1. MechanicalMechanical
VentilationVentilation
With the LTVWith the LTV®®
12001200
Ventilator:Ventilator:
Applications forApplications for
EMSEMS

2. LTVLTV®®
’s Versatile Applications’s Versatile Applications
• Adult & Pediatric (> 5kg)
• Invasive (ETT, King LT, or Combitube) or
Non-Invasive (Mask) Ventilation
• Emergency and Non-emergency Transport
• Long-Term Care
• Rehab
• Homecare

3. LTVLTV®®
1200 Ventilators1200 Ventilators
Small & Light Weight
• 3” x 10” x 12”
• Weighs less than 15 pounds
• Built-in turbine;
no compressor or 50 psi
air source needed
• Multiple power options

4. Indications for UseIndications for Use
• The majority of the time the LTV 1200 will be used
during the transport of a patient already supported by
a ventilator
• Emergency patients for whom the ventilator may be
used:
– Cardiac and/or Respiratory Arrest (apnea)
– Respiratory Failure (inadequate rate and/or volume)
– Impending Respiratory Failure (multiple causes)
– Patients already on a vent with unassociated problems

5. Mechanical VentilationMechanical Ventilation
The BasicsThe Basics

6. Ventilation vs. OxygenationVentilation vs. Oxygenation
• Ventilation is the movement of gas into and
out of the lungs and does not necessarily
provide oxygenation.
(e.g. a patient with no heart beat or circulatory support is not
being oxygenated by simply blowing oxygen into their lungs.)
• Oxygenation is the delivery of oxygen to the
blood and tissue level of the patient and does
not necessarily require ventilation.
(e.g. a patient on heart-lung bypass is being oxygenated without
any ventilation of the lungs)

7. Of Course …Of Course …
• Humans usually provide oxygen to their
system by ventilating themselves (breathing)
with air which includes approximately 21%
oxygen.
• A functioning circulatory system will send
enough blood flow past the alveoli in the
lungs to adequately absorb oxygen and
excrete CO2.

8. and . . .and . . .
• A decrease in blood oxygenation (hypoxemia)
or increase in blood carbon dioxide levels
(hypercarbia) will increase the body’s need
for ventilation.
↑CO2 and/or ↓ O2 = ↑ Respiratory Drive
Need for More Ventilation

9. Mechanical VentilationMechanical Ventilation
Definition
• Mechanical ventilation is the use of a
mechanical device to inflate and deflate the
lungs.
Purpose
• Mechanical ventilation provides the force
needed to deliver air to the lungs in a patient
whose own ventilatory abilities are diminished
or lost.

10. Mechanical VentilatorsMechanical Ventilators
Range of devices:
Bag-Valve-Mask
Emergency Vents
Transport Vents
Homecare Vents
Critical Care Vents

11. Pressure vs. Volume VentilationPressure vs. Volume Ventilation
• Ventilating Pressure is controlled and the
resulting tidal volume is based on the
physical size of airways and lungs and the
patient’s lung compliance (stiffness).
or
• Tidal Volume is controlled and the
resulting pressure is based on the physical
size of airways and lungs and the patient’s
lung compliance (stiffness).

12. ““Modes” of Ventilation on the LTV 1200Modes” of Ventilation on the LTV 1200
• AC – Assist/Control
• SIMV - Synchronized Intermittent Mandatory
Ventilation
• PSV - Pressure Support Ventilation (PSV)
• CPAP – Continuous Positive Airway Pressure
• NPPV – Non-Invasive Positive Pressure
Ventilation (a.k.a. Bi-Level)

13. Assist / Control VentilationAssist / Control Ventilation
• A minimum number of mandatory breaths per
minute is set, the breaths are given at either a
set tidal volume or a set pressure. The patient
may breath faster than the set rate, but the
breaths will be measured and may be assisted
in order to reach the set tidal volume or set
pressure.
– Example: The ventilator is set to a rate of 8. The patient
will get at least 8 “controlled” breaths per minute, but the
ventilator can respond to patient effort and “assist” with
additional breaths, all at the set tidal volume or pressure.

