Pt on bi-pap with supp liquid O2 at HS

[LadyinScrubs, ASN, RN]

I have a question to ask of those of you who have/had a pt who is on Bi-Pap with supp O2 during HS.

My pt must maintain a SPO2 >94% (per order). He uses the bi-pap at night and it is connected to supplemental liquid O2 whose levels can be 6-12 L/min to maintain SPO2. I have noted that when he goes to bed and is connected to the bi-pap with the supp O2, his sats tend go down very quickly after connection. Before he goes to bed, his is just connected to liqui O2, mask and tubing; his sats are maintained at that time.

I have also noted that his bi-pap has two vents (one near the connection where the O2 comes into the large bi-pap tubing and another vent and filter just before the tubing goes into mouth piece (he is a mouth breather and cannot use a mask).

I have no way to determine whether the two vents in the bi-pap set up is actually decreasing the pt's O2 concentration by allowing the O2 to escape before it gets to him. I do note as the nite progresses so does the level of supplemental O2 to maintain a spo2 >94. He is connected to a SPO2 finger probe so I know when his sats drop and I have to take action.

Has anyone else noted/ experieced anything similar?

[SDALPN]

The vents are one way valves. They work as the patient exhales to prevent rebreathing exhaled air. (carbon dioxide) You should be fully trained on the equipment before taking care of a patient on equipment that you aren't familiar with. O2 with a bipap is common and the set up you are explaining is common. But not seen in PDN often.

[LadyinScrubs, ASN, RN]

The vents are one way valves. They work as the patient exhales to prevent rebreathing exhaled air. (carbon dioxide) You should be fully trained on the equipment before taking care of a patient on equipment that you aren't familiar with. O2 with a bipap is common and the set up you are explaining is common. But not seen in PDN often.

Yes, I am familiar vents an the rationale behind the one way valve.

However, this is not a vent but a bi-pap (some could argue that they are the same).

The tubing, mouith piece, O2 conections, lines are all washed daily. When putting the bi-pap together, the first vent opening is just after the connection to the supplemenntal O2 supply. That appears to be possibly a one way valve, but I really never examined closely.

However, the vent that is at the connection between the bi-pap tube and the mouth piece is just a oval opening covered by a small white filter and the cover has slits--which allows air to escape. Still I don't know if the pt is getting the appropriate oxygenation through the bi-pap with supplemental O2 or if the vents allowing oxygen to escape decreasing his SPO2.

The bi-pap company swears that this is not the case but if the filterized vent is a 2 way opening, and because of this (without taking into consideration the other vent valve) it should follow that the pt is losing his high O2 supplementation--or at least to me.

As far as bi-pap in private duty. What can I say. This pt was constantly alarming throughout the night with lot SPO2 despite resp tx's, etc. Because of facial anomly, the pt could not tolerate the bi-pap mask. Finally, the resp therapist tried the mouth piece and it worked well, but took years for the pt to become accustomed to it. Now two years later, the pt can sleep at night without problems. The problem I see is once he is off the regular O2 mask with supplemental O2 and put on the bi-pap with same supplemental O2, his sats eventually fall and he gets low SPO2 alarms. If I put him back on the O2 mask and liquid O2 at same rate and stop the bi-pap, there is no a problem however, his sleep apnea continues--not that it is 100% with bi-pap, but it is much better.

That is the reason for my question - will a pt on bi-pap with high supplemental liquid O2 (6-12 L/m)have the same or better SPO2 with the bi-pap than if the pt were using only O2 mask with same rate of supplemental liquid O2?

[SDALPN]

I never said anything about a ventilator. I was talking about a bipap. If there are desats while on the bipap, the bipap settings may need to be checked and the bipap may need to be checked itself to make sure it is functioning properly. There is a device to check and see if the pressure coming out of the bipap is the same as the settings on the bipap to make sure its calibrated right. If the device is working properly, the patient may need another sleep study or need to be evaluated by a Dr.

[LadyinScrubs, ASN, RN]

I never said anything about a ventilator. I was talking about a bipap. If there are desats while on the bipap, the bipap settings may need to be checked and the bipap may need to be checked itself to make sure it is functioning properly. There is a device to check and see if the pressure coming out of the bipap is the same as the settings on the bipap to make sure its calibrated right. If the device is working properly, the patient may need another sleep study or need to be evaluated by a Dr.

Yes, you are correct but the calibration is set by the company / physician. As far as a sleep study, that is not necessary as the is a congenital problem with micro airway (in fact all tubes are micro) and not a nose breather related to the micro airway. This problem has been life long and keeps night nurses active to keep sats above 95% on 6-12 L/min. Lots of resp tx's etc to keep air way open, stop spasms, and dislodge mucus plus.

I liked your suggestion. I am going to have a long talk with the PCG (who is also an adv pract nurse, well as SW and the mom. She has a doctorate in her young adult). Something is not right and since I am NOC, I never see the resp people or MD; yet it is my duty to keep the airway open, SPO2 >95% with continuous supp liquid O2 at 6-12 l/m, monitor the severe apnea even with the bi-pap, and to keep the pt from coding. Seldom a shift goes by w/out not numerous alarms for apnea, low sats, mucus plugs, brady/tachy cardia, or bad seal on the bi-pap mouth piece. However, without the HS bi-pap the pt is a walking zombie r/t repetitive apnea problems.