Things I do with my ventilator that you might Unconventional!

As the user of an LTV ventilator, I do some pretty unconventional things with it that really help me with both humidification, AND with airway clearance. Now, I want to begin by  the insertion of a DISCLAIMER!!

DISCLAIMER: This info is personally what I do for myself. It is not, being used to administer medical advice, and should not be taken as such. If you have questions about your own Techniques I strongly advise you to talk to your Medical Dr. And/Or your DME provicer. What I'm stating below is what I do and works for me, however what i do, is not sutable for Everybody, as variables are different from patient to patient. NO TWO PATIENTS ARE THE SAME. Thank you, and God Bless.

So first we'll talk about the T-Piece simulator, or the TPS!

Some of you might know what a T-Piece is, some of you might not, but to explain it thoroughly, I need to first explain to you the Trach collar as many of you trach patients, or caregivers/parents/loved ones, of a trach patient probably know what this device is.

If you or somebody you know had ever been connected to a loud compressor who's drone may also be combined with a heating up of the room from this machine which in my case Is a plus, and you noticed a blue or clear hose coming from a bottle to possibly a drainage bag or some other device that drains excesscondensation, which also connects to another tube that might be clear or blue, and that goes to a clear ish device that strapped around your or the other person's neck where the trach tube is located, chances are, this is a trach collar, and what it is doing is providing cooled or warmed gases depending on the absence or presence of a heated humidifier, to the patient's trach to keep their trach moist. The presence of a trach tube means that if it is not capped well the patient is breathing air into the trach which bypasses the humidification aspect of your nose and mouth, and so this air will be dry and could and most likely will make secretions thicker. This increases the risk of plugging, and discomfort to the patient. So to prevent this, you might be placed on a trach collar, or a T-Piece. The Trach collar, sometimes also known as the Trach Mask or Trach Shield is there to keep moisture in the airways, and to prevent plugging, and discomfort. In the hospital, the drone of the compressor will most likely be replaced by the hissing of an oxygen or air supply, because most likely the wall supply will be used as the gas source for the patient's humidification. This means that there really  is not the need for the compressor if you have a wall oxxygen and/or medical air supply. So Now that we've discussed the trach  collar, Let's discuss a T-Piece which is what I preferred for my humidification when I was in the hospital, and what I still would rather have.

The  T-Piece is shaped like a T, and connects to the blue/clear tubing that would usually connect to the trach collar, or another typeof mask. This is connected directly to the tracheostomy tube, and also allows for In-Line Suction systems to be placed so that suctioning does not have to be an open system. The T-Piece does exactly what the trach collar does which is humidifies the airways. So now that we've discussed the trach collar, and the T-Piece Let's discuss what I mean by T-Piece Simulator.

OK, In the short bursts of time I get off my vent when I'm not receiving breaths, I can turn the breath rate off by setting it to dashes, and then set a very small level of pressure Support above the PEEP so that I'm just getting enough Gas Flow to  humidify my airways. This is what I call the T-Piece Simulator, or the TPS. I'd actually asked my DME for a T-Piece but well the RT did not even understand what I was talking about, so I got the standart old Trach collar. That thing gets so annoying to me and actually hurts my neck sometimes, so using the T-Piece simulator not only Humidifies my airways, but in the instance i forget to breathe, as I Often do, the ventilator will go into APNEA VENTILATION and will alarm. So this is what getting off the vent means for me usually. It's much more comfortable than my Trach Collar, and I can hear my music better without the Drone of the compressor that gets in the way of the music I listen to sometimes. It's so much more pleasant because I don't get moisture around my trach which can increase the risk of break down.


MY SIMULATED IPV:

All right, now this is rather complicated for people who may not be ventilator users or may not understand the vent very much, however I will explain to you what IPV is first and then how I do it since My DME doesn't even have IPV machines.

OK, So WHAT  IS IPV? This is short for Intrapulmonary Percussive Ventilation. It's a device that delivers 100-300 breaths per minute of nebulized medication to help loosen up secretions, and can also be used to administer nebulized Saline Solution. Well, what I  do with my ventilator may not reach up to 100 much less 300 Breaths Per Minute, however it is as good as it's going to get. It's not like I have my own Oscillator, but if I did WOOOOOH, that would be AWESOMELY AWESOME!! OK, so what i do is  place my Nebulizer in Line with my Ventilator Circuit and then I actually Place my vent into Pressure Control, and after setting the Inspiratory Time to 0.3 Seconds, I max out the Respiratory Rate on the ventilator at 80 breaths Per Minute.

This is one minus about the LTV, and that is it does not go up to 100 like ventilators such as the Drager Evita XL, does, but Hey, It goes up to 80 which is better than what I have heard the Trilogy does which is 60!

NOTE: I AM SO THANKFUL, that I did not get a Trilogy. Thank you Dear Lord!!

Anyhow, once I do this,  I increase the PEEP and the Inspiratory Pressures  to get MAPs around 30 and 35cmH2O whilst the Nebulizer is administering the Nebulized medication.

This is not very comfortable, because as I've said In a previous blog post a while back, I am very very comfortable at the High range of what my Ventilator can provice for me.

Once my Nebulizer treatment has finished, I suction, and then I go back to the conventional ventilator settings which are still rather high, but not  the IPV like settings.



I also perform some recruitment Maneuvers as well, but I'm not going to go into detail about those.

These procedures that I have listed are very carefully performed and are VERY comfortable.

When I'm at home I'm  on the vent essentially all the time, however when I'm off It's usually with the TPS.

Thank you so much for listening or reading this blog Post, and May God bless you, and Keep you and your family, as well as all of your friends.

Remember, ONLY HE, can Love you PERFECTLY!!