 The Puritan Bennett LP-10 ventilator is a portable, electrically powered ventilator capable of providing ventilatory support to a variety of patients. It has relatively rudimentary design, it has many capabilities of more advanced ventilators. For troubleshooting and comprehensive training, please refer to the manufacturer's operating manual. This ventilator unit is fully contained and has the capability to operate without any external gas sources or electricity for short amounts of time. Caution must be taken when any power or oxygen source is disconnected to prevent patient injury. Battery power may not be sufficient for extended periods and concentrated levels of oxygen are not available without external connections. Although this ventilator may have been pre-assembled or is currently operational, it is important to have some basic understanding of the assembly and function of the external connections. The connections to the ventilator can be divided into two categories, those that supply the ventilator with power and supplemental oxygen, and those that provide an interface between the patient and the ventilator. The external connections that provide oxygen and power to this ventilator are the following, power cord, the external supplemental oxygen reservoir system, the external supplemental oxygen reservoir system consists of several key pieces, the valve and bracket, corrugated hose, oxygen tubing, intake adapter, and the reservoir bag. Attach the valve and bracket assembly to the side of the ventilator unit by sliding the grooved opening onto the accessory arm. Attach the reservoir bag to the bottom adapter port underneath the bracket arm. Attach one end of the white corrugated hose to the adapter port on the top of the bracket arm. Use the intake adapter on the other end of the white corrugated hose to connect to the intake port on the ventilator. Attach one end of the small bore oxygen tubing on the top of the valve to the small nipple connection and the other end to the available oxygen source. Supplemental oxygen can be adjusted by increasing or decreasing the flow on the flow metering device. The precise oxygen concentration may not be known. External power supply. The external power supply is simply a standard AC 110 volt plug adapter that plugs into a wall outlet. In order to use the external power and not the unit's internal battery, the power switch adjacent to the power cord must be turned on. If the unit is to run on the internal battery, the switch must be turned off. The ventilator will continue to operate as long as the battery has sufficient power. The battery life will vary depending on usage. The connections that supply the interface between the patient and the ventilator consist of three hoses along with several other pre-assembled pieces that are termed the ventilator circuit. The connections for the ventilator circuit are located on the lower right front of the panel. The ventilator circuit connections consist of the following. The ventilator gas source to patient labeled patient air. The pressure monitor connection labeled patient pressure. The exhalation valve connection labeled exhalation valve. To connect these fittings, connect the 22 millimeter corrugated hose to the ventilator patient air fitting. Connect the green transducer hose to the ventilator patient pressure hose fitting. Connect the clear exhalation valve hose to the ventilator exhalation valve hose fitting. As assembly has been completed, the unit should be evaluated for proper function before being connected to a patient. The following will demonstrate the proper procedure for adjusting parameters on the mechanical ventilator. Preliminary settings should be dialed in to assess proper function of the unit. First attain prescribed ventilator parameters from physician or appropriate care provider. If the unit is not to be placed on a patient and is simply being checked for proper function, use the following settings. Add AC, respiratory rate, 12, inspiratory time, 1 second, tidal volume, 600 cc, high pressure, 50 centimeters of water, low pressure, 4 centimeters of water. Now look at the control panel on the unit located under the protective flap. Turn the ventilator on by first turning on the power switch located on the back of the unit and by turning the mode to the desired mode of ventilation on the control panel. The ventilator will automatically begin a self-check to assure the ventilator control mechanisms are functioning properly. After about 5 seconds, the ventilator will begin to ventilate at previous settings and start to alarm low pressure apnea. Silence the audible alarm by depressing alarm button on the control panel. Turn the control knobs as labeled to the desired parameters as shown. Once the parameters are dialed in, set the high and low pressure alarms. Generally, 50 centimeters of water for the high and 4 centimeters of water for the low is an appropriate place to start. Once complete, occlude the patient end of the ventilator circuit with gloved hand. After a delivered tidal breath, you should see the previous low pressure alarm apnea change to a high pressure alarm. The alarm panel still indicates a low pressure. Check circuit connections because there may be a leaking or disconnected tube. Before connecting ventilator circuit to patient, verify that prescribed settings are set according to the prescribed orders. Connect the end of the ventilator circuit directly to the patient's endotracheal or tracheostomy tube. You should visualize the patient's chest rising and falling with each breath of the mechanical ventilator. Reset the alarm on the control panel by once again depressing the alarm button. If functioning appropriately, alarm should cease and no red lights will be illuminated on the alarm screen. At the upper right hand corner of the ventilator, the peak pressure will be displayed on the analog manometer. The pressures over 35 cm of water should be reported to the appropriate care provider. Reset the high pressure alarm 10-15 cm of water above the average peak airway pressure noted. The low pressure limit should be adjusted 5-10 cm of water above the pressure noted at the end of the expiratory phase. This is usually 5-10 cm of water unless external peep is applied. If peep is ordered, contact the appropriate care provider for assistance. Remember to monitor the patient as necessary. Watch for alarms that may indicate dangerous conditions for the patient. If at any time an alarm occurs and the reason is unknown, disconnect the ventilator and provide manual ventilatory support as described in previous modules until help is available. For a complete list of alarm messages, see the ventilator operator's manual. Commonly, a high pressure alarm indicates obstruction of the endotracheal tube or ventilator circuit. When this alarm is displayed, quickly evaluate tubing and verify there are no kinks or obvious obstructions. A high pressure alarm could also mean that there is a buildup of secretions in the lungs or airways. If the patient exhibits symptoms of coughing, the patient should be suctioned as described in previous modules. A low pressure alarm can mean that there is a leak or disconnect in the tubing. When this alarm is displayed, quickly evaluate and verify the circuit is appropriately connected. If no leak is found and the low alarm setting is appropriately adjusted, it may be necessary to manually ventilate the patient until help is available. Commonly, adjustments to the ventilator will need to be made. To adjust any of the parameters, simply dial the control knob to the prescribed setting. Adjustments to the alarms may be necessary after adjustments are made. To do so, follow the same procedure as described earlier. As always, monitoring patient's response to changes in the ventilator settings is imperative.