14. Assist / Control VentilationAssist / Control Ventilation
• If patient DOES NOT have any spontaneous
respiration's, then the patient will receive the set
number of breaths at either the set pressure or the set
tidal volume each minute.
• If the patient DOES try to initiate a spontaneous
breath, the patient will receive the set tidal volume or
pressure.
Time
Pressure
• Machine-initiated and/or
patient-initiated breaths are
all delivered at the set
parameters (volume or
pressure)
Controlled breath Assisted breath
Patient effort

15. Basic Assist / Control SettingsBasic Assist / Control Settings
• Breath Rate
• Tidal Volume or Pressure Control level
• Inspiratory Time (or Peak Inspiratory Flow rate)
• Oxygen %
• PEEP
• Sensitivity

16. PSV - Pressure Support VentilationPSV - Pressure Support Ventilation
• The patient’s spontaneous breathing effort is
supported to a set positive pressure from the
ventilator.
• There are no mandatory breaths from the
ventilator. Patient effort determines respiratory
rate, inspiratory time, peak flow, and tidal
volume

17. PSV - Pressure Support VentilationPSV - Pressure Support Ventilation
• Goals
– Overcome the work associated with moving
gas through the artificial airway and circuit
– Improve patient/ventilator synchrony
– Augment spontaneous tidal volume
10cm
Time
Pressure
Patient effort
Pressure Support Setting

18. Basic PSV SettingsBasic PSV Settings
****THE PATIENT MUST HAVE ADEQUATE
SPONTANEOUS RESPIRATORY EFFORT
• PSV
- Range 5-25 cmH2O (typical)
• PEEP
• FiO2

19. Assist / Control vs. Pressure SupportAssist / Control vs. Pressure Support
Assist / Control
• Set Tidal volume or set
Pressure
• Breaths may or may not be
spontaneous
• Tidal Volume, inspiratory
time, flow rate, and minimal
set breathing rate are
determined by clinician
Pressure Support
• Set Pressure assist level
• All breaths are spontaneous
• Patient determines
respiratory rate, inspiratory
time, peak flow, and tidal
volume

20. Spontaneous breath
SIMV –SIMV – Synchronized Intermittent Mandatory VentilationSynchronized Intermittent Mandatory Ventilation
• This ventilation mode provides a mixture of mandatory
(controlled) and spontaneous breath types.
• The LTV will give and/or “sync” with enough breaths to
achieve the set breathing rate; the patient may breath
in between these mandatory breaths, but the “in
between” breaths will not be assisted
Time
Pressure
Synchronized machine breath
Patient effort
Machine breath

21. Basic SIMV SettingsBasic SIMV Settings
• Breath Rate
• Tidal Volume or Pressure Control level
• Inspiratory Time
• Oxygen %
• PEEP
• Sensitivity
Time
Pressure
Synchronized machine breath
Patient effort

22. PEEP and CPAPPEEP and CPAP
• Definition:
– PEEP = Positive End Expiratory Pressure
– CPAP = Continuous Positive Airway Pressure
PEEP: a technique of assisting breathing by increasing the air
pressure in the lungs and air passages near the end of
expiration so that an increased amount of air remains in
the lungs following expiration
CPAP: a technique of assisting breathing by maintaining the
air pressure in the lungs and air passages constant and
above atmospheric pressure throughout the breathing
cycle

23. PEEP and CPAPPEEP and CPAP
Function:
** Functionally, CPAP and PEEP do the same thing:
Splint open airways and alveoli - Increases
functional residual capacity (FRC)
• Improves oxygenation
• Redistributes lung water from alveoli to
perivascular space (very beneficial in CHF
and Pulmonary Edema patients)

24. CPAPCPAP
• CPAP is actually not a mode of “ventilation”
as CPAP does not move gas into and out of
the patient. CPAP requires a spontaneous
breathing patient.
Paw
SpontaneousSpontaneous Spontaneous Spontaneous

25. CPAPCPAP
• CPAP machines used for obstructive sleep
apnea are typically used to “splint” upper
airway structures open, but have the same
effect as CPAP on the ventilator.

