Passy-Muir PMV 005 Mode D'emploi page 11

VALVE PLACEMENT
FOR USE WITH
VENTILATOR DEPENDENT
PATIENTS
PASSY-MUIR TRACHEOSTOMY
SPEAKING VALVE CONNECTS
DIRECTLY TO
TRACHEOSTOMY TUBE
WITH 15MM HUB
VALVE PLACEMENT
WITH STANDARD SWIVEL
ADAPTER
WARNING: IF THE PATIENT EXPERIENCES DIFFICULTY UTILIZING THE PMV, THE PATIENT
MAY HAVE AIRWAY OBSTRUCTION DUE TO STENOSIS, MASS, TRACHEOMALACIA,
GRANULATION, VOCAL CORD PARALYSIS IN THE MIDLINE POSITION, SECRETIONS,
OR A TRACHEOSTOMY TUBE THAT IS OVERSIZED FOR THE PATIENT'S TRACHEA.
WITH CORRECTION OF THE OBSTRUCTION, THE PATIENT SHOULD BE RE-
EVALUATED FOR PMV USE.
5. Airway Pressures: Airway pressures may rise when patients use the PMV due to
exhalation through the oronasopharynx which creates (natural) physiologic PEEP. This
is part of the natural physiology restored with a closed respiratory system created by
the positive closure "no leak" design of the PMV. Consequently, mechanical PEEP
requirements may be reduced. In addition, normal turbulent airflow through the tubing
is increased, creating higher pressures. Although airway pressures may rise, they
should be within allowable limits for a patient.
When peak pressures are above the allowable limits, the PMV needs to be removed
immediately and assessment for upper airway patency performed. In addition, due to
a slight increase in airway pressure experienced by some patients with PMV use, it is
necessary as with any modification to the ventilator circuit to re-evaluate low pressure
settings for disconnect to ensure that settings are appropriate.
6. Ventilator Alarm Settings: All alarms on ventilators need to be re-evaluated for
appropriate adjustments before, during and after use of the PMV.
WARNING: FAILURE TO RE-EVALUATE AND ADJUST VENTILATOR ALARMS MAY
COMPROMISE PATIENT SAFETY.
When the PMV is placed in-line with the ventilator, the patient will no longer be exhaling
into the ventilator circuit. Therefore, on most acute care ventilators the high and low
tidal volume, the high and low minute volume and the apnea alarms must be
reassessed. High and Low pressure alarm settings on the ventilator must be
reassessed at this time (e.g., making them more sensitive for disconnect and
obstruction) to ensure patient safety. Follow manufacturer's recommendations
for ventilator self testing (e.g., a short EST should be performed with circuit
changes on some acute care ventilators).
7. Monitoring and Removal of PMV: Observe the patient with the PMV in place to ensure
the patient has adequate airflow around the tracheostomy tube. If patient exhibits signs
of respiratory distress, remove PMV immediately and reassess for airway patency. To
remove PMV, take PMV out of ventilator circuit and replace with original set up. Return
ventilator to all previous settings before reinflating tracheostomy tube cuff.
PMV
Fig.6
Adult Tube w/
WITH PMV 005, PMV
2000 OR PMV 2001,
WIDE MOUTH SHORT
FLEX TUBING SLIDES
OVER VALVE
15mm hub
Fig. 5
9
Fig.5
WITH PMV 007,
CONNECT
DIRECTLY TO
DISPOSABLE
TUBING
ADAPTER CONNECTS
SHORT FLEX TUBING TO
RESPIRATORY LINE
15mm Adapter
Pediatric Tube w/
15mm Inner Cannula