APPENDIX 1

Bronchoaspiration

Materials

Disposable gloves

Sterile 12/14 mm Ø aspiration tubes

Aspirator

Procedure / Date / Date / Date
1 / Wear disposable gloves
2 / Replace the inner cannula (only if fenestrated)
3 / Connect aspiration tube to the aspirator (Don’t take it off the packaging)
4 / Turn on the aspirator
5 / Take aspiration tube off the packaging
6 / Disconnect patient from ventilator
7 / Insert 1/3 of aspiration tube’s length
8 / Draw extracting tube with circular movements from the cannula
9 / Replace inner cannula (only if necessary)
10 / Reconnect patient to ventilator
11 / Roll up aspiration tube into the glove
12 / Dump everything in special containers
13 / Wash connection tube with water and Euchlorine or another suitable disinfectant
14 / Turn off the aspirator

Please pay attention

  • Wash hands before and after procedure
  • Never use the same aspiration tube for more than one procedure
  • Never place the connection tube in contact with the ground

APPENDIX 2

Trachestomy tube management

Materials

Disposable gloves

Inner cannula cleaning container

Pipe cleaner

Saline water

Sterile gauzes

Important

If the patient has no respiratory autonomy, substitute the inner cannula with another one before starting the cleaning procedure.

Procedure Date
1 / Place the patient in half sitting position, avoiding cannula traction
2 / Bronchoaspiration
3 / Mouth cleaning with gauzes and mouthwash
4 / Inner cannula cleaning
a. Wear disposable gloves
b. Rotate and take off the inner cannula without tractions
c. Clean it with a soft pipe-cleaner and saline
d. If it is especially dirty dip into hot water
e. Dry it with sterile gauzes
f. Repose correctly the inner cannula
  • Wash hands before and after procedure

APPENDIX 3

APPENDIX 4

Cough assist machine use

Materials

1 cough assist machine

1 power cable

1 antibacterial filter

1 connection circuit

1 mask or catheter mount

Procedure Date
1 / Correctly positioning the machine and connect the power cable to electric current
2 / Connect the circuit:
a. / Connect the antibacterial filter
b. / Attach the connection pipe to the circuit
c. / Attach an oronasal mask or a catheter mount at the other extremity of the pipe
3 / Place the patient in half-sitting position
4 / If the patient is tracheostomized check the cuff resting of the cannula.
Substitute the fenestrated inner cannula
5 / Set command to AUTO
6 / Set insufflation, exsufflation and pause times as medical or physiotherapy prescription
7 / Verify inspiration/exspiration pressures closing the tube and re-set them if necessary
8 / Connect the patient to the circuit through mask or catheter mount
9 / Turn on the machine
10 / Check if patient’s chest is expanding during insufflation
11 / Perform cough assistance with abdominal thrust during expiration
12 / Repeat 4-6 cough cycles (insufflation
and exsufflation)
13 / If necessary repeat from point 8 for maximum 5 times
14 / Turn off the machine

APPENDIX 5

Oxygen Saturation Level Measurement

The saturation can be easily monitored by a pulse oximeter applied to the finger of the patient.

A pulse oximeter is a medical device that indirectly monitors the oxigen saturation of a patient's blood.

Acceptable normal ranges are from 94 to 100 percent .The patient could have an inferior level of saturation because of his patology.

Danger levels: decrease of oxygen saturation of 3 points from patient baseline value, or if you have not this data, consider danger level <90%. If the level of saturation is permanently under this value and if it is not caused by lower extremity hypothermia or positioning errors of the device contact the family doctor.

If the saturation level is very low (< 80%) it is necessary to call emergency ambulance service.


YOUR BASELINE VALUE IS______


APPENDIX 6

Ventilator use

Materials

1 Ventilator

1 Circuit with condensation container

1 Humidifier

1 Humidifier chamber

1 Antibacterial filter (if present)

1 Catheter mount

1 Oxygen tube

Procedure Date
1 / Online / Battery level check
2 / Ventilator’s connection / disconnection
3 / Circuit check (Expiratory valve, Oxygen, pressure)
4 / Humidifier functioning (Heating level, water level)
5 / Condensation container emptying
6 / Antibacterial filter changing
7 / Catheter mount changing
8 / Ventilator cleaning
9 / Circuit/Humidifier chamber changing
10 / Filter washing
11 / Oxygen tube changing

The consumables’ change time is dependent on the local health service