308 Nasal CPAP

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Nasal CPAP
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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
_____cmH20 of Nasal CPAP at _____% oxygen during the hours_____.
Mode: CPAP or AutoCPAP
Equipment
•
Fisher&Paykel SleepStyle200
•
Healthdyne Tranquility Plus
Good Knight Nasal CPAP
Respironics BiPAP STD 30 (in the CPAP mode) see Section 310.11 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
RCS SFGH
Reviewed11/10, 6/12
Revised 8/98, 02/02,12/04, 10/07, 11/2010
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Nasal CPAP
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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.
RCS SFGH
Reviewed11/10, 6/12
Revised 8/98, 02/02,12/04, 10/07, 11/2010
308
Nasal CPAP
RCS SFGH
Reviewed11/10, 6/12
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Revised 8/98, 02/02,12/04, 10/07, 11/2010
308
Nasal CPAP
RCS SFGH
Reviewed11/10, 6/12
308 / Page 4 Of 7
Revised 8/98, 02/02,12/04, 10/07, 11/2010
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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
H2O 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.
RCS SFGH
Reviewed11/10, 6/12
Revised 8/98, 02/02,12/04, 10/07, 11/2010
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Nasal CPAP
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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 SpO2 level or FiO2 is obtained.
4. Measure the FiO2 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.
RCS SFGH
Reviewed11/10, 6/12
Revised 8/98, 02/02,12/04, 10/07, 11/2010
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•
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 H2O 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.
RCS SFGH
Reviewed11/10, 6/12
Revised 8/98, 02/02,12/04, 10/07, 11/2010