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Definitions of terminology used

Definitions of terminology used

VTE

  • Expired tidal volume
  • Amount of gas passing in and out of the lungs in one cycle

PEEP

  • Positive end expiratory pressure
  • Increases the surface area of the alveoli

PIP

  • Peak inspiratory pressure
  • The highest level of  pressure applied to the lungs during inspiration

Flex

  • Enhances patient comfort
  • It will lower the pressure when the patient exhales and slowly increase the pressure on inspiration

Ramp

  • Allows the machine to start at a lower pressure and then increases the pressure over a set time frame
  • This allows the patient to get use to the mask at lower pressures first

Leak

  • The amount of air escaping from the mask
  • Should be less than 60 if possible
  • Usually due to the fit/size of the mask

FiO2

  • Fraction of inspired oxygen
  • Amount of oxygen being delivered to the patient
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Patient anxiety

Patient anxiety

Anxiety related to syncing with the mask, finding the mask uncomfortable, feeling claustrophobic and/or feeling like they can’t breath when using the machine
  • Check with doctors if medication can be given to help with this
  • Ensure regular breaks are discussed with the patient
  • Ensure the patient has their call bell within reach
  • Regular reassurance and encouragement
If the patient has had the mask on for a few days they may be anxious when we are weaning down the pressures and oxygen
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Continence

Continence

  • Does the patient need a catheter?
  • Will the patient be short of breath when using the commode?
  • Does the patient want/need a pad for comfort?
  • Consider that patient will become short of breath when using the toilet/commode/bedpan so oxygenation needs to be monitored.
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Dry eyes/mouth

Dry eyes/mouth

Does the patient need eye drops/artificial tears? Consider using mouth care pack to moisten lips and mouth.
  • Do not use a paraffin-based product if the patient is on oxygen.
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Pressure sores

Pressure sores

Pressure areas to consider when patient is in bed:
  • Any bony prominence on a patient e.g. sacrum, shoulders, heels
  • Facial pressure sores due to NIV mask
Areas to consider:
  • Cheeks
  • Nose bridge
  • Forehead
  • Back of head where the straps come into contact with the skin
  • Chin
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Oral intake

Oral intake

Fluid

  • Is the patient drinking enough?
  • Do IV fluids need to be considered?

Food

  • Is the patient able to have breaks off of the CPAP to eat, and do they maintain their oxygen saturations while eating?
  • If not consider NGT/dietician referral.
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Gastric distention

Gastric distention

A consequence of tight fitting mask around mouth and nose is that pressurised air delivered by CPAP is sometimes swallowed (aerophagia) resulting in a progressively swollen/distended stomach. This most often results in patients experiencing more flatulence, but there remains a serious risk of vomiting and aspirating.
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Secretion clearance

Secretion clearance

Nurses

Consider oral suctioning if needed

  • Use Yankauer suction tube
  • Suction levels for adults are 100-150 mmHg on wall suction and 10-15 mmHg on portable suction units
  • Only suction what you can see

Consider a referral to physiotherapy

  • They can offer chest clearance exercises
  • They can perform deep suctioning if it is required