Question: What's the RN's Responsibility with BiPAP/CPAP?

Import: The emphasis of our unit brings us into frequent contact with “noninvasive positive-pressure” ventilation. Recent nights and codes remind me of this. There was an article in Nursing2006, vol. 36, #5 p. 46-7, on this topic, from which much of the rest of this post is gleaned.

Fxn: improve gas exchange w/o intubation

Bilevel Positive Airway Pressure=df. 2 settings, higher on inspiration, than expiration. Can do full ventilation.

Continuous Positive Airway Pressure=df. 1 setting, same on insp. as on exp. (exhaling against pressure helps reexpand and stabilize the alveoli). Pt must be able to spontaneously breathe; cannot do full ventilation.

Whose Responsibility: RT initiates; RN educates, evaluates for, and monitors while on

And now for my newest mnemonic:

1^st and always assess mentition, vitals, ABCs, skin color (aura)

Then, what should also be noted on assessment and documented: “BiPAP”

• B breath sounds
• I inspired oxygen (FiO2)
• P pulse oximetry level
• A accessory muscle use
• P production of sputum (think ability to cough/clear secretions)

Commentary: If a recent and serious negative change has warranted placement of a patient on BiPAP for maintenance of oxygen saturation, then one wants to be particularly thorough AND PERSISTENT in assessments. This is a particularly precarious situation with potentially rapidly changing circumstances. If one has red flags going off, that things are not all well, then simply monitoring “as usual,” or less, not monitoring at all, is insufficient and negligent. This is time for Rapid Response; or you will be coding your patient.

Yours truly,
Christopher

P.S. The following link will take you to the AHRQ National Guideline Clearing House site for CPAP and BiPAP where you will find the practice parameters for the use of these devices to treat adult patients with sleep-related breathing disorders:
http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=9076&nbr=&string=#s21

¶ 1:57 PM