CPAP (RPA) - Intensive Care & Coordination Monitoring Unit

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DRAGER XL & EVITA VENTILATORS: SETUP: see picture below for assistance • Keep humidifying ventilation circuit intact • Attach bacterial/viral filters to both inspiratory and expiratory arms of ventilator • Attach short arm of blue tubing to filter on inspiratory side of ventilator and other end to humidification bath • Attach long arm of blue tubing from humidification bath to CPAP mask • Assemble “blue” wire of the humidification bath holder, to blue tubing • Attach white tubing to filter on expiratory side of ventilator, attach “yellow” wire of the humidification bath holder to white tubing • Attach “Y” piece to mask • When ventilator is in “Stand By” select “Mask” and confirm. If using the EVITA ventilator (not all EVITA’s can do NIV, check for sticker to indicate) the screen will change from blue to green and the top right corner will state that the ventilator is in Non Invasive mode. If using the XL ventilator touch the “Tube/mask” tab and select “ Mask” the words “Mask Ventilation” should appear in the top right corner in orange • Check ventilator as per invasive ventilation • Touch the PEEP dials until desired parameter is reached and confirm • Attach mask to patient Setup of CPAP on Drager XL ventilator (Same set up for Drager ventilators with NIV function) ©ROYAL PRINCE ALFRED HOSPITAL INTENSIVE CARE SERVICE
NURSING RESPONSIBILITIES: • Explain to patient and relatives regarding the compliance to the mask as well as: o It may be uncomfortable o Difficulty in breathing out o Tightness of the mask o Feeling of “locked in” o Possible eye swelling • Second hourly mouth and pressure relief care (whenever possible) • Padding may be required as the mask are not individualised • Regular check of equipment, as there is no integrated monitoring facilities • Hourly observations and recordings (monitor water level) • Monitor airway and respiratory function (If patient is in difficulty inform Dr.) • Monitor ABG’s • Consult with medical officer for the need of a nasogastric tube to prevent gastric distention and vomiting • Be aware of CPAP complications (see below) • Change tubing weekly and perform safety valve check • Be aware of CPAP complications (see below) COMPLICATIONS: Complication Treatment Rationale Skin necrosis (nose Apply soft dressing Cushions and protects the and chin) area Gastric insufflation Placement of nasogastric tube Relives abdominal and aspiration distension Mask intolerance and Select appropriate mask size Provides better seal and leaks comfort and prevents gas from escaping Transient hypoxia Provide alternative O2 source eg Reduces hypoxia and can nasal prongs when eating and replace mask quickly if closely monitor patient removed Hypotension Ensure patient is adequately Reduces the effects of filled. Keep PEEP less than 8cm H20 if possible. increased thoracic pressure CO2 rebreathing Ensure minimal dead space is Reduces resistance in the present and appropriate expiratory circuit and allow CO2 to valve is used escape Barotrauma Assess airway pressures and Prevents over expansion of lungs Nasal congestion and Ensure adequacy of humidified air Prevents build up and sinusitis increased viscosity of secretions Eye irritation and Avoid mask leaks, apply eye Reduced air flow into the conjunctivitis drops as appropriate eyes. ©ROYAL PRINCE ALFRED HOSPITAL INTENSIVE CARE SERVICE
Page 1 and 2: INTENSIVE CARE SERVICE NURSING POLI
Page 3: Entire designated CPAP circuit PARA

CPAP (RPA) - Intensive Care & Coordination Monitoring Unit

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