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Glossary of TermsIntroduction & Glossary of TermsGlossary of TermsThe following is a list of words that you will find in the manual. Some of the terms are things youmay hear your healthcare worker say. Always ask if you do not understand something.AAerosol: Solution that is given in a mistApnea: Not breathingCardiopulmonary resuscitation (CPR):Artificially supporting breathing and thecirculationAntibiotics: Medicines that fight infectionsCarina: The point of where the right and leftbronchi separateArtificial nose: A device that warms andmoistens the airCatheter: A small tube placed inside the bodyto add or remove liquidsArtificial airway: A cut made in the trachearesulting in an opening that bypasses thenose and mouth. Also called “trach” or“tracheostomy”CPAP: A ventilation mode that helps a patient’sown breathing efforts. Stands for continuouspositive airway pressureAspiration: Food or liquid breathed into theairway instead of swallowedAsthma: Difficult breathing with wheezingthat is caused by swelling or spasms of theairwaysBCuff: The inflatable balloon on some trachtubesCyanosis: A bluish color of the skin due toreduced oxygen in the bloodDDecannulation: Removal of the trach tubeBacteria: GermsDiaphragm: The big muscle below the lungsthat controls breathingBacterial: Caused by bacteriaDysphagia: Difficulty swallowingBreathing bag: Ventilating bag used formanual resuscitationDyspnea: Labored or difficulty breathing,shortness of breathBronchi: The two main branches leading fromthe trachea to the lungsCCap: A small cap used to plug the trachopeningCannula: The tube part of the trach tubeCarbon Dioxide (CO2): Gas eliminated fromthe lungs with exhalationEEdema: Swelling of tissue.Encrustation: Hard and dried mucus that canbuild up around the inner cannula.ENT: It is a term used for type of doctor thatspecializes in the ‘ear nose throat’. ENT doctorsdo tracheotomy surgery

Glossary of TermsIntroduction & Glossary of TermsET tube (endotracheal tube): A tube used toprovide an airway through the mouth or noseinto the trachea.Home healthcare supplier: Also called medicalequipment supplier. They provide equipment,oxygen, trach care supplies.Epiglottis: “Trap door”. A piece of cartilage thathangs over the larynx like a lid and stops food,and liquids from going down into the lungsHumidity: Moisture in the airEsophagus: The tube between the throat andthe stomachExhale: To breathe outExtubation: Removal of the endotracheal tubeHydrogen peroxide (H2O2): Mild cleaningagentHypoventilation: Reduced rate and depth ofbreathingHypoxemia: A low amount of oxygen in thebloodExpiration: Breathing out of air from lungsIFFenestrated: Having an opening in the trachtube to allow speechFenestrated inner cannula: An inner cannulawith holes in it. This lets air go from the trachtube up to the mouth, and nose. The outercannula must also have holes in it to workFenestration: A single hole or pattern ofsmaller holesFlange: Part of the trach tube, also called theneck plateGGlottis: The sound producing part of thelarynx that consists of the vocal cordsHHeat moisture exchanger (HME): A filterdevice that fits into the end of the trach tubeto warm and moisten the air the patientbreathesHome healthcare professional: Individualwho gives care at homeInflation line: The thin plastic line attachedto trach tube balloon on one end and pilotballoon on the other. It is used to inflate anddeflate the trach tube balloon (cuff ).Inflation syringe: A plastic syringe withoutneedle used to inflate the trach tube balloon(cuff )Inhale: To breathe in.Inner cannula: The inner removable tube thatfits inside the outer cannula. May be removedto clean or exchanged with different innercannula.Inspiration: To breathe inIntubation: Placement of a tube into thetrachea to help with breathing.LLarynx: “Voice box” or “Adams apple”. Is just ontop of the trachea.Lumen: The inside of the trach tube throughwhich air passes.

