/kg?
Is patient cardiovasculary stable?
Is patient settled and showing no signs of fatigue?
Is respiratory rate/TV ratio <105 breaths/min (spontaneous rate for
1 min divided by the TV in Litres)
Signs of fatigue are:
           Decreasing TV
           Increasing respiratory rate
           Changes in blood gases
           Decreases in O2 saturations
           Tachycardic
           ECG changes
           Hypertension
           Breathlessness
           Use of accessory muscles
           Changes in conscious levels
           Sweating
     Inform Anaesthetist and discontinue weaning if any
                      changes noted.
Document: All changes on ventilator and check ventilator changes
with another nurse.

Rachel Imeson
Review Date:
February 2004
           Nurse Led Weaning
             Project Process
Identified need for protocol:
          Patients not assessed prior to
          weaning
          Weaning not always continued
          at a weekend
          Process not consistent
          Decision to Wean can be
          delayed
          Weaning not nurse led

Mapped current patients’ weaning process
Contacted other Units within Network &
throughout the country for currently used
nurse-led weaning protocols
Performed literature search
Developed a Protocol to be followed
during weaning
Devised Assessment Tool to ensure
patients are ready to be weaned
Devised Individual Weaning plan to
 Rachel Imeson
record agreed plan and the progress the
 Review Date:
patients make
 February 2004

				
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