26. Sensitivity:Sensitivity:
Understanding how the vent cyclesUnderstanding how the vent cycles
• Sensitivity determines when the ventilator will
recognize a patient’s inspiratory effort.
• The LTV 1200 offers flow sensitivity.

27. Flow SensitivityFlow Sensitivity
Flow
Sensors

28. SensitivitySensitivity
Ventilator delivers a low level of constant flow
(10 lpm) into the patient circuit. This is called
the “bias” flow.
Delivered flowReturned flow
No patient effort

29. SensitivitySensitivity
• As the patient begins to inhale, some of this
constant flow is diverted to the patient.
• Change in flow in the vent circuit will cause
the vent to “cycle” and deliver gas to patient.
Delivered flowLess flow returned

30. SensitivitySensitivity
• Sensitivity is usually set 2-3 liters per minute in the
hospital.
• May require slightly higher setting during transport in
field to avoid “auto-cycling” of the ventilator.
Delivered flowLess flow returned
Setting too low can
cause auto-cycling of the
ventilator (usually due to
leak in system)
Setting too high can
“lock out” patient from
being able to “trigger”
any spontaneous
breaths

31. Ventilator AlarmsVentilator Alarms
• High airway pressure
• Low airway pressure
• Low minute volume
• Apnea

32. Ventilator Alarms-Ventilator Alarms- High pressure limitHigh pressure limit
– Setting High Pressure Limit Alarm:
• Usually set within 10 cmH2O above
patient’s average Peak Pressure.
• *** When activated, ventilator will
terminate breath and the patient does
not receive full tidal volume

33. Ventilator Alarms-Ventilator Alarms- High pressure limitHigh pressure limit
• Causes of high pressure alarm violation:
– Resistance to gas flow:
• kinks in tubing or monitoring lines
• patient coughing
• secretions
• bronchospasm
• gagging, “fighting the ventilator”
– Decrease in lung compliance:
• atelectasis
• pneumothorax
• pulmonary edema

34. Ventilator Alarms-Ventilator Alarms- Low Pressure AlarmLow Pressure Alarm
– Setting Low Pressure Alarm:
• 5-8 cmh2o less than ventilating pressure

35. Ventilator Alarms-Ventilator Alarms- Low Pressure AlarmLow Pressure Alarm
• Causes of Low Pressure Alarms:
– Cuff Leak
– Vent Circuit
• Check tubing for holes or kinking
• Check monitoring lines for tight fit or kinking
(Leur connections can become loose)
• Check connection at “Y” connector
– If using a Ballard suction device, check that all
connections are secure (cap for saline port)
– Vent not meeting patient’s inspiratory need
(A/C)

36. Ventilator Alarms-Ventilator Alarms- Low minute volumeLow minute volume
Definition:
Minute volume = total volume of breaths
over 1 minute time
e.g. 10 breaths per minute x 600 ml per breath = minute
volume of 6000 ml 6.0 L minute volume
– Setting Low Minute Volume:
• Set 3 Liters under patient’s minute volume, with
a minimal setting of 5L/m.
• Ensures adequate alveolar ventilation is
maintained.

37. Ventilator Alarms-Ventilator Alarms- Low minute volumeLow minute volume
– Causes of Low Minute Volume alarms:
• Neuro changes (A/C or PSV)
• Sedation issues (A/C or PSV)
• Patient fatigue (PSV)
• Decrease in compliance (PSV)
• High pressure alarm active and ventilator
dumps delivered tidal volume (A/C or PSV)

38. Ventilator AlarmsVentilator Alarms
• Apnea Parameters
– Activated when no exhalation is detected for a
selected time period (e.g. 20 seconds)
– Tidal volume and pressure control level should
be set appropriately for patient, as these will
be used for apnea ventilation.

