308 Nasal CPAP 308 / Page 1 Of 7

Transcription

1 308 Nasal CPAP 308 / Page 1 Of 7 Description CPAP via nasal mask may be used to relieve upper airway obstruction. Nasal CPAP is primarily used with patients who suffer from sleep apnea disorders. It is effective in treating obstructive sleep apnea and, in some cases, central sleep apnea. Nasal CPAP may also be used to increase a patient's FRC and promote re-expansion of collapsed alveoli. Nasal CPAP can be administered using three different devices: Healthdyne Tranquility Plus, Good Knight Nasal CPAP and the Respironics BiPAP STD. The three different systems can be used with the same type nasal mask and breathing circuit. The Healthdyne Tranquility Plus is equipped with a special feature called Ramp Time. When choosing a nasal CPAP system, the Respironics BiPAP system should be used last. NEVER use a full face mask with Nasal CPAP machines. Physician Order Equipment cmh 2 0 of Nasal CPAP at % oxygen during the hours. Mode: CPAP or AutoCPAP Fisher&Paykel SleepStyle200 Healthdyne Tranquility Plus Good Knight Nasal CPAP Respironics BiPAP STD 30 (in the CPAP mode) see Section BiPAP Respironics STD 30 2 x 40 inch smooth bore tubing with universal adapter. Castle adapter. Nasal CPAP mask with swivel connector. Head strap for nasal CPAP mask. If supplemental oxygen is required: pressure line adapter, oxygen connecting tubing and oxygen flow meter with nipple adapter. Pulse oximeter (optional). Fisher&Pakel humidifier Sterile water Procedure SleepStyle 200 (for adult use only) 1. Gather all necessary equipment. 2. Explain procedure to the patient. 3. Plug CPAP machine into the electrical outlet

2 308 Nasal CPAP 308 / Page 2 Of 7 4. Assemble and fill humidifier chamber to the fill line with sterile water only. The addition of heated respiratory humidification to the device relieves and drying and irritating effects on the patient airways common with CPAP delivery. 5. Connect the two sections of 40 inch aerosol tubing using the universal adapter. 6. Attach one end of the aerosol tubing to the outlet of the CPAP humidifier. 7. Attach the other end of the aerosol tubing to the castle adapter. 8. Attach the other end of the castle adaptor to the swivel connector on the appropriate size Nasal CPAP mask. 9. Ensure air filter is clean. 10. Plug unit into red power plugs, 11. Power on device by pressing on/off button. The current humidity setting will display. 12. See Controls and Display below for description of icons and display menu.

3 308 Nasal CPAP 308 / Page 3 Of 7

4 308 Nasal CPAP 308 / Page 4 Of 7

5 308 Nasal CPAP 308 / Page 5 Of 7 I. Healthdyne Tranquility Plus 1. Gather all necessary equipment. 2. Explain procedure to the patient. 3. Plug CPAP machine into the electrical outlet 4. Connect the two sections of 40 inch aerosol tubing using the universal adapter. 5. Attach one end of the aerosol tubing to the outlet of the CPAP machine. 6. Attach the other end of the aerosol tubing to the castle adapter. 7. Attach the other end of the castle adaptor to the swivel connector on the appropriate size Nasal CPAP mask. 8. Turn on the CPAP machine set pressure to ordered CPAP level. 9. Position the head strap around the patient's head and gently secure the Nasal CPAP mask to the patient's nose so there are no leaks around the mask. 10. Set ramp time to accommodate patient comfort. 11. Have the patient breathe and get use to the feeling of the mask for a few minutes. Note: When the ramp time is set (5-30 minutes), the pressure will start at 3 cm H 2 O and will gradually increase in the selected time period to the set pressure level. 12. Observe the patient and check for air leaks around the mask. Note: The "Leak Test" switch operates only when the ramp feature is in use. The leak test position will increase pressure to the set pressure level. This allows the user to adjust the nasal mask for leaks and to adjust the pressure attained after the ramp sequence is finished. The "Normal" position returns the system to the ramp sequence.

6 308 Nasal CPAP 308 / Page 6 Of 7 II. Healthdyne Tranquility Plus CPAP System If Supplemental Oxygen is to be Used: 1. Place pressure line adaptor at the outlet of the device being used. 2. Connect the pressure line adaptor to an oxygen flowmeter with oxygen connecting tubing. 3. Adjust flowmeter until the desired S p O 2 level or F i O 2 is obtained. 4. Measure the F i O 2 by connecting oxygen tubing to the port on the nasal mask. Patient Assessment / Reassessment The patient s response to therapy should be assessed and reassessed. Patient assessment and reassessment should be performed according to the general RCS policy (see Section IV - Patient Assessment / Reassessment in the RCS Policy Manual). The need to continue therapy should be reassessed every 24 hours. Specific criteria for assessment and reassessment should include: Changes in upper airway obstruction Patient s tolerance to therapy Development of the following complications Contraindications/Complications Patients requiring a backup respiratory rate or Biphasic NIV will be transferred to 4b, 4e, 5e or 5r for appropriate monitoring and improved staffing levels to insure patient safety.

7 308 Nasal CPAP 308 / Page 7 Of 7 A mask should not be used unless the device is switched on, and operating properly. The vent hole(s) associated with the mask should never be blocked. At low CPAP pressures, the flow through the mask may be insufficient to clear all exhaled gas from the tubing, and consequently some re-breathing may occur. Apnea Nasal CPAP is generally contraindicated in patients with a history of bullous lung disease, pneumothorax or pathologically low blood pressure. A temporary contraindication may exist if the patient contracts a sinus or middle ear infection, since the positive pressure may reduce drainage from these sites. Agitation - if procedure is not tolerated by patient, stop procedure and notify physician. Pressure necrosis or dermatitis. Nasal CPAP may result in a dermatitis reaction due to mask pressure on the skin. Stop therapy and notify physician. House Formula 5 cm H 2 O of Nasal CPAP at Room air (9:00 pm to 6:30 am for sleep apnea) (continuously when used to maintain patency of upper airway.) Discontinuation Procedures Upon discontinuation all reusable equipment is to be cleaned, set up, and stored in the 4F9. Charting / Charges Nasal CPAP should be checked at least every four hours. Charting should reflect this. In 4E and 5E, chart in the ICIP. In all other locations, chart on the Respiratory Therapy Record. Charge for Adult Nasal CPAP Setup each initial setup and Nasal CPAP Daily for any date other than the setup or change day.