Written instructions, equipment manuals and audiovisual aids reinforce the personal instruction. HME providers also provide initial home assessments to verify adequate electrical wiring and ensure there is enough space for the patient and his or her equipment and supplies. Home care respiratory therapists perform periodic clinical assessments such as pulse oximetry and end-tidal CO2 monitoring, and ventilator troubleshooting. Equipment Selection Home care ventilators can provide all traditional modes of ventilation, but the simplistic, user-friendly design prohibits some more sophisticated technologies such as pressure support, which is commonly used in noninvasive nasal mask applications. The team should consider these limitations when discharging a patient.
Any ventilator can experience a malfunction.
Failure to cycle, alarm failure, malfunction of auxiliary support equipment, operator error or misapplication, and malfunction from the use of inappropriate systems or outside design specifications are just a few potential problems. To protect patients, a back-up unit may be necessary. Back-ups are recommended for patients who cannot sustain up to four hours of continuous spontaneous ventilation or when a replacement ventilator cannot be provided within two hours. Some HME providers may have even stricter clinical policies than those recommended by the Consensus Conference for infants and children. If a child has already been weaned from continuous support and only needs nocturnal ventilation, the care team may use noninvasive positive pressure ventilation, eliminating the need for a back-up device.