39. Key PointsKey Points BEFOREBEFORE TransportingTransporting
– See how the patient is interacting with their
current vent
• If in A/C
– Breathing Rate
– Minute Volume
– Peak Pressures
– Peak Flow on the hospital vent?
– Sensitivity

40. Key PointsKey Points BEFOREBEFORE TransportingTransporting
– See how the patient is interacting with their
current vent
• If in PSV
– Breathing Rate
– Spontaneous tidal volumes
– Minute Volume
– Sensitivity

41. Key PointsKey Points BEFOREBEFORE TransportingTransporting
– Talk to the patients therapist and nurse:
• Secretions
– (If already in place, keep the in-line suction
device attached to the patient when you go)
• Weaning schedule or ventilator goals for this patient
• Any “Quirky” respiratory patterns
– example: pt will breath 50 times per minute
when he/she gets anxious.
– See what relieves the “quirkiness” (changing
modes, settings, favorite medication,
reassurance, etc)

42. Key PointsKey Points WhileWhile TransportingTransporting
– Set alarms appropriately
• if set appropriately, alarms can alert you to
subtle changes before they become large
problems.
– Monitor patients vent parameters
• Minute Volume (A/C or PSV)
• Peak Pressure (A/C)
• Tidal Volumes (PSV)
– Anticipate what changes you would make if
patients vent needs change?

43. LTV 1200 Ventilator SetupLTV 1200 Ventilator Setup
Overview

44. LTV 1200 Ventilator Setup - OverviewLTV 1200 Ventilator Setup - Overview
• Making the connections
• Turning the unit ON
• Adjusting the settings
• Extended Menus
• Monitoring the patient
• Turning OFF and processing the unit

45. THE LTV 1200 VENTILATORTHE LTV 1200 VENTILATOR

46. Front Panel OverviewFront Panel Overview

47. Left Side Panel OverviewLeft Side Panel Overview
Cooling
Fan
Power and
Communication
Connections
High/Low
Pressure O2
connection
Turbine Intake
Filter

48. Power SourcesPower Sources
• External AC Adapter 120VAC/12VDC
• External Lithium Ion Battery 12V (3 hours)
• Internal Battery (1 hour)

49. Lithium Ion BatteryLithium Ion Battery
Lithium Ion Battery in
pocket of Backpack
carrying case

50. Oxygen SourceOxygen Source
• The LTV 1200 can be used with either a 50-
PSI oxygen source or with Low Pressure
oxygen.

51. Oxygen SourceOxygen Source – 50 PSI– 50 PSI
• A 50 PSI Oxygen source allows you to use
the internal oxygen-air blender to set a
specific O2% from 21-100%.
• The 50 PSI source can be from a regulated
oxygen cylinder or off the ambulance or
hospital wall source.
• An input O2 of less than 35 PSI will cause an
alarm.

52. Oxygen SourceOxygen Source – Low Pressure– Low Pressure
• Home ventilator patients may utilize low
pressure oxygen (from a flow meter or
oxygen concentrator) bled into the unit using
a nipple adapter on the oxygen fitting on the
unit.
• The “Low Pressure O2 Source” button must
be activated and the blender will no longer
active.
• An O2 Input pressure of more than 35 PSI will
cause an alarm.

53. Right Side Panel OverviewRight Side Panel Overview

55. Front Panel OverviewFront Panel Overview Display of Monitored Data
Ventilation Controls
Alarm SettingsSet Value Knob
LED Pressure Bar
Silence +
Reset
Other indicators

56. Key LTV Ventilator SettingsKey LTV Ventilator Settings
• Rate: 0 to 80 bpm
• Tidal Volumes: 50 to 2000 ml
• Press. Control: 1 to 99 cmH2O
• I-time: 0.3 to 9.9 sec
• Press. Support: 0 to 60 cmH2O
• O2%: 21 to 100%
• PEEP: 0 to 20 cmH2O

57. • High Pressure
• Low Pressure
• Low Minute Volume
• Apnea
• Low/High Oxygen
Pressure
• Disconnect/Sense
• Power Low, Power Lost
• Hardware Fault
• Battery Low, Battery
Empty
• Vent Inoperative
LTV®
Alarms
Operator Set
Preset - Automatic

