Ventilation Support

Breathing depends on muscles, nerves and the brain working together to move air in and out of the lungs. When these are weakened or damaged, a person may not breathe deeply enough to keep oxygen up and carbon dioxide down. This lesson explains in simple terms why some participants need a ventilator. Key points: common reasons include neuromuscular conditions such as motor neurone disease and muscular dystrophy, high level spinal cord injury and some neurological conditions; some people use ventilation only overnight, others all day; and a ventilator supports breathing but does not treat the underlying condition.

Ventilation can be delivered in two broad ways. Non invasive ventilation uses a mask or mouthpiece over the nose, mouth or both. Invasive ventilation delivers air through a tracheostomy tube placed in the windpipe through the front of the neck. This lesson explains the difference in general terms. Key points: non invasive ventilation is often used overnight and the person can usually remove the mask; invasive ventilation is used when a person needs long term or full time support or cannot protect their airway; and each person's settings are prescribed and must never be changed by support workers.

Ventilator management is one of the high intensity daily personal activities in the NDIS Practice Standards, and the NDIS Commission's High Intensity Support Skills Descriptors describe, in general terms, the knowledge and skills workers need for it. This lesson explains how this applies to you. Key points: this course builds knowledge only; you must be trained on the person's specific equipment and plan and assessed as competent by a qualified health practitioner; you must follow the ventilation and emergency plans exactly; you must never change settings; and you must know the person's emergency steps before you work alone with them.

Non invasive ventilation uses a ventilator, a circuit of tubing, often a humidifier, filters and an interface such as a mask. This lesson introduces the parts of a typical set up in general terms and the daily checks you may be trained to do. Key points: know each part of the person's equipment and what it does; check the machine, circuit, humidifier and mask are clean, connected and undamaged before use; use only the type of water the plan names in the humidifier; and follow the manufacturer's and plan's cleaning and replacement schedules.

A well fitted mask keeps ventilation effective and comfortable. A poorly fitted one leaks air or presses too hard on the skin. This lesson covers mask fitting and skin care in general terms. Key points: fit the mask exactly as you were trained, with headgear snug but not tight; check for leaks, especially towards the eyes; check the bridge of the nose, cheeks and behind the ears for redness or broken skin; report pressure areas, sore eyes or a dry mouth; and never change the mask type or size without advice from the health team.

Ventilation affects communication, eating, sleep, comfort and independence. This lesson looks at how to support the person as a whole while they use non invasive ventilation. Key points: agree a way for the person to communicate while the mask is on; know whether the person can remove their own mask and, if not, how to remove it quickly in an emergency; understand the vomiting and choking risk with full face masks; follow the plan on eating, drinking and positioning; and respect the person's routines and preferences around ventilation.

Invasive ventilation delivers air through a tracheostomy tube, which is inserted through an opening in the front of the neck into the windpipe. This lesson explains the set up in general terms. Key points: the air bypasses the nose and mouth, so it must be warmed and moistened by a humidifier or a heat and moisture exchanger; many ventilated people have a cuffed tube; the circuit connects the ventilator to the tracheostomy; a disconnection can quickly become life threatening; and tracheostomy care should only be carried out by workers trained and signed off to do it.

People on invasive ventilation need regular checks of the person, the tracheostomy and the equipment. This lesson outlines, in general terms, the daily care you may be trained to provide. Key points: check the person's breathing, colour, comfort and alertness; check the circuit is secure and not pulling on the tracheostomy; drain condensation away from the person if trained; manage secretions and suction only if trained and signed off; support positioning and mouth care; and follow strict hand hygiene and cleaning practices.

Living with invasive ventilation affects how a person talks, eats, moves around and takes part in community life. This lesson focuses on the person behind the equipment. Key points: many people with a tracheostomy cannot use their voice in the usual way, so have their communication method always within reach; speaking valves and cuff changes are only used as the plan directs; with a portable ventilator, charged batteries and spare equipment people can go out and enjoy life; and treat the person, not the machine, as the focus of your support.

Ventilator alarms warn that something may be wrong with the person or the equipment. Alarm names and settings vary between machines, so participant specific training on the actual device is essential. This lesson describes common alarm types in general terms. Key points: high pressure alarms often mean resistance to air flow, such as secretions, coughing or a kinked tube; low pressure or disconnection alarms often mean a leak or a loose connection; power and battery alarms warn of a power supply problem; and alarm settings are prescribed and must never be turned off or changed.

When a ventilator alarm sounds, your first priority is always the person, then the equipment. This lesson describes a general approach to responding, which your participant specific training and the person's plan will make specific to their machine. Key points: go to the person immediately; check their breathing, colour and distress; then check the circuit from the person back to the machine; fix simple causes such as a disconnected tube only as trained; follow the plan's emergency steps if the person is in distress; call triple zero if the person is not breathing adequately; and report every significant alarm.

Recording and reporting alarms helps the health team adjust the plan and equipment before a serious problem occurs. This lesson covers what to record after an alarm and when to report. Key points: record the alarm, the time, what you found and what you did; report any alarm that needed more than a simple fix, alarms that keep happening, and any time the person was distressed; report faulty equipment to the supplier contact in the plan and your team leader; and complete an incident report if the person was harmed or at risk of harm.

Every person who uses a ventilator needs a written emergency plan that everyone supporting them knows well. This lesson explains what an emergency plan usually contains and the emergency equipment that should always be with the person. Key points: the plan covers what to do if the person becomes distressed, the ventilator fails, the circuit disconnects or the tracheostomy is blocked or dislodged; emergency equipment such as a manual resuscitation bag, a backup ventilator where prescribed, suction and spare tracheostomy tubes must be checked every shift; and only trained workers use this equipment.

Ventilators depend on electricity, so every person needs a plan for power failures, both planned outages and unexpected ones such as storms and bushfires. This lesson covers the basics. Key points: households with life support equipment can register with their electricity retailer, who must then give notice of planned outages, but registration does not guarantee power during unplanned outages; internal and external batteries must be kept charged; the plan should say how long batteries last and what to do when they run low; and severe weather and emergencies need planning in advance.

A breathing emergency can happen suddenly, whether from equipment failure, a blocked airway or an illness. This lesson brings together how to recognise and respond to one in general terms. It does not replace a nationally accredited first aid certificate. Key points: call triple zero early and tell them the person uses a ventilator; follow the person's emergency plan; use emergency equipment only if trained; start CPR if the person is unresponsive and not breathing normally, as taught in your first aid course; hand over the plan and medical details to paramedics; and report and debrief afterwards.