Glossary of TermsMMucous: Slippery fluid that is made in thelungs and windpipeMm: Short form for millimeter. One millimeterequals .039 inchesIntroduction & Glossary of TermsRetractions: Pulling or jerky movement ofthe chest and neck muscles. It’s a sign ofrespiratory distressSSecretions: Another word for mucous.NNebulizer: A machine that puts moisture andor medicine into the airway and lungsNeck plate: Part of the trach tube that sitsagainst the neck, also called the flangeSpeaking valve: A one way valve that lets aircome into the trach tube when you breathein. When you breathe out, the valve closessending air out past the vocal cords andthrough the mouth so speech is possible.Nosocomial infection: An infection that yougot during your hospital staySpeech language pathologist: A persontrained to help with speaking and swallowingproblemsOStoma: The hole in the neck where you insertthe trach tubeObstruction: BlockageObturator: The guide that goes in the trachtube to help insert the tube into the tracheaOuter cannula: The main tube with neck platethat is placed into the tracheaOximeter: Equipment that monitors theamount of oxygen in the bloodOxygen: A gas that the body needs to stayaliveSterile: Very clean and free from germsSuctioning: One way to keep the inside of thetrach tube clean and free of mucus. A smallcatheter is connected to a suction machineand placed into the trach tube to removemucousSwivel neck plate: A neck plate that can swivelup and down and/or side to side. Allows forgreater range of head and neck movementwithout discomfort.Syringe: Device to measure medicinePPatent: Open, clear airwayTPneumonia: Swelling of the lung that is oftencaused by germsTrach: An opening into the tracheaRTrachea: “Windpipe”. The tube through whichair flows between the larynx and the lungsRespirologist: A doctor who looks after thelungsRespite: A break for caregivers who care for adisabled family member at homeTrach mask: A device that fits on the end ofthe trach tube to provide moistureTracheal wall: The inside lining of the tracheaTrach Tube: A tubular device placed into thetrach

Glossary of TermsTrach Ties: Cotton twill or Velcro tapes used tohold the trach tube in place. Connects to theslots in the trach tube neck plateVVentilator: A machine that helps a personbreatheVirus: A germ that can cause illnessViscid: Thick or stickyVocal cords: Two strips of tissue in the voicebox in the neck, which allows vocalizationWWheeze: A whistling sound coming from thelungs because of a narrowing in the wind pipeor airways.Introduction & Glossary of Terms

Discharge Identification & PreparationIdentification and Preparation ToolDischarge ChecklistsPreparation for ICU DischargePreparation for Hospital DischargeIntroduction &Glossary of TermsSection #2: Healthcare ts& CaregiversAppendices

Introduction &Glossary of TermsHealthcareProfessionalsPatients/Clients& CaregiversAppendicesSection #2: Healthcare ProfessionalsDischarge Identification & PreparationIdentification and Preparation ToolDischarge ChecklistsPreparation for ICU DischargePreparation for Hospital Discharge

Discharge Identification & PreparationDischargeIdentification& PreparationIdentificationandPreparationTool

Discharge Identification & PreparationDischargeIdentification& PreparationNotes

IdentificationandPreparationTool

Identification and Preparation ToolHealthcare ProfessionalsEvaluation and Discharge PlanningDischarge AssessmentThe following is a high-level approach the interdisciplinary team can use during thepreliminary stages of identifying a candidate for home or community placement.Assessment of the Home EnvironmentAssessment includes geographic location, available space, and accessibility. A home to go toHome environment prepared in advance to accommodate the patient’s needsAdequate number of grounded electrical outletsRespiratory equipment supplier is aware of individualSturdy bedside table for the ventilator placementAssessment of CaregiversCaregivers must be motivated and able to learn the care routines. Patient is able and willing to supervise/direct care Individual is able and willing to participate in self care, or has sufficient caregiverassistance to adequately meet medical, respiratory, and personal care needsEducation and TrainingThere is a comprehensive education plan with learning objectives and evaluation forindividual, family and caregivers. Caregivers identified and trained prior to discharge (See Home Ventilation & Tracheostomy Care, and Education Checklist and Learning Log provided in thismanual)Adequate nutrition program is in placeSuccessful and stable trials: for at least two weeks prior to discharge with no changesB On home equipment ventilator prior to discharge, (e.g. ventilator, monitor,oxygen, if applicable)B Leaving the hospital setting with home caregiversPage 1

