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Constant Positive Airway Pressure (CPAP) - Continuous and Intermittent (3.03)

Constant Positive Airway Pressure (CPAP) - Continuous and Intermittent (3.03) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Volume Expansion

3.03






3.03 CPAP-Continuous and Intermittent
Category: UWHC Patient Care Policy
Effective Date: September 19, 2017
Version: Revision
Section: Volume Expansion

I. PURPOSE
CPAP is defined as, the application of positive pressure to the airways of the spontaneously breathing patient
throughout the respiratory cycle. This results in an increase in functional residual capacity (FRC), improvement
in static lung compliance, decreased airway resistance, improved ventilation-perfusion matching, decreased
oxygen requirement, and the stenting of upper airway obstructions. Intermittent CPAP is used to treat persistent
atelectasis/lobar collapse while continuous CPAP is used for the treatment of:
A. Severe hypoxia.
B. Pulmonary edema
C. To reduce air trapping in asthma and COPD
D. Obstructive sleep apnea/upper airway resistance syndrome
E. Apnea of prematurity
F. Tracheal malacia or similar abnormalities of the lower airways
G. Transient tachypnea of the newborn

II. CONTRAINDICATION
There are no absolute contraindications for CPAP, but the following conditions should be carefully evaluated for
potential complications before administering therapy:
A. Recent facial, oral, or skull surgery or trauma
B. Epistaxis
C. Esophageal surgery
D. Active hemoptysis
E. Untreated pneumothorax
F. Known or suspected tympanic membrane or middle ear pathology
G. Untreated diaphragmatic hernia
H. Upper airway abnormalities that make CPAP ineffective or dangerous such as choanal atresia or
cleft palate

III. POLICY
A. All patients will be assessed by the Respiratory Care Practitioner (RCP) to evaluate the effectiveness of
therapy and to intervene for complications such as:
1. Increased work of breathing that leads to hypoventilation and hypercarbia
2. Pulmonary barotraumas or air leak syndromes
3. Increased intracranial pressures
4. Gastric distention
5. Claustrophobia
6. Skin breakdown
7. Nasal mucosa damage due to inadequate humidification
B. Therapy will be provided in accordance with a provider’s order.
C. Patients that are treated with CPAP must be placed in a care setting appropriate for their condition per the
following guidelines:
1. Patients with acute respiratory failure or decompensation must be admitted to an ICU, IMC, the
emergency department, or the recovery room. Such patients shall not be placed on any general
care unit of UWHC while receiving continuous support. Treatment of acute respiratory failure
may be started on a general care floor, but provisions for patient transfer to an IMC/ICU must be
made within one hour.
2. Patients with chronic conditions (particularly those previously maintained on CPAP at home),
appropriate mental status and not at acute risk for apnea may be placed on CPAP 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
D. Patients may use continuous support if on the palliative care service for comfort measures.
E. Patients and/or their families may self-administer CPAP support with the use of their home equipment
with a written order from a physician. The respiratory therapist will complete an assessment which will
include:
1. A passed safety and functionality check of the patient owned equipment
2. Communication with the RN to determine that the pain/sedation plan will not impair the
patient’s ability to self-administer.
3. Oxygen administration through the CPAP system that does not exceed the dose the
patient receives at home.
4. The patient and/or family’s ability to administer and maintain their own support.
F. Appropriate alarm systems will be utilized to assure that the alarms are audible with respect to distance
and competing noise.
1. Devices that have a built in, audible, alarm will be linked to the nurse call system to signal
disconnect.
2. Patient’s that require continuous CPAP for acute respiratory failure must use a device that has a
built in, audible, alarms that will be linked to the nurse call system.
3. All patients using continuous CPAP for obstructive sleep apnea must be monitored with a
continuous pulse oximeter connected to the nurse call system.
4. Home CPAP devices frequently do not have alarms. The oximetry listed in F3 above will be used
to monitor these patients.
G. Patients receiving continuous CPAP will be assessed by an RCP a minimum of every 4 hours.
H. Protective skin barriers will be used to protect the facial skin of anyone on continuous CPAP in the
American Family Children’s hospital. Adult patients may receive skin barriers per the discretion of the
RCP or RN.
I. Intermittent CPAP can be used for treatment of atelectasis and/or lobar collapse in any inpatient care
setting. Patients whose clinical presentation necessitates intermittent CPAP every two hours or more
must be monitored in and IMC or ICU setting.
J. An exception to this policy in accordance with administrative policy 8.14, 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 patients concerns on adult
units. In the absence of the Medical Director, Respiratory Care will contact
a. The attending physician on the Pulmonary Consult Service from 0700-1700.
b. The triage officer 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.

IV. EQUIPMENT
A. Interface
1. Appropriately sized mask with exhalation port/valve .
2. Artificial airway adaptor.
B. Appropriate CPAP System.
C. A humidifier for:
1. Continuous CPAP that is administered for greater than 8 hours.
2. Patients with an artificial airway
3. All pediatric patients

V. PROCEDURE
A. Acknowledge the provider’s order which should include the prescribed pressure, FiO
2
, frequency, and
duration of treatment.
B. Review the patient's chart.
C. Obtain and assemble the appropriate equipment.





D. Introduce yourself to the patient and/or family. Explain the reason for treatment and treatment
technique.
E. Determine the appropriate type of circuit and mask to use while considering the before mentioned
precautions.
F. Assess need for protective barrier and apply per policy.
G. Assess appropriate system and/or external alarm settings and function while performing a system check
every 4 hours.


VI. REFERENCES
A. References:
1. AARC Clinical Practice Guidelines: Use of Positive Airway Pressure Adjuncts to Bronchial
Hygiene Therapy.
2. AARC Clinical Practice Guidelines: Neonatal CPAP via Nasal Prongs or Nasopharyngeal Tube.
3. Egan's Fundamentals of Respiratory Care, Sixth Edition.
B. Respiratory Care Services (RCS) P&P #2:13 Non-Invasive Assisted Ventilation
C. UWHC P&P #8.14 Guidelines for Administration of Continuous Invasive and Non-Invasive Respiratory
Support







Approved by Director and Medical Director of Respiratory Care:

A copy of this Policy & Procedure is available in the Respiratory Care Office [E5/489].