Pride Cometh Before a Recalcitrant Ventilator

I shouldn't have written about how good nurses are at working with ventilators, because the gods sent me a test soon afterward.

I was called to a bedside where the vent was reading high expiratory volumes and low inspiratory volumes. Usually it's the other way around... some of the gas escapes around the side of the ETT and isn't measured by the machine, or there's a leak somewhere else. However I'd just had a morning of recalibrating vents that weren't reading volumes correctly, so my index of suspicion was higher than usual for a machine fault.

It could be the patient, it could be (most likely) the small amounts of blood that had gotten into the flow sensor, could be any number of things. I wasn't happy to ventilate a patient with a machine whose problem I didn't immediately understand, so I decided to swap it out for another one.

Well. Then I thought I'd get clever. While a colleague 'bagged' the patient, I swapped the old circuit (plastic tubes and wires) over to the new ventilator so as not to waste it. I'm fast. I'm cool. I can do it, no problem.

Uh... checks failed. Hrm. No worries, probably just a loose exhalation valve. I pull out the valve, disassemble it, put it back together. Run the check. Fail.

I check the flow sensor, gas lines, look for leaks in the circuit. Run the check again. Fail. I run to the store room for another valve. Run the check again. Fail. Dammit!

By this time I am starting to sweat a little. My colleague is being extremely patient, but obviously didn't expect to be standing there hand-ventilating a baby for quite this long. I imagine the conversation in the tea-room... "Yeah, PaedsRN tried to be a smart-ass again. I was bagging until end of shift while he built a ventilator from scratch..."

I decide to switch vents again, and check the equipment room. Grab another one, put a new circuit on, run the checks. Fail. Oh god...

Meanwhile the patient is absolutely fine, but my colleage has that expression which says they wish they'd never walked into the room.

I rip the exhalation valve apart, check each seal, and fit it back into the vent. Please please please...

Pass! Whew. Persistence pays off. I reconnect the patient and spend quite a bit of the rest of the day stripping and testing those two ventilators.

Couldn't find a single thing wrong with 'em. Bastards.