Identification and Preparation ToolHealthcare ProfessionalsAssessment of ResourcesThis includes professional services, support systems, individual’s financial resources. Adequate financial resources and mechanisms for reimbursement identified prior to dischargePotential referrals in place: Respirologist, Occupational Therapist, Physical Therapist,Social Worker, Registered Dietitian, Pharmacist, Community Care Access Centres(CCAC)Appropriate application forms completed:B Assistive Devices Program:o Tracheostomyo Ventilatoro Enteral feeds, if applicableB Home Oxygen Program, if applicableB Special services at homeB Handicapped parking permitsB WheelchairContact the Ventilator Equipment Pool (VEP) to discuss the most appropriateequipment available and lead time for deliveryPlan of CareA written management plan for respiratory, medical care, and emergencies. Individual is medically stable: oxygen requirement less than, or equal to 40%; stable blood gases; mature tracheostomy and no events requiring CPR for at least onemonthComprehensive discharge plan in placeThe treatment plan for all medical conditions is in placeB Plan does not require frequent changesB Plan is transferable to the communityDischarge planning meetings in place, including the individual, caregivers, healthcareteam and community servicesPage 2

Identification and Preparation ToolHealthcare ProfessionalsTeam MeetingsInitial team meeting are to take place while the ventilator assisted individual (VAI) is in thehospital.First Team MeetingPrimary aims of this meeting are: Determine the short and long term goalsIdentify issues and potential barriers to dischargeCreate plans to manage issues and potential barriers to dischargeComplete feasibility assessment of required community supportIdentify additional funding opportunities for the patientTeam members should include the individual, their caregivers and the inter-professionalteam: IndividualFamily and caregiversMost responsible physicianNurse (RN)Community Respiratory Therapist (RT)Social Worker (SW)Physical Therapist (PT) Speech Language PathologistOccupational Therapist (OT)Registered Dietitian (RD)PharmacistCCAC Case ManagerDischarge planner Second Team MeetingPrimary aims of this meeting are: Determine if discharge to home or community facility is achievablePrioritize goals and timelines; those to be achieved prior to dischargeDetermine a realistic discharge dateDelineate roles and responsibilities for all team members, including the caregiver andfamilyB Care plansB Funding applicationsB Discharge guidelinesB Learning needs assessmentsB Education training programsB Equipment acquisitionPage 3

Identification and Preparation ToolHealthcare ProfessionalsAdditional team members at this meeting should include the community care providers: Community RTCommunity PTCommunity OTNursing agency providerFollow up MeetingsPrimary aims of this meeting are: Monitor progress toward goalsUpdate the patient and caregiversIdentify other barriers to discharge and develop a resolution planCommunicate among the inter-professional disciplinary teamPage 4

Identification and Preparation ToolHealthcare ProfessionalsPlacement Considerations in the HomeAdequate Daily Care CoverageIn addition to the care provided by the caregiver(s), the patient may receive additional carehours through CCAC. Access to immediate assistance is recommended for any individual whorequires 24 hours ventilation or is fully dependent in their activities of daily living. This can bea trained community care provider, such as a Registered RT, Nurse, PSW or trained familymember.Individuals who live in Ontario who require suctioning or catheterization as part of theirnormal daily routine have a legislated exemption in the Regulated Health Professional Act(RHPA) allowing non-registered professionals to provide this service, provided they arecompetent to do so.Additional ConsiderationsMobilityA VAI may require a wheelchair with ventilator and oxygen carrying capacity. The vehicleused for mobility must be able to safely carry a ventilator and external battery withouttipping. Home ventilators can weigh up to 35 lbs. Ventilator shelves can be attached tosome standard wheelchairs, but some of these chairs may not be wide enough orbalanced enough to hold the additional weight. Often a VAI has their own wheelchair thatcan be adapted by the supplier to carry the ventilator and battery. If this is not possible,an application for a customized wheelchair with ventilator carrying capability can bemade.Assessment and applications are usually made by the OT or PT and signed by thephysician. The chair supplier will need the ventilator and battery dimensions. Informationthat can be obtained from the RT.Other mobility devices may be required, such as ambulation aids and positioning devices(lifts).Applying early in the process will reduce delays. Check with the equipment provider forthe anticipated delivery date.Page 5

