Circuit Change

Objective:
To change all of Don’s vent tubing, the humidifier, suction buckets, and suction wand holders.

Materials:

• From guest room closet: 1 blue circuit, 1 clear/white circuit, and 1 humidifier
• From white drawers by the back door: 
• Top drawer: plastic lung, 1 duck bill,
• Middle drawer: 1 humidifier
• Bottom drawer: 1 accordion, 2 blue filters

Little Bertha

1. Disconnect all tubing, set aside. Disconnect power cord
2. Take Little Bertha off the back of the wheelchair and take machine out of the blue holder as far as you need to reach the white filter on the bottom. 
3. Take the white filter out and flick it to clean it. Put filter back in
4. Use fingernail to get to the foam part of gray filter. Rub/flick to clean foam. Put back together. The black piece will snap back in. 
5. Get machine back into blue case and redo the Velcro as tight as you can!!! 
6. Put the vent back on the wheel chair and reconnect the power. Make sure vent doesn’t look like it’s falling out of holder. If so, make the Velcro tighter!!!
7. Take new white circuit out of the bag (put the extra short tube in the basket behind Kate’s desk) and lay new circuit on the floor next to the old one. 
8. Remove funky double white clip. Move white clips from the old one to the new one. They should be about a foot apart. On this circuit there should be 1 clip above the PEEP valve and 3 clips below the PEEP valve. 
9. Put new humidifier cup on circuit. 
10. Put new blue filter and short clear connecter (came in bag with new circuit) together. 
11. Without crushing/bending the new circuit, connect blue filter to circuit. 
12. Connect whole new circuit assembly to Little Bertha and hook up the 3 sensor tubes.  
13. Attach the other end of circuit to the plastic lung. Turn on Little Bertha and push the “SELECT” button until you get to the PEEP readout.
14. Adjust PEEP valve until you get to 5 (righty-tighty, lefty-loosey!). Once it’s at 5, let it breathe for a few minutes to ensure the PEEP is stable. 
15. Put Don on Little Bertha. Keep an eye on the PEEP as it may change. 

Baby Bertha (Do it in this order!!!)

1. Turn Baby Bertha off. Disconnect 3 vent sensor tubes from Big Bertha machine. On Baby Bertha, disconnect short gray wire from back of tube and disconnect long gray wire from Baby Bertha. 
2. Disconnect all vent tubes going in and out of cup. Take the short blue tube out of the vent as well. You may need to get the pliers from the garage to get the clear plastic piece out. 
3. Get the new humidifier. Unwind the little tubing and remove the blue and white plastic pieces. 
4. Take the water bag off the hook and set on floor. Remove old cup from heating plate and set on floor. Slide new cup into place. 
5. Unplug old cup from water bag and plug in new cup. While there is no plug in the water bag do not turn the bag upright!!! 
6. Place water bag back on the hook. Check the bottom of it for leaks and air bubbles. If there are bubbles at the bottom, pinch the tube to get the bubble out. 

Big Bertha

1. Clean white and gray filters as you did with Little Bertha. 
2. Lay old circuit on the floor. Lay new circuit next to it. 
3. We need to move gray wire from old circuit to new circuit. It may be easiest to remove all white clips first including the funky double white clip from new circuit. There should be 2 clips above the PEEP that are red. The next clip should be 2-3 inches below the PEEP valve and should be 2 clips together. 
4. There should be 3-4 more regular clips below this. Be sure to keep all the sensor tubes together. 
5. The very last clip will just hold the extra gray wire to the tube. 
6. Get the new blue filter and connect to the short clear piece (usually found in one end of new short blue tube.) Connect the blue filter (not clear piece) to short blue tube. 
7. Insert clear plastic piece into vent machine and connect other end of short tube to the humidifier cup. 
8. Connect new duckbill and accordion. You may have to look at the assembly on Don to ensure you’re doing it correctly. Push these together as much as you can. Grab a q-tip from hospital table in Don’s bedroom. Stick wooden end of q-tip through the opening we stick the worm into and push through the lips to separate them. 
9. Connect the accordion to appropriate end of new circuit. Connect the other end to the humidifier. Replug long gray wire into humidifier and short gray wire into the plug on the tubes. 
10. Connect the 3 vent sensor tubes. You make have to adjust some of the white clips when you do this. 
11. Put circuit back up on the arm and attach plastic lung.  
12. Turn vent on and set PEEP to 5 as you did with Little Bertha. 
13. Once PEEP is set, hold plastic lung and tubes up over Don so they are near the placement that they will ultimately be once hooked to Don. Twist white connector between the “Y” and the blue tube (where the gray wire plugs in) until the white tube is lower than the blue tube and the sensor wires are on top. 
14. Remove trach roll out. Unhook plastic lung and switch vents including duck bill and accordion. Turn off Little Bertha and put tubes away. Remove the old duckbill and accordion and throw them away. Replace trach roll. Turn on Baby Bertha.
15. Go the bathroom and in the top drawer there is a roll of ribbed tape (not the soft micropore stuff). Rip off about an inch then rip it in half the long way. Tape first clip below PEEP valve that clips all of the tubes together. This is to keep people from accidently undoing this clip. 

Suction Buckets

Materials:

• From Don’s bedroom closet (top right side): Two bags from the suction bucket box, two long tubes from the box with the wands
• From the garage: 3 new water bottles

1. Label the new bottles with today’s date and grab a sharp knife from the kitchen
2. Open up bags and take everything out. You can discard the hose in these bags. 
3. Use the knife to cut off the two small plugs on both lids. Put the lids on the buckets. 
4. Assemble the 3 little pieces to match bucket in the living room. 
5. Take out the new hoses and stretch them out as much as you possibly can!!!!! Attach one end of new hose to the sticky-outey bit on the side of the lid. 
6. Put some water in the bucket (about a cm). You can use water from sink or from water bottle. 
7. Switch out the buckets. I find it easier to attach the part with the filter to the machine first and then the bucket. Then switch out the hose that’s attached to the wand. 
8. Dump out the liquid in the buckets. No need to rinse. Then throw the buckets and tubes out. 
9. Find the 3 oldest water bottles (they should all be the same date). Check the bedroom, the suction machine bag in the closet, and WC bag. Empty these water bottles (can fill already empty bottles, dump in jug by the meds, in the teapot or in the jug in the fridge.)
10. Use the now empty bottles to replace the bottles that the wands sit in: one in Don’s bedroom, one on the living room cart, and one in the travel bag in the closet. For the living room cart, you have to undo the red Velcro strap and the rubber band on top. Put the new bottle in and redo that Velcro and rubber band.  
11. Rinse out the old water bottles and recycle them.

Throw out everything else you replaced today. Nothing is recyclable. The extra set of tubes from the suction buckets can be put in the box in the garage or thrown out.