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

                     Tolerated? See criteria
                                                                 review with

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

            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.)

   YES               NO                                      YES                NO
CPAP 5cm        Reverse most                         Assess with             Reverse most
overnight       recent change                        Anaesthetist            recent
T piece trial   Rest Patient                                                 CPAP)
in am
                                                    patient (or if
                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
            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
           ECG changes
           Use of accessory muscles
           Changes in conscious levels
     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 not always continued
          at a weekend
          Process not consistent
          Decision to Wean can be
          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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