58. Monitored ParametersMonitored Parameters
Display Monitored Data Description
PIP
Peak Inspiratory
Pressure
 Greatest pressure measured during the
inspiratory phase
 Updated at end of inspiration
MAP Mean Airway Pressure
 The average airway pressure for the last
60 seconds.
 Updated every 10 seconds
PEEP
Positive End Expiratory
Pressure
 The pressure in the patient circuit at the
end of exhalation.
 Updated at the end of exhalation
f Total Breath Rate
 Breaths / minute based on the last 8
breaths. Includes all breath types.
 Recalculated and updated at the end of
each exhalation or 20 seconds

59. Monitored ParametersMonitored Parameters
Display Monitored Data Description
Vte Exhaled Tidal Volume
 Displays the Exhaled Tidal Volume as
measured at the patient wye
 Updated at the end of exhalation
VE Exhaled Minute Volume
 Displays the exhaled tidal volume for the
last 60 seconds, calculated from the last 8
breaths.
 Updated every 10 seconds
I:E
Inspiratory / Expiratory
Ratio
 Displays the ratio between measured
inspiratory and expiratory time
 Also displays inverse I:E ratios
Vcalc
Calculated Peak Flow
(Volume Breaths only)
 The calculated peak flow based on tidal
volume and inspiratory time settings
 Displayed when selected or whenever these
two controls are selected

60. Front Panel – On/OffFront Panel – On/Off
Press to turn ON
To turn OFF, press On/Standby for 3
seconds, then press Silence/Reset

61. LTV 1200 PresetsLTV 1200 Presets
• Presets are loaded in the LTV to facilitate the
quick initiation of mechanical ventilation when
operators with limited knowledge of the
equipment must apply it.

62. LTV 1200 PresetsLTV 1200 Presets
SAME
NEW

63. PresetsPresets
INFANT
PEDIATRIC
ADULT

64. PresetsPresets

65. PresetsPresets
• The preset values are simply recommended
starting points and should be safe levels for
most patients. Once mechanical ventilation is
initiated, adjustments and changes should be
made to meet the needs of the patient.
• The full range of ventilator settings is
available to the operator, regardless of the
preset used.

66. Basic Operations – Vent SettingsBasic Operations – Vent Settings
• When there are variable settings or options:
– Press the button by the parameter or setting to
be changed
– Turn the Set Value knob clockwise or
counterclockwise to the desired setting
– Press the parameter button again to confirm
setting

67. Rules to keeping it simpleRules to keeping it simple::
Rule # 1
You either set the ventilator to deliver a
volume or you set the ventilator to deliver
a pressure.
• If you set volume, you monitor pressure closely.
• If you set pressure, you monitor volume closely.

68. Basic Operation - Mode SelectionBasic Operation - Mode Selection
• Modes are selected on the bottom row of the green
ventilator setting box.
• Selections are made by pressing the Mode “Select”
button. One push and the next mode selection
flashes. A second push confirms the mode and
makes the change.
• The NPPV mode (Non-invasive Positive Pressure
Ventilation) is the Bi-Level setting for the LTV.
– A non-vented mask is necessary when applying NPPV with
the LTV.

70. Rules to keeping it simpleRules to keeping it simple::
Rule # 2
Monitor minute volume closely
• If minute volume changes, understand what
caused it to change.
• Anticipate what adjustments you will make if
patient’s minute volume changes. (dependant
on what mode patient is in)

71. Monitor Display (scrolling)Monitor Display (scrolling)

72. Rules to keeping it simpleRules to keeping it simple::
Rule # 3
Alarms:
if set and used appropriately, they will alert
you of changes in the patient’s ventilation
before they become life threatening.

73. Alarm SettingsAlarm Settings

74. AlarmsAlarms
• Audible and visual alarm when parameter is
violated.
• If situation is corrected, audible alarm will
silence, but visual will stay lit until
Silence/Reset button is hit.
• The monitor display will show the active alarm
violation until reset.

