BIPAP Tip Sheet The Bipap machine offers both C-PAP and BIPAP: Review of C-PAP continuous positive

e airway pressure Provides 1 level of pressure Usually ordered for sleep apnea At sleep, soft tissues relax and collapse during sleep which can block the airway, lead to periods of apnea; some cases can be so severe that people can die. C-PAP provides pressure to keep the airway open; C-PAP acts like a splint Review of BIPAP: Provides 2 levels of pressure 1. IPAP= Inspiratory pressure which is a higher pressure than EPAP 2. EPAPA= Expiratory pressure which is the lower pressure (this is a lower number than IPAP) Pressure support: IPAP EPAP = pressure support Example: IPAP= 10 and EPAP = 5 10-5= 5 (5 is your true pressure support) If the pts Co2 level is high, the doctor may increase the IPAP pressure setting.

BIPAP Goals: 1. Improve ventilation 2. Improve oxygenation 3. Decrease the labor of breathing BIPAP INDICATIONS 1. Resp. Failure 2. COPD 3. On a pt who has been extubated to decrease the chance of reintubation 4. Assessments for those who may need BIPAP: what are the O2 sats? What is their resp. rate? Are they having trouble breathing & using accessory muscles? BIPAP Contraindications 1. Resp. Arrest---this person needs a ventilator 2. Airway obstruction 3. Check ABGSif pH is 7.3 or even 7.2, pt is too acidotic and needs a ventilator 4. Untreated pneumothorax 5. Any pt at risk for aspiration or vomiting is not a good candidate for BIPAP PARTS of the BIPAP: 1. Exhalation Port- a purposeful vale or leak that allows the exhaled CO2 to escape. This valve or opening MUST NOT be blocked by pillows, blankets, etc

2. Face Maskscomes in small, medium, and large sizes 1. Velcro straps adjust for a good fit; you do NOT want the mask too tight---can cause facial irritation and you want some leak at the mask. If the mask had zero leakage, it would be too tight for the patient. 2. Nasal mask just fits over the nose; pt must be able to keep his mouth closed.; also available in different sizes. Leak levels are maintained at 5-25 liters/minute 3. Humidity is used with face masks because the air is very drying (sterile water is used for humidity) On/Off button- white button on the back of the machine in the upper right had corner. Machine will do a self test when you turn it on (takes about 15 seconds). The machine is checking the leak port to make sure it is not blocked. Alarms will display in the upper window of the machine. Silence button is on Right hand side of machine and the reset button is on the right sideuse this when you correct the alarm. Vent in-op Alarmthis is an IMPORTANT alarm. This key on the right side (has a wrench symbol) will turn red and cause an annoying continuous alarm. You cannot silence this alarm. Check to see if the power cord is unplugged from the back of the machine. The check vent alarm will alarm once. It is a warning that something is wrong with the machine---have resp. therapy check the machine for you. Settings: you will see settings for IPAP, EPAP, rate (usually 4-40), and a back-up rate in case the pt stops breathing (usually set at 10). What can nursing do? 1. Adjust face masks. Remember the mask should not be too snug! 2. If your pt goes off the floor for a test, you may put the machine is stand by mode. Push Monitoring button, then push stand by button. When pt returns, reapply the mask and the stand by mode goes off/ventilation mode occurs 3. Meal time: wait about 1 hour before reapplying the maskdue to high risk of aspiration. You can put the machine on standby and apply 02 as needed (assess your pts 02 sats to determine how much oxygen is needed) OR under parameters, look at the FiO2 setting: 1 liter of O2 = 24% FiO2; for every additional liter of O2 add 4 %. Example: 2L = 28%, 3L= 32%...

Resp. Therapy is here to support you! Dont feel like you will be an expert on Bipap after one inservice. You will become more comfortable with the machine each time you use it. Resp. Therapy will do 2 hours checks on all BIPAP. There is a flow sheet for the BIPAP and it is located at the bedside.