Clinical Procedures - Non Invasive Ventilation ( CPAP) Non-invasive ventilation should only be set up by experienced operators. The following is a guide only. Background CAP = continuous positive airways pressure. CAP traditionally has its own equipment and 'set-up'. Recently more clinicians are delivering CPAP through the BiPAP Vision@. There is also a 'low-flow' version used mainly for transport of CPAP-dependent patients. Equipment )rd • Mask (‡ T-piece), hood • Head strap (mask), shoulder straps (hood) • Oxygen circuit and humidification • High flow generator (e.g. Whisper Flow®, Vital Signs®) • Positive end-expiratory pressure (PEEP) valves (usually 5, 7.5, or 10cmH,O) • 'Blow off' safety valve (10cmHO above the PEEP used). Procedure • Use available templates to assess appropriate sized interface and minimize air leaks (if using the BiPAP Vision • Decide on level of PEEP to apply • Attach PEEP valve to mask (if using traditional set-up, may need T-piece) • Attach oxygen circuit with humidification including 'blow off' valve (for safety) • Set inspired oxygen level • Set flow rate to ensure the PEEP valve opens a small distance and never closes • Titrate oxygen and PEEP in response to the patient's work of breathing, saturations, pH, Pa02, and PaCO2 • If appropriate, set alarms on ventilator (if using BiPAP Vision® • Write a prescription chart of PEEP or ventilation settings and acceptable saturations, Pa02 and PaCO, continuous or intermittent. Procedure Tips • If valve closing fully, there is an air leak or patient requires higher PEEP • May need to put more air into the mask rim for patient comfort and a better seal • Better fit of mask if the patient keeps their dentures in! • Large-bore nasogastric tubes will cause a leak, change to small-bore or bulk up cheek tissue with granuflex. Indications • Type 1 respiratory failure (e.g. lobar or bibasal collapse post surgery, pneumonia) • Cardiogenic pulmonary edema • Obstructive sleep apnoea • Weaning. Contraindications /Cautions • D Undrained pneumothorax (absolute contraindication) • Facial fractures • Life-threatening epistaxis • Bullous pulmonary disease • Proximal lung tumours (air trapping) • Active TB (spread) • Acute head injury • Low blood pressure • Uncontrolled cardiac arrhythmias • Sinus/middle ear infection. Risks • Abdominal distension (secondary to 'swallowing' air) • Decreased cardiac output (drop in blood pressure) • Pressure sores from mask • Aspiration of vomit • CO, retention if patient breathing small tidal volume against Documentation • Oxygen prescription chart • Clear record of ABGs with evidence of time, inspired oxygen and PEEP • Continuous or intermittent • Good practice to document 'ceiling' of treatment in clinical environment (pressure and Fi02).
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