Assembly and Troubleshooting of BiPAP Units

Assembly

1. Connect to an appropriate power source. These units use 110v AC line power.

2. Attach the patient circuit to the patient

a. The full face mask is fit tightly to the face using a head harness.

b. Nasal masks must be carefully fitted to the patient's face. These come in several sizes. Some companies supply a sizing gauge to match the mask size to the patient's nose/facial structure. A proper sized mask should fit close to, but not touching, the point where the nose meets the forehead, the sides of the widest part of the nose, and the base of the nose where it joins the upper lip. Use the smallest possible size within these parameters. Foam spacers are provided which aid in mask alignment and comfort. The correct spacer will fill the gap between the forehead and mask and fits over the top extension on the mask. Have the patient hold the mask in place while you use the straps to fit it into place. Tighten the straps just enough to eliminate leaks.

4. Establish initial settings.

a. Respironics BiPAP S/T is capable of CPAP, the same pressure during inspiration and expiration, or bi-level pressure, with higher pressure during inspiration than on expiration, resulting in pressure support ventilation. It can also be used as a ventilator, for assistance on spontaneous breaths, to set a backup rate, or to control the patient's respiratory rate.

 

b. Respironics recommends starting at a relatively low pressure, about 5 cmH2O. The pressure can be gradually increased as the patient becomes comfortable with the equipment.

 

c. If BiPAP is ordered, the difference between them should be kept the same. That is, if either the inspiratory or expiratory pressure is changed, the other must be changed by the same amount to maintain the same level of pressure support.

5. Supplemental oxygen can be bled into the BiPAP at the blower outlet and/or at the mask. Since oxygen levels will vary with the patient's tidal volume and inspiratory flow rate, it is recommended that oxygen be titrated by blood gases or saturations rather than to try to set a specific oxygen percentage.

6. Monitor the patient's ventilatory status through blood gases, saturation, and observation.

Troubleshooting

1. If the pressure alarm sounds:

a. Check for leaks around mask. BiPAP will compensate for most leaks but cannot overcome large ones.

 

b. Check pressure line connection. The BiPAP unit will alarm OFL in this case.

2. Other problems and solutions are the same as for the above CPAP unit.

Modified from Blazer, C: Quick reference to respiratory therapy equipment assembly and troubleshooting, St. Louis, Mosby, 1994.