75. Basic Ventilator SettingsBasic Ventilator Settings
• Breath Rate, Tidal Volume, Pressure Control,
Insp. Time, Pressure Support, O2 %,
Sensitivity
• Set by selecting the parameter button,
rotating the set value knob, and pushing
parameter button again or waiting 5 seconds

76. Basic Ventilator SettingsBasic Ventilator Settings

77. Monitoring the PatientMonitoring the Patient
• Measured and calculated values scroll
through the monitor display
• Press the ‘Select’ button to find to a desired
parameter
• Double click the ‘Select’ button to resume the
automatic scroll
• Airway pressure is dynamically displayed on
the light bar above monitoring display

78. Monitor Display (scrolling)Monitor Display (scrolling)

79. Other Settings on Front of LTVOther Settings on Front of LTV
• Insp/Exp Hold
– These are maneuvers that are used to assess
the lung compliance of the patient and
determine if there is any air-trapping
happening during ventilation.
– You will not be utilizing these maneuvers.
• Low O2 Source
– This button must be selected when a low
pressure O2 source is used.
– You will be utilizing a high pressure source, so
this option should not be On, or lit.

80. • Manual Breath
– This can be used to temporarily increase
the ventilation for a patient
– Sometimes used after a stressful situation
to help the patient “catch up” with their
ventilation demands
– Manual breaths also send burst of air
through sensing lines to clear them of
fluid/secretions
Other Settings on Front of LTVOther Settings on Front of LTV

81. Other Settings on Front of LTVOther Settings on Front of LTV
• Control Lock
– Pressing this button will lock the controls on
the unit, so they may not be accidentally (or
intentionally) changed.
– The indicator is lit when the controls are
locked out.
– Simply press the button again to turn off the
lock, thus allowing changes.

82. Extended MenusExtended Menus
• Accessed by pressing and holding the
‘Select’ button
• Access to extended Alarm and Ventilator
setup and operations including:

83. Extended MenusExtended Menus
Alarm Op
Alarm Vol
Apnea Int
HP Delay
LPP Alarm
High Rate
High PEEP
Pt. Assist
Exit
Vent Op
Rise Time
Flow Term
Time Term
PC Flow Term
NPPV Mode
Leak Comp
Ctrl Unlock
Language
Ver XXX
Usage XXX
Com Setting
Set Date
Set Time
Date Format
PIP LED
O2 Flush
O2 Cyl Dur
Exit
XDCR Zero
AP XXP
FDw xxP
FDn xxP
Event Trace
256 Event Codes
455 Events
Set Value
Knob
RT XDCR Data
Leak

84. Extended MenusExtended Menus
• The extended menu settings can be preset to
standard and acceptable levels for most
applications, then accessed only when
necessary, by properly trained personnel.

85. Extended MenusExtended Menus – O2 Cylinder Duration– O2 Cylinder Duration
• Particularly useful for transport teams
Accessed in:
Extended Features
Vent Op
O2 Cylinder Duration
Cyclinder Type?
Cylinder Pressure?
Calculate >>>

86. O2 Cylinder DurationO2 Cylinder Duration
O2 DUR 04:55
O2 CYL DUR 04:55

87. IMPORTANT !!!IMPORTANT !!!
• NEVER silence an alarm without
knowing the cause of the alarm and
attempting to correct.
• ALWAYS reset the alarm after you’ve
taken corrective measures or
completed suctioning.

88. IMPORTANT !!!IMPORTANT !!!
• Treat the patient, not the machine
• Troubleshoot, starting with the patient:
– Look at your patient – distressed, moving,
coughing, seizing, disconnected from vent, ???
– Look at the vent alarm – which one is activated?
– Look at the physiologic monitor – how is patient
responding?
• If patient is not being ventilated effectively,
solve the problem quickly or ventilate manually
(BVM)

89. Suctioning / Clearing SecretionsSuctioning / Clearing Secretions
• Utilize the suction catheter on the patient’s
existing circuit, or have catheter available
• May need to pre-oxygenate and/or post-
oxygenate some patients using O2% button
• Use of the ‘Manual Breath’ button will deliver
a breath at set volume or pressure, and will
also send burst of air through sensing lines to
clear any fluid/secretions blocking ports

