CPAP (RPA) - Intensive Care & Coordination Monitoring Unit

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INDICATIONS FOR CPAP: • Acute respiratory failure • Pulmonary contusion and flail chest • Cardiogenic pulmonary oedema • Asthma • Chronic airways disease • Post-operative atelectasis • Obstructive sleep apnoea • Pneumonia CONTRAINDICATIONS: • Unstable facial fractures • Extensive facial lacerations • Laryngeal trauma • Recent tracheal or oesophageal anastomosis • Basal skull fracture, (use with caution) • Patients at risk of GIT bleeds/ileus USE WITH CAUTION • Patients with recent GI surgery • Decreased level of consciousness EQUIPMENT: Drager CPAP machine/Drager Ventilator with NIV function Ventilation tubing for wet circuit (humidification base in tubing pack) Sterile water bag CPAP mask and head strap PEEP valve (5,7.5, 10 or 12.5, may start with 10cmH20) Bacterial/viral filter (machine side of tubing) Test lung White rubber connector (for dedicated Drager CPAP unit only) CPAP MACHINE SET UP: See pictures below for assistance • Keep “Y” connector attached to ventilator tubing • Remove white side of vent tubing • Place bacterial/viral filter to CPAP machine, then attach short arm of blue tubing from filter to humidification bath • Attach long arm of blue tubing from humidification bath to CPAP mask • Assemble blue wire of humidification bath holder to blue tubing • Using white rubber connector attach PEEP valve to exposed end of “Y” connector • Perform safety valve check (see below) • Adjust prescribed Fi02 (use flow rate of 40L/min) Equipment for Designated CPAP circuit ©ROYAL PRINCE ALFRED HOSPITAL INTENSIVE CARE SERVICE
Entire designated CPAP circuit PARAMETER SETTING: • Medical orders are prescribed (Fi02, PEEP level and flow rate) • Inform patient and relatives of the procedure and management (see nursing care) • Usually the flow rate is 40L/min (see below for additional information) • Use the table on the front of the machine to set the oxygen and air flow rates to obtain the required flow rate and FI02 by turning the oxygen and air “black knobs” • Check the level of PEEP on the pressure gauge of the CPAP machine to ensure the correct level is being delivered once insitu to patient’s face • Ensure CPAP mask is air tight as possible to obtain the desired CPAP level Flow rate: A flow rate of 30-40L/min is the usual rate required. This roughly corresponds to about 1.5times the usual minute volume. This flow rate should ensure an ample reservoir of gas from which to breathe, however higher gas flows may be required in patients who are tachypnoeic and those able to generate a large negative pressure through the circuit. PEEP: PEEP is ordered in cmH20, the Drager pressure gauge measures in millibars, there is a difference of approximately 2 units between millibars and cmH20. Therefore, there will be a difference between what is ordered and what the Drager gauge measures SAFETY VALVE CHECK: • Set flow rate at approximately 20L/min (use 20L/min only for testing) • Place test lung on patient end of the circuit and occlude PEEP valve • Ensure the bellows expand to their full length • The pressure indicated on the pressure gauge must not exceed 30mbars • The safety valve at the rear will release air audibly • Ensure this check is recorded in log book ©ROYAL PRINCE ALFRED HOSPITAL INTENSIVE CARE SERVICE
Page 1: INTENSIVE CARE SERVICE NURSING POLI
Page 5 and 6: NURSING RESPONSIBILITIES: • Expla

CPAP (RPA) - Intensive Care & Coordination Monitoring Unit

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