BIPAP Performance Check
Total Points 30
1. BIPAP Checkout
a. Setup circuit without mask attached (tees airway pressure line into back of Monitor)
b. Completely block tubing outlet without blocking exhalation port
c. Set IPAP 8 and EPAP 5 (wait 3-5 sec)
d. Check that Vest (est leak) = 20 LPM or less
2. Apply mask
a. Measures nose properly with gauge.
i. Near to or just above bridge of nose (nasal bone - cartilage junction.
ii. On the sides of the external nares (may slightly touch)
iii. Just below the lowest point of the nose and above the lip
b. Selects proper sized mask based on gauge size
c. Properly uses nose spacer - Hold the mask against the pt face and measure for the proper sized spacer. It should fill the gap between the forehead and the mask. (#3-6)
d. Secures head strap to mask making strap the largest possible.
e. Have unit running with mask not connected to circuit.
f. Hold mask in place and slide head strap on and adjust head straps. (Top first, sides, bottom)
g. Connect circuit and readjust with patient lying down.
3. Connects mask to circuit
a. Sets Mode to Spontaneous
i. 5 IPAP
ii. 2.5 EPAP
iii. Increases IPAP pressure x 2.5 if desaturates
iv. Increases EPAP x 2.5 if apnea persists
b. Sets Mode to S/T
i. Sets BPM
ii. Identifies indicator light during timed breaths
c. Sets Mode to Timed
i. Set BPM
ii. Set IT%
d. Sets Airway Pressure Monitor Alarms
i. Powers APM on
ii. Knows Inadvertent OFF warns if monitor off and unit on.
iii. Sets High Pressure Alarm - Knows can't be silenced until condition corrected. Goes on and off with each breath
iv. States pressures over 50 cm H20 will damage Monitor.
v. Sets Low Pressure Alarm and ALARM DELAY
(1) States Low Disable Alarm activated when pressure below Low Set Pressure longer than the Delay time.
(2) Pushing Disable Button silences alarm for 20 or 60 secs
vi. Replace Battery Alarm - Continuous alarm lights and intermittent tone will activate as soon as battery voltage below recommended operating level. Indicates 4 - 6 hours left. Won't silence until replace battery.
e. Est VtE Position
i. Accuracy +/- 25% of the reading under stable leak conditions.
ii. Updates after each transition from EPAP to IPAP
iii. Flashing digital display indicates est volumes may be inaccurate, that est leak has changed by 15 LPM.
f. OFL - Displayed in all selections - when less than 1.0 cmH20 pressure is measured by the BIPAP pressure transducer.
g. OOO - VTE - If there is no change in flow indicating ventilation, the reading will change to "000" after 20 seconds.
4. Pre-operational Check
a. With the ventilator OFF, turn APM ON using the power switch. IF the Replace Battery Alarm activates, turn APM off and replace battery. The LOW PRESSURE ALARM will activate if airway pressure < Low Set.
b. Turn ventilator ON and gradually apply 10 cm H20 pressure to the proximal airway pressure line. Turn APM OFF. The Inadvertent OFF alarm should activate.
c. Maintain 10 cm H20 pressure in the circuit and the turn APM ON. Adjust the Low Set to 15 cm H20. The Low Pressure Alarm should activate. Press Low Disable to silence.
d. Occlude mask outlet and run through IPAP pressure levels and EPAP pressure levels. Open one of the mask ports to simulate spontaneous trigger and verify that EPAP cycles into IPAP in S and S/T modes.