90. Use of a “closed” suction systemUse of a “closed” suction system
• ATTACH SALINE BULLET, THEN UNLOCK THUMB
VALVE
• WHILE DEPRESSING THUMB VALVE,
• SET WALL SUCTION (120-140 mm Hg)
• HOLD CONNECTOR WITH ONE HAND AND INSERT TIP
OF CATHETER INTO THE ENDOTRACHEAL TUBE
• LAVAGE (DEPENDING ON PROTOCOL)
• PASS CATHETER DOWN THE ENDOTRACHEAL TUBE
(measured or until resistance)

91. Use of a “closed” suction systemUse of a “closed” suction system
• DEPRESS THUMB VALVE ,WAIT FOR 1-2 SECONDS
BEFORE SLOWLY PULLING THE CATHETER BACK
(CONTINUOUS SUCTION)
• WITHDRAW CATHETER UNTIL BLACK STRIPE IS
VISIBLE IN SHEATH (*see below)
• WHILE CONTINUING TO DEPRESS THE THUMB VALVE,
FLUSH THE INSIDE OF THE CATHETER WITH 15 ML OF
SALINE ** then release thumb valve**
• DISCONNECT SALINE, LOCK THUMB VALVE
• CHANGE CATHETER EVERY 24 HOURS.

92. Providing Oxygen “Flush”Providing Oxygen “Flush”
• Pressing and holding the O2% button for 3
seconds will set the vent to deliver 100%
oxygen (oxygen flush) for 2 minutes
• This can be used to pre-oxygenate or post-
oxygenate the patient during suctioning or a
stressful event

93. Oxygen % (100% flush)Oxygen % (100% flush)

94. Oxygen % (100% flush)Oxygen % (100% flush)

95. Sequence of LTV SetupSequence of LTV Setup
1. Connect breathing circuit to the LTV ventilator.
2. Make sure ventilator is connected to adequate
power source – battery, UPS, or AC-DC supply
(internal battery should only be used for short
transport or during switch to alternate power
supply).
3. Connect oxygen source to ventilator (if ventilating at
greater than 21% O2).
4. Turn unit ON – UNIT SHOULD NOT BE
CONNECTED TO THE PATIENT AT THIS TIME.
5. Select the patient type (Adult, Pediatric, Infant)
using the Presets in the LTV.
6. Make any necessary adjustments in the ventilator
settings.

96. Sequence of LTV SetupSequence of LTV Setup
7. Set proper alarm limits, as appropriate for patient.
8. Check the low pressure, high pressure, and
disconnect alarms before applying to the patient.
9. Connect LTV breathing circuit to the patient and
closely monitor the patient.
*Utilize HME (heat and moisture exchanger) and
closed suction catheter, if on patient circuit at facility.
10. Keep flow sensing lines up to avoid water and
secretions in these lines.
11. Monitor your patient. Make appropriate adjustments,
and CALL FOR HELP, if you’re uncomfortable with
what you see. Use the BVM if necessary.

97. Key PointsKey Points BEFOREBEFORE TransportingTransporting
See how the patient is interacting with their current
vent.
• If in A/C
– Breath Rate
– Minute Volume
– Peak Pressures
– Sensitivity
• If in PSV
– Breath Rate
– Spontaneous tidal volumes
– Minute Volume
– Sensitivity

98. Key PointsKey Points BEFOREBEFORE TransportingTransporting
• Talk to the patients therapist and nurse:
• Secretions
– (keep the in-line suction device attached to the
patient when you go)
• Weaning or goals
• Any “Quirky” respiratory patterns
– example: pt will breath 50 times per minute when
he/she gets anxious.
– See what relieves the “quirkiness” (changing
modes, settings, favorite medication, reassurance,
etc)

99. Key PointsKey Points WhileWhile TransportingTransporting
• Set alarms appropriately
• if set appropriately, alarms can alert you to subtle
changes before they become large problems.
• Monitor patient’s monitored vent parameters
• Breath Rate
• Minute Volume (A/C or PSV)
• Peak Pressure (A/C)
• Tidal Volumes (PSV)
• Anticipate what changes you would make if
patient’s vent needs change?
• If you need help, ask for it.

100. TroubleshootingTroubleshooting

101. Scenarios – Practical TrainingScenarios – Practical Training