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Florence Yap, Ho Oi Man, Gavin Joynt, Charles Gomersall
Avoid splashing of respiratory secretions
- high quality heat and moisture exchange bacterial/viral filter (HMEF) at Y-piece
- high quality hydrophobic bacterial/viral filter at expiratory port
- scavenge expiratory gases
- avoid breaking ventilator circuit if possible
- if breaking the ventilator circuit is unavoidable turn ventilator to
standby mode prior to breaking the circuit
- use disposable ventilator circuits
- avoid nebulizers and heated water humidifiers
- ensure cuff of endotracheal tube is adequately inflated
- high quality hydrophobic bacterial/viral filter
- between mask and bag of
self-inflating resuscitator (eg Ambu bag or Laerdal bag)
- at expiratory port
- this may require the addition of a custom made adaptor as well as
expiratory gas divertor
- filters should be discarded (as clinical waste) immediately after use
- minimize use of bag-valve-mask ventilation. If essential, should be
carried out by two members of staff
- one person holds mask tightly against patient's face
- other person squeezes bag gently
- CPR when only two people are available:
- person responsible for chest compressions will also squeeze the
bag at a ratio of 15 compressions: 2 breaths
Tracheal suction
- Avoid open suctioning of airway secretions
- Use closed tracheal suction
- keep suction tubing connected to closed-suction catheter
Non-invasive ventilation
- avoid non-invasive ventilation through BiPAP ventilator due to
inability to filter or scavenge expiratory gases and air leak around
mask
Oxygen masks
- avoid Venturi masks. Use simple face masks, nasal cannulae or non-rebreathing
masks
- avoid nebulizers. Consider use of metered dose inhalers with spacers (eg
Aerochamber)
Intercostal drains
- high quality hydrophobic bacterial/viral filter at the outlet of the
underwater seal
Peak flow
- avoid peak flow measurements
© Florence Yap, Ho Oi Man, Gavin Joynt, Charles Gomersall,
September 2003, January 2004 |
