Care Fusion 3100B Pocket Manual

Pocket guide

3100B high frequency
oscillatory ventilator

This clinician’s guide describes equipment set-up and patient management procedures

for the 3100B High Frequency Oscillatory Ventilator (HFOV).

Warning

Do not use this pocket guide as a substitute for (1) reading and understanding

the operator’s manual, (2) as a substitute for being properly trained or (3) as a

substitute for competency using the 3100B High Frequency Oscillatory Ventilator.

Use this document as a guideline for initiating and managing the patient on

HFOV. Management of a patient on the 3100B HFOV must be altered based on the

patient’s individual clinical needs. This document is not intended to be used as a

substitute for clinical experience or medical guidance.

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Contents

Indications and contraindications .......................................................................................1

Things to consider before placing the patient on HFOV ...................................................4

Pre-use checklist ...................................................................................................................6

Patient circuit calibration ....................................................................................................8

Ventilator performance check ...........................................................................................10

Initial settings and management ......................................................................................12

Managing oxygenation and ventilation ...........................................................................16

Assessment of the patient on HFOV .................................................................................18

Documentation of oscillator settings ................................................................................21

Weaning HFOV and transitioning to conventional ventilation ......................................22

Transitioning to conventional ventilation ........................................................................23

Troubleshooting .................................................................................................................24

Recruitment maneuvers for adult patients on HFOV ......................................................34

Cuff leak procedure ...........................................................................................................36

Outcome assessment form .................................................................................................41

Useful information .............................................................................................................42

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Indications and contraindications

Indications

The 3100B High Frequency Oscillatory Ventilator is indicated for use in the ventilatory

support and treatment of selected patients weighing 35 kilograms and greater with

acute respiratory failure.

Contraindications

The 3100B High Frequency Oscillatory Ventilator has no specific contraindications.

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Identifying patients for high-frequency oscillatory ventilation

Patients with ALI or ARDS, weighing 35 kilograms or greater, who are currently

failing on conventional ventilation with a protective lung strategy, will benefit from

HFOV. The following criteria are generally used for determining the feasibility of

using HFOV.

• FiO2 ≥ 60, PEEP ≥ 10 with a P/F ratio < 200

• Plateau pressure > 30 cmH2O

• Presence of bilateral infiltrates on the chest x-ray consistent with ARDS

• Oxygenation index > 24

Note:

Several clinical papers and randomized control trials have
demonstrated that the earlier application of HFOV on patients with
severe ARDS may be important for successful outcomes.

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The Multicenter Oscillatory Ventilation for Acute Respiratory Distress Syndrome Trial1

(MOAT2) excluded severe COPD and asthma patients from the RCT trial of the 3100B

HFOV. High frequency oscillatory ventilation is recognized as less effective in diseases

with increased airway resistance and using it in such cases may potentially result in air

trapping and hyperinflation.

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Things to consider before placing the patient on HFOV

• Hemodynamic status:

– The patient should be hemodynamically stable with a mean arterial pressure

of at least 75 mmHg

– If mean arterial pressure is less than 75 mmHg, consider fluids and/or

vasopressors to optimize the hemodynamic status before starting

the oscillator

• Obtain ABG

– Ideally, pH should be greater than 7.2

– If pH is less than 7.2, consider correcting with a buffer for the transition

• Patient’s sedation status:

– You may need to consider sedation and neuromuscular blockades for

transition—due to the fixed Bias Flow of the device, patients are unable to

actively breathe and maintain a stable airway pressure and lung volume

– Once transitioned, patients may be able to be maintained on sedation only

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• Ensure the patient has had a recent chest x-ray

• Consider the type of mattress the patient is on—you should have the ability to

firm up the mattress if needed

• Verify whether the patient requires an off-unit procedure such as a CT scan or

MRI; if this is the case, consider doing the off-unit procedure before placing

the patient on HFOV

• If using an in-line suction catheter, ensure the fit to the circuit and suction

patient before placing on HFOV

• Give a brief explanation of HFOV to the family and patient to prepare them

for noise, chest wiggle, etc.

