is anyone free to teach me briefly about BIPAP, the do's and donts, and how you know what pressure to set.
Jan 10, '07
Our RTs deal with the BIPAP machines themselves, so I'm not so sure about pressures and such. (Besides, pressures in the peds world are different from grownup-land). But as far as dos and don'ts, one comes to my find right away:
DO assess under the mask frequently for breakdown. This will usually occur on the bridge of the nose, so applying some thick duoderm (kind of in the shape of one of those pore strips) is helpful. But I've seen it under the nose as well (upper lip/bottom of septum area) on patients with just a nasal mask. If you're in the peds world, and the patient has nasal prongs (not sure if they do that in the adult world), be sure to take them right out and assess the septum itself at least Q2 for breakdown. I've known of NICU babes who have lost their septums because no one was checking.
Oh, and on the side of the masks, there's usually a little clear hose, about the size of IV tubing. Often your machine will be beeping like crazy and you can't figure out why and your patient is desatting, but the seal on the mask looks fine. If this happens, check the waveform on the display. If it's flat with no respiratory pattern, check to make sure that hose is connected (providing your patient IS actually breathing, of course).
Jan 11, '07
The pressure settings should be ordered specifically. 12 and 4 are common. That is the inspiratory and expiratory positive pressures. I think different machines are different. Often there will be a humidifier with a tempurature setting. There should be tubing like on a vent, and it has a tempurature sensor.
If the pt has an NG tube it will cause an airleak and they have to set the pressures higher than they want. On our machine there is a gauge on the right that gives you the actual pressures.
Bipap puts pressure on the superior vena cava and will cause a drop in BP, I think because of baroreceptors, correct me if I'm wrong anyone. Often there will be O2 bleeding into the main tubing.
Jan 11, '07
Ahhh! I didn't know there was a temperature gauge.. my dad was fraeking out cause it was numbing his nose.. they could have warmed it up for him!! I didn' tknow he said the pressure is awful but the cold is what got him well when we had one lol
Jan 11, '07
Don't know alot, but there are many different machines with many different options. There is even quite a few different "masks" that may be used.
A biPap delivers air pressure at 2 different rates. one rate is for inspiration, then other for expiration. I've been told that there is usually better compliance with a BiPap as opposed to a CPAP, but I have no documentation to back that up.
If the order is for humidified air, the will be some sort off attachment to the unit with a resevoir that you put distilled water in. They vary with different companies.
Some come with a "smartcard" that does a mini sleep study each night.
Some are programable, some are programed only by a smart card, so you can't change the settings yourself.
If someone is on O2, you can get an adapter that bleeds O2 into the mask area (Kinda hard to get a seal with a nasal canula on).
If you have a patient that is using an assistive machine, it may be beneficial to do a seach for that model to see if you can get info for that specific model.
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