Identification and Preparation ToolHealthcare ProfessionalsEquipment AcquisitionThe Ministry of Health and Long-Term Care (MOHLTC) funds 75% of the cost ofrespiratory supplies through the Assisted Devices Program (ADP). The remaining 25% isthe responsibility of the individual.Contact the VEP or alternate provider for details on equipment acquisition. Note: someindividuals are not eligible for equipment through the VEP. For example, patientsdischarged to long term care facilities do not have access to VEP equipment. See VEPwebsite for more information on eligibility http://www.ontvep.ca.Home Mechanical VentilatorsA VAI discharged to the community is provided with: Ventilator(s)Battery chargerHeated humidifierExternal battery for emergency power onlyBattery cableRe-useable ventilator circuitsThe cost of this equipment is 100% covered by the MOHLTC, through ADP. Applicationsmust be signed by the physician.The VAI should have completed several successful trials on a home mechanical ventilator,before setting them up for indefinite use.Other Respiratory SuppliesRequests are made by the home respiratory care service, to the ADP. This equipment mayinclude: Apnea cardiorespiratory monitors Compressors for aerosolized medication deliveryPostural drainage boardsSuction machines Tracheostomy suppliesPercussorsResuscitatorsPositive airway pressure systems75% of the cost of this equipment may be covered by the MOHLTC. The remaining 25% isthe responsibility of the individual.Page 6

Identification and Preparation ToolHealthcare ProfessionalsSome equipment, although necessary for some VAIs, may not be funded through ADP.The following equipment is not funded:B cough-assist devicesB oximeters for individuals 18 years or olderB 12 volt batteries for mobility purposesOther Medical SuppliesOther medical supplies may be necessary in the community setting and eligible for ADPfunding e.g. enteral feed equipment. Check with the interprofessional healthcare teamfor details.Individual, Home Care Providers and Family EducationA successful discharge requires a simplified and comprehensive transfer of care routinesfrom healthcare team to the community provider team. Ideally the community teamwould receive the transfer of skills within the acute care facility. This allows them to be indirect contact with the individual and work closely with the acute care team. This trainingtechnique serves to increase the confidence and comfort of both the community careproviders, the individual and the caregivers.Information provided in respiratory teaching packages typically should cover: Tracheostomy and ventilator care Individual-specific training checklist that must be completed prior to discharge; can also be used as a scheduling guideEmergency guidelines that are provided to address common problems that may arisewithin the home environmentRespiratory EducationThe training should include, but is not limited to: Respiratory anatomy and physiology Hands-on training with tracheal suctioning Ventilator troubleshooting and maintenance Tracheostomy tube cuff care; changing if applicable Page 7Use of the manual resuscitator bagSwitching to ventilator batteryCharging the ventilator batteryCircuit assemblyEmergency planningCleaning of equipmentVolume augmentation manoeuvres

Identification and Preparation ToolHealthcare ProfessionalsEmergency Plan and Recommended Physician CoverageEmergency guidelines are provided to address common problems that may arise withinthe home environment. These guidelines are provided for each individual and placementsituation. Included are: what should be done; who should do it; what services should becalled, etc.The individual's wishes regarding resuscitative efforts should be addressed and beavailable in the home for emergency response personnel.The individual must have: A Family Physician who will manage day to day general medical needs A Respirologist or other consultant who has expertise in mechanical ventilation, to manage ventilation needsA “home-base” hospital location should an emergency occur that cannot be solved athome. Ideally this is the acute-care facility discharging the individual homeFor those caregivers wishing for Cardiopulmonary Resucsitation (CPR) certification,discuss this training with your healthcare provider.Guidelines are provided that include contact numbers of home care providers andsupport services.Communication and Transfer of Information to Community ProvidersWith the individual’s consent, the discharge team should ensure the community carepartners receive information on: Medical history Written consent Care plan, preferences, daily routines, typical patterns where interventions are requiredTransfer and discharge notes from the discharging

Respiratory Therapy Services A Continuum of Care from Hospital to Home A Training Manual for Paediatrics & Adults Healthcare Professionals, Patients/Clients and Caregivers June 2010 Introduction Introduction & Glossary of Terms 180 Dundas Street West, Suite 2103 Toronto, Ontario M5G 1Z8 Tel: 416-591-7800 Fax: 416-591-7890 Toll free: 1-800-261-0528