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Non-Invasive Assisted Ventilation (2.12)

Non-Invasive Assisted Ventilation (2.12) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Mechanical Ventilation

2.12






2.12 Non-Invasive Assisted Ventilation (Bipap)
Category: UWHC Patient Care Policy
Effective Date: September 19, 2017
Version: Revision
Section: Respiratory Care Services

I. PURPOSE
A. Non-Invasive Assisted Ventilation (NIV) mechanical ventilation or bi-level positive pressure
(BiPAP) provided through an appropriate delivery device to supplement the spontaneously breathing
patient. These devices regulate the flow of gas to the patient until a preset volume or pressure level
is achieved. Please refer to the User’s Manual for each respiratory assist device for a full description
of the modes available.


II. CONTRAINDICATION
There are no absolute contra-indications for NIV however, if the patient has any of the following conditions, the
Respiratory Therapist must discuss and document the discussion outcome with the ordering provider before
performing the procedure.
A. Recent facial, oral, or skull surgery or trauma.
B. Choanal atresia, cleft palate, or tympanic membrane disorder.
C. Epistaxis.
D. Esophageal surgery.
E. Untreated pneumothorax.
F. Untreated diaphragmatic hernia.

III. POLICY
A. All patients will be assessed by the respiratory care practitioner (RCP) to determine if the appropriate
indications for therapy are present.
B. Therapy will be provided in accordance with a provider’s order.
C. Patients who are treated with non-invasive forms of respiratory support must be placed in a care setting
appropriate to their condition per the following guidelines:
1. Patients with acute respiratory failure or decompensation must be admitted to an ICU, IMC unit,
Emergency Department or the Recovery Room. Such patients shall not be placed on any general
care unit of UWHC while receiving continuous respiratory support. Treatment of acute
respiratory failure may be started on a general care floor, but provisions for patient transfer to an
ICU/IMC unit must be made within one hour.
2. Patients with chronic conditions (particularly those previously maintained on non-invasive
ventilation at home), appropriate mental status and not at acute risk for apnea may be placed on
non-invasive respiratory support on a general care unit. Examples include:
a. The treatment of central and/or obstructive sleep apnea.
b. Diagnostic studies
c. Patient instruction purposes.
d. Treatment of chronic respiratory failure.
3. Patients may use continuous non-invasive support if on the palliative care service for comfort
measures.
4. The use of non-invasive assisted ventilation may be applied intermittently for support of chronic
conditions previously maintained on non-invasive ventilation at home; however, this therapy
must not be used as treatment of acute respiratory failure or decompensation.
5. In UH a patient using a mechanical ventilator for nasal ventilation requires placement in an ICU
or IMC qualified to take ventilated patients.
6. Patients and/or their families may self-administer non-invasive support with an order from the
physician and an assessment by the RCP that includes the following:
a. A passed safety check of patient-owned equipment.





b. Communication with the RN to determine plan for sedation/pain medications that may
impact patient’s ability to self-administer.
c. Oxygen and/or pressure level settings that are equivalent to the patient’s home
prescription.
d. The patient and/or family’s ability to administer and maintain their own support.
D. Appropriate alarm systems will be utilized to assure that the alarms are audible with respect to distance
and competing noise.
1. Devices that have nurse call connectivity will be linked to the nurse call system..
2. Patient’s that require continuous BiPAP/Non-Invasive Ventilation for acute respiratory failure
must use a device that can be linked to the nurse call system to signal disconnect.
3. All patients using continuous BiPAP for obstructive sleep apnea must be monitored with a
continuous pulse oximeter.
4.
E. Protective skin barriers will be used on all pediatric patients. Adult patients may receive skin barriers per
the discretion of the RCP or RN.
F. An exception to this policy may be made by the Medical Director of Respiratory Care or their designee.
1. The Medical Director for Respiratory Care is the contact for all patient concerns on adult units.
In the absence of the Medical Director, RC will contact:
a. The attending physician on the Pulmonary Consult Service from 0700-1700.
b. The Critical Care Attending covering the Critical Care Service in the Trauma Life
Support Center, 1700-0700.
2. The Assistant Medical Director for Respiratory Care is the contact for all patient concerns on the
Pediatric units. In the absence of the Assistant Medical Director, Respiratory Care will contact
the attending physician on the Pediatric Pulmonary Service.

H. All patients that require continuous non-invasive support for more than 8 hours must have humidity
added.

IV. EQUIPMENT
A. An appropriately sized nasal mask with exhalation port/valve .

B. Appropriate NIV delivery device
C. Alarm systems if applicable
D. A humidifier for:
1. Continuous BiPAP/NIV that is administered for greater than 8 hours.
2. All pediatric patients.

V. PROCEDURE
A. Acknowledge the provider’s order.
B. Review the patient’s chart.
C. Obtain and assemble the appropriate equipment.
D. Introduce yourself to the patient &/or family. Explain the reason for the procedure.
E. Determine the appropriate type of circuit and mask to use while considering the before mentioned
precautions.
F. Apply protective skin barriers as indicated in the Policy Section above.
G. Assess appropriate system and/or external alarm settings and function every four hours.

VI. REFERENCES
A. Respiratory Care Services Policies & Procedure #2.21, “Aerosol and/or Humidity Therapy.”
B. UWHC Administrative Policy #8.14, “Guidelines for Administration of Continuous Invasive and Non-
invasive Respiratory Support.”
C. Individual Product Literature; all manuals are located on u-connect in the Respiratory Care section.



Approved by Director and Medical Director of Respiratory Care