• If lung recruitment maneuvers are not part of your ventilation protocol, speak

with the physician to consider Treatment with Oscillation and Open Lung

Strategy (TOOLS)

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Pre-use checklist

1. Connect the source gases to system.

2. Connect the power to system.

3. Check that the patient circuit support is installed on the system.

4. Connect the patient circuit and the humidifier to the system.

5. Connect the patient circuit control and pressure sense lines to the system.

6. Turn on the power.

7. Check that the source gas lights are off.

8. Check that the start/stop light is off.

9. Check that the alarm silence light is on.

10. Perform the patient-circuit calibration described in the following section.

11. Perform verification performance.

12. Perform the alarm-check procedure as described in the Operators Manual.

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13. Preset the flow, frequency, % inspiratory time, power and running mean

airway pressure.

14. Set the Max Paw and Min Paw switches.

15. Set the blender and humidifier controls for the desired operation.

16. Remove the stopper from the patient circuit and connect it to the

patient’s ET tube.

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Patient circuit calibration

Perform the patient circuit calibration procedure before ventilating a patient.

Each circuit that is used on the oscillator must be calibrated. The circuit calibration

procedure verifies the circuit is leak-free and will hold pressure. Perform this

procedure before placing a patient on the 3100B HFOV and anytime a circuit

component is changed.

1. Insert the stopper in the patient circuit wye and turn on the bias flow gas.

2. Rotate the ADJUST control to Max.

3. Set the Max Paw Alarm to 59 cmH2O.

4. Set the bias flow to exactly 20 LPM (the middle of the ball is at the line—you may

need to bend down to see this accurately.).

5. Depress and hold RESET (Oscillator OFF).

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6. Observe the mean pressure display and adjust the patient circuit calibration screw

for a reading of 39 to 43 cmH2O.

a. Before adjusting the calibration screw, confirm there are no leaks, the bias

flow is at 20 LPM and the circuit is set up correctly. See the troubleshooting

guide for more information.

b. Use caution when adjusting the calibration screw. Do not over tighten or

apply excessive force because equipment damage may occur.

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Ventilator performance check

The ventilator performance check ensures the 3100B HFOV is functioning properly.

Perform this procedure before placing a patient on the 3100B HFOV. Insert the

stopper in the patient circuit wye and turn on both gas sources.

1. Turn the Adjust control to the 12 o’clock position.

2. Set the bias flow at 30 LPM.

3. Pressurize the system by pressing and holding Reset and Adjust for a mean

pressure of 29 to 31 cmH2O.

4. Set the frequency to 6.0 Hz, % I–time to 33 and press START/STOP to start

the oscillator.

5. Set the power to 6.0.

6. Observe the following parameters using the appropriate altitude range and verify

they fall within the ranges specified.

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Verify the following parameters according to the altitude of your hospital.

Altitude (feet)

0 to 2,000 26 to 34 113 to 135

2,000 to 4,000 26 to 34 104 to 125

4,000 to 6,000 26 to 34 99 to 115

6,000 to 8,000 26 to 34 86 to 105

mPAW (cmH2O) P (cmH2O)

Note:

See troubleshooting on pg. 22 for additional information.

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Initial settings and management

1. Set bias flow between 25 to 40 LPM.

Patients with severe air-leak syndrome or cuff leak may require higher set Bias

Flow to achieve the desired mPaw.

2. Set the initial mean airway pressure (mPaw) at 5 cmH2O pressure above the

conventional ventilator mPaw.

a. You may consider a recruitment maneuver first if the patient is extremely

hypoxic by applying 40 cmH2O for 40 to 60 seconds.

b. If oxygenation worsens, increase mPaw in 3 to 5 cmH2O increments every

30 minutes until the maximum setting is reached.

Note:

Oxygenation typically may worsen in the first 30 minutes of
recruitment in severe ARDS.

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