Advanced Ventilation and Adjunct Therapies —
Training activity: 10

Details

Troubleshoot technical/circuit/accessories issues with mechanical ventilation

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Circuit set up and potential issues
• Humidification, and heat and moisture exchangers
• Bacterial filters and nebulisers

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to identifying the source of technical/circuit/accessories problems and resolving them efficiently or escalating appropriately.
• Consider how the learning outcomes apply, specifically in relation to assessing and troubleshooting technical issues while interpreting monitoring parameters and ensuring appropriate alarm settings.
• Discuss with your training officer to gain clarity of what is expected of you in relation to the systematic approach to troubleshooting technical problems and recognising when specialised support is needed.

What is your prior experience of this activity?

• Think about what you already know about different components of the ventilator system (circuit, humidifier, nebuliser, filters) and common technical issues (leaks, blockages, kinking).
• Consider possible challenges you might face during the activity, such as technical problems that require technical support rather than bedside resolution.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if a major equipment component fails (e.g., ventilator unit) or a persistent issue cannot be resolved via routine bedside troubleshooting (e.g., sensor errors).
• Acknowledge how you feel about needing to resolve technical issues, especially in urgent situations.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as systematically identifying the source of technical problems (e.g., leak location, circuit blockage identification).
• Identify the specific insights you hope to gain into the failure modes of different ventilator components or circuit configurations.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of troubleshooting equipment malfunctions or performing pre-use checks.
• Identify important information you need to consider before embarking on the activity, such as reviewing user manuals for specific ventilators, focusing on setup and troubleshooting guides, and practising assembling ventilator circuits.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst investigating a technical problem?
• Are you encountering situations such as:
  • The cause of the technical issue is something other than expected (e.g., a technical failure within the machine itself rather than a simple circuit leak)?
  • Fixing one issue (e.g., replacing a filter) leads immediately to another (e.g., a persistent low volume alarm)?
  • Unusual artefact appears on the monitoring display that is difficult to distinguish from a technical fault?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Did you change your troubleshooting steps? Did you need to consult a manual or colleague immediately?
• Consider the steps you are taking in the moment, such as:
  • Systematically checking all components of the circuit and accessories (humidifier, nebuliser)
  • Immediately consulting the technical manual for the specific equipment failure or error code
• How are you feeling in that moment? For instance, did encountering an unexpected technical issue affect your confidence in troubleshooting? Were you able to remain focused on finding a solution?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully identifying and resolving the technical issue related to the circuit or accessories? Are you needing support because the technical issue is beyond your current ability to resolve independently, such as requiring specialist biomedical engineering input?
• What are you learning as a result of the unexpected development? For example, did you learn a new troubleshooting technique or gain insight into how a specific part of the ventilator circuit or accessory functions?

On action

What happened?

• Begin by summarising the key steps you took when troubleshooting technical/circuit/accessories issues with mechanical ventilation.
• Consider specific events, actions, or interactions which felt important, such as efficiently locating and repairing a circuit leak, or successfully troubleshooting an issue related to a ventilator accessory (e.g., humidifier or nebuliser).
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately checking for kinks in the circuit when a high pressure/low volume alarm persisted unexpectedly.
• How did you feel during this experience, e.g., did you feel confident in your ability to adapt your approach to the specific technical problem, or stressed by the persistent technical issue?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding technical troubleshooting. What strengths did you demonstrate, e.g., systematic checking of all potential leak sites in the circuit?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the failure modes of specific ventilator accessories?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in efficiently identifying and resolving technical, circuit, or accessories issues?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding a technical problem that required specialist technical support beyond bedside resolution, and how you reacted to this.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to learning new troubleshooting techniques for common circuit faults or accessory failures.
• What will you do differently next time you approach troubleshooting technical/circuit/accessories issues, for instance, by proactively checking the functionality of all ventilator accessories before use?
• Do you need to practise any aspect of the activity further, such as systematically identifying the source of technical problems (e.g., leak location, blockage identification) or key learning outcomes related to assessing clinical and technical issues with ventilators?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of troubleshooting technical issues with critical care equipment or other ventilators/circuits since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent case involved unresolvable technical malfunction requiring escalation to specialist support forced you to re-evaluate the thoroughness of your initial bedside technical check during your first attempt at this training activity.
• Considering what you understand about systematic technical analysis and failure modes of ventilator components now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your protocols for identifying and resolving circuit/accessories issues based on further learning and experiences? For example, how you proactively reviewed and integrated specific manufacturer guidelines for identifying common equipment failures or circuit leakage sources based on further learning.
• Has discussing technical troubleshooting or equipment failures or the impact of unresolved equipment issues on patient care with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a circuit issue that resulted in accidental positive pressure delivery refined your understanding of the critical nature of meticulous technical troubleshooting.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent technical problem-solving experiences with ventilation equipment, contributed to your overall confidence and competence in technical problem-solving, systematic analysis, and ensuring equipment reliability, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated skills in systematically checking ventilator components and applying troubleshooting protocols now enables you to confidently perform troubleshooting exercises on a selection of technical issues during a DOPS assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to ventilator maintenance and technical support? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer or Technical Specialist immediately when a major equipment component fails (e.g., ventilator unit) or a persistent issue requires technical knowledge beyond routine bedside resolution, recognising this falls outside routine troubleshooting scope.
• Looking holistically at your training journey, how has this initial troubleshooting technical/circuit/accessories issues experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to selecting appropriate alarm settings, interpreting monitoring and assessing technical issues/troubleshooting? For example, how this foundational experience has supported your development in technical problem-solving, systematic analysis, applying knowledge of equipment function, and ensuring equipment reliability in critical care.

Relevant learning outcomes

#	Outcome
# 3	Outcome Select the appropriate alarm settings on the ventilator with respect to patient safety and monitoring.
# 4	Outcome Interpret and apply monitoring techniques on high specification ventilators.
# 6	Outcome Assess clinical and technical issues with ventilators and troubleshoot accurately.