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Breathhold with Mechanically Ventilated Patients in CT (2.06)

Breathhold with Mechanically Ventilated Patients in CT (2.06) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Mechanical Ventilation

2.06






2.06 Breath Hold with Mechanically Ventilated Patients in CT/MRI
Category: UWHC Patient Care Policy
Effective Date: December 21, 2016
Version: Revision
Manual: Respiratory Care Services
Section: Aerosol Therapy

I. PURPOSE
Mechanically ventilated patients requiring thoracic CT/MRI scans will require ventilation to be
suspended. This is necessary to minimize movement and optimize the quality of the scan. Thoracic
CT/MRI scans and the necessary ventilator adjustments will be performed in accordance with a
provider’s order.

II. POLICY
A. Therapy will be provided in accordance with a provider’s order.
B. Provider’s order should specify the level of CPAP for the breath-hold maneuver (i.e., +20
cmH2O).
C. Suspended ventilation of mechanically ventilated patients should only be undertaken following
a careful evaluation of the risk-benefit ratio.
D. Breath hold maneuvers in CT will only be performed using the patient’s critical care ventilator,
or Hamilton Transport Ventilator in CSC. In AFCH, they may use the babyPAC.
E. Breath Hold maneuvers in MRI, will only be done in AFCH.
F. The Respiratory Therapist (RT) must take precautions in order to limit their exposure to
radiation in CT scan.
1. A lead apron with neck protection should be worn during the procedure to reduce
radiation exposure.
2. The lead aprons provided by the hospital are four times more attenuating than the
minimum state requirement necessary to optimize radiation protection.
3. The RT should step away from the scanner to further reduce exposure.

III. EQUIPMENT
A. Mechanical ventilator with CPAP mode
B. Lead apron and neck protection
C. Hemodynamic monitor with pulse oximeter

IV. PROCEDURE
A. Review and acknowledge the provider’s order.
B. Review patient’s chart.
C. Obtain the appropriate equipment.
D. Introduce yourself to the patient and/or family. Explain the reason for the procedure.
E. Ventilation will be suspended by placing patient on CPAP mode of ventilation.
1. Patients spontaneously breathing and able to hold their breath will be placed on CPAP of
5 and instructed to hold their breath by CT tech.
2. Patients unable to hold their breath will be placed on CPAP of 20 cm H2O. These
patients may require sedation and/or paralysis to prohibit them from spontaneously
breathing.
F. When it is time to suspend ventilation, the CT/MRI tech will inform the RT.
1. The RT will change the ventilator to CPAP mode at the appropriate level.
2. The RT will resume previous ventilator settings when indicated by CT/MRI tech.
3 The patient will be monitored appropriately throughout the entire CT/MRI scan.









VI. REFERENCES

A. UWHC Respiratory Care Policy # 2.05, “Transportation of Patients Supported by Mechanical
Ventilator.”
B. UWHC Respiratory Care Policy #2.11, “Recruitment Maneuver”
C. UWHC Administrative Policy # 8.10, “Transport of ICU Status Patient Within UWHC.”

Approved by Director and Medical Director of Respiratory Care: