OUTCOMES: While receiving CPAP, the patient will experience an adequate supply of oxygen and concurrently, adequate elimination of carbon dioxide at the cellular level. The patient will express verbally that their work of breathing has been reduced following instigation of CPAP.

EQUIPMENT: CPAP machine with circuit; appropriately sized mask and rubber securing band;
Alternate oxygen mask

Sterile water for irrigation (1000 ml bottle) R : 45.1 PROCEDURE:
* Confirm with Medical Officer the desired FIO2; level of positive airway pressure and time period for CPAP therapy.
* Attach CPAP machine medical air and oxygen gas lines to wall sources.
* Prepare humidification source (refer to policy / procedure: Humidification).
* Select prescribed FIO2 on oxygen blender.
* Turn flow on to level above 25 litres / min.
* Position rubber securing band behind the patient's head, centred on occiput.
* Position face mask over the patient's face ensuring that a firm seal around their chin is established.
* Attach lower rubber straps to mask creating a secure fit around the chin.
* Run upper straps over the ears and along cheek line and secure on mask while maintaining a tight seal.
* Listen to and feel gas flow to verify that minimal air leak around the mask rim is present.
* Adjust level of positive expiratory pressure to prescribed level.
* Adjust inspiratory gas flow so that minimal fluctuations are present on pressure gauge.
* Observe and document respiratory rate; work of breathing and SpO2.
* If respiratory work is excessive or the patient complains of continuing dyspnoea - increase inspiratory flow.
* Maintain continuous SpO2 monitoring with alarm function in place.
* Humidification temperature is usually maintained at 36 o C, or at temperature as tolerated by the patient.
* Remain with patient until apprehension is allayed.
Required Observations:
* Every 30 minutes: visual check. Note respiratory rate and effort; SpO2; nausea and vomiting.
* Hourly: pulse rate and rhythm; blood pressure; peripheral circulation and proper functioning of humidification system.
* Every two hours: condition of skin around and under mask and rubber securing band. Document condition and interventions; condition of conjunctivae.
* Every four hours: palpate abdomen for distension and assess need for stomach decompression. Auscultate lungs for equal air entry.
* Every four hours: palpate abdomen for distension and assess need for stomach decompression. Auscultate lungs for equal air entry.

Reviewed January 1996 F : 45.2