Clinical Skills: BiPAP and CPAP

Hello. This video covers how to initiate bipap and CPAP on your patient.

Normally you do everything on this list but to keep things concise, this video will focus on the steps in blue and will also cover special populations.

Like Children frequently asked questions, tips, troubleshooting and include a summary. As a word of caution, we're not covering every possible type of equipment on the market.

Make sure you understand how your own equipment works and how it may affect your procedure. Here's all the equipment you'll need liquid skin barrier, a hydrocolloid dressing, CPAP or bipap machine, humidified oxygen, an appropriately sized full face or nasal mask and a pulse oximeter.

Have your patients sit in an upright position with the head of bed at 30 degrees or more. Inspect the integrity of your patient's skin and protect the bony areas as needed.

Attach the tubing to the noninvasive positive pressure ventilation also called N I PPV. Then attach the pulse oximeter to your patient.

Now turn the N I PPV on and set the machine settings at the lowest level of support normal physiological positive end expiratory pressure or peep is around five centimeters of H2O and So we should initially set our CPAP to something similar like 4 to 8 centimeters of H2O.

In our example, let's start with a CPAP of five centimeters of H2O. When setting up bipap for your patient, you will need to program two settings, an inspiratory pressure of 10 to 12 centimeters of H2O and an expiratory pressure of 5 to 7 centimeters of H2O.

You will also need to set the F IO two. In our example, let's set ours to room air or 21% oxygen, but some patients may need more oxygen.

Now that the initial set up is complete. Have your patient hold the mask on their face until they feel comfortable breathing with the ventilator.

Give them a few minutes to get used to the mask before securing it to their face. The mask should fit snugly over your patient's nose or for a full face mask over your patient's nose and mouth.

The mask shouldn't dig into your patient's eyes or nose or hang over their chin, run your fingers along the edges of the mask to check for air leaks.

You don't want any air leaks, adjust the straps if you feel leaks or if the mask is uncomfortable for the patient. Ok.

So now we're ready to gradually increase the pressure support setting to the level prescribed with BIPAP, start by increasing the level of expiratory pressure.

Then slowly adjust the inspiratory pressure with CPAP. You'll only need to adjust one setting as inspiratory and expiratory pressure are tied together.

Remember that adjustments can make it hard for your patient to coordinate their breath. If your patient can't verbally tell you that they don't like the ventilator changes, make sure to watch them for signs of dyspnea, increased work of breathing or general agitation and stop increasing their support.

Finally set the pressure alarms of the ventilator. You want your low alarm to ring if the patient is not getting enough pressure support and your high alarm to sound when your patient gets too much pressure.

So for example, if you are delivering a peep of five centimeters of H2O, set your low alarm to four centimeters of H2O. And if you're delivering inspiratory pressure of 10 centimeters of h2o, set your high alarm to 11 centimeters of H2O to stop the N I PPV.

Just turn the machine off and remove the mask. Once the mask is off, check the patient's skin for any pressure sores also make sure your patient's work of breathing doesn't increase or their SP two doesn't decrease dramatically with the mask off.

Here are some frequently asked questions about bipap and CPAP machines. Are there any contraindications to N I PPV?

Yes. The use of Bipap and CPAP forces air into the patient's lungs and can be high risk for aspiration and worsening of your patient's prognosis.

It should not be used in patients that are actively vomiting or if there's a concern that they may vomit or who are not protecting their airway or have an altered mental status.

Why do I protect the skin? Noninvasive positive pressure ventilation masks fit tightly to get a good seal but can cause skin breakdown, pressure sores and sometimes even pressure necrosis.

So be careful, not too tight, barrier cream or hydrocolloid dressings placed over the highest pressure points like the nose and cheek bone areas can help reduce this risk.

The are there different N I PPV masks? Yes, noninvasive positive pressure ventilation masks can be nasal or full face and come in different sizes.

Choose a mask that fits your patient properly and allows proper delivery of pressure. Remember, the mask should fit snugly over your patient's nose or for a full face mask over your patient's nose and mouth.

The mask shouldn't dig into your patient's eyes or hang over their chin and there should be no air leaks. Should the N I PPV mask ever be removed?

Yes. Remove the mask when giving oral medications or food because otherwise the positive pressure can push them into the lungs after that's done.

Put the mask back on. Why do I start at a low setting with trial periods?

Noninvasive positive pressure ventilation provides high pressure airflow similar to sticking your head out of a car window while driving.

Many patients feel uncomfortable and find it difficult to coordinate their breasts. At first, lower settings provide lower airflow.

This plus trials of the mask may decrease your patient's anxiety and increase their compliance to the treatment. Another way to increase compliance is to offer rest periods during therapy.

What if our patient is still anxious? Once the treatment has started asynchronous breathing is common when starting this therapy, especially if your patient already has respiratory compromise, stay with your patient after initiating the noninvasive positive pressure ventilation, letting the patient know what to expect with N I PPV.

As well as using relaxation techniques can help prevent anxiety. What can interfere with the seal?

Anything that prevents the mask from fitting snugly to your patient's face can interfere with the seal such as a nasogastric or orogastric tube.

Men with beards and mouth breathing with a nasal mask. Additionally, dentures could interfere with mask, fit and airflow, poorly fitted dentures can block the airway when air is forced in tightly fitting dentures, however, may help the mask fit better.

Here are some troubleshooting tips when using bipap and CPAP machines. Many times low alarms happen because of an air leak or a system disconnect, check your system set up, readjust your patient's mask and check for any leaks along the jawline and the nose areas.

You may have to resize the mask or coordinate with respiratory therapy to create a better seal. High alarms can happen with a mass that is secured too tightly.

Your patient's lung compliance has changed or there are secretions that have built up in the airway mask, readjustment, chest physio and suctioning might help.

Here's another tip, noninvasive positive pressure, ventilation can cause gastric distention, nausea and vomiting. Placing a nasogastric tube or oro gastric tube can help with air decompression.