A non-invasive ventilation strategy system used for an infant with respiratory distress syndrome
BCPAP provides continuous positive airway pressure to a spontaneously breathing infant to maintain lung volumes during expiration
The pressure is maintained by immersing the distal end of the expiratory tubing into sterile water. The depth to which the tubing is immersed underwater determines the pressure generated in the infant’s airways. The “bubbling” of the water causes gentle oscillations which aid in gas exchange
Preterm to term infant’s (24 weeks- 42 weeks) can be placed on BCPAP
Flow is proportional to the infant’s size
24-28 weeks= 7-8 LPM
29-34 weeks=8-10 LPM
35-42 weeks= 10-12 LPM
The initial BCPAP pressure is 7cmH2O
Bubbling sound from the BCPAP system should be heard throughout both lung fields
The water is changed every 30 days along with the entire BCPAP system. This will include the FlexiTrunk, CPAP hat, prongs and masks
Set-up
Parts of the F&P BCPAP system
Water chamber
Inspiratory Limb
Expiratory Limb
CPAP Generator
Pressure Manifold
Oxygen Tubing
Water funnel
Only sterile water can be used
Other supplies needed
Measuring Tape
CPAP Flexi-Trunk: 3 sizes available and each Flex trunk kits contains a nasal prong /mask sizing guide and extra risers
50mm
70mm
100mm
Sween cream
Water based lubricant
CPAP bonnet or headgear
CPAP Bonnet or Headgear
Obtain the infant’s FOC (Frontal-Occipital Circumference)
CPAP hat or headgear changes usually occur on Sunday night shift
Selecting Flex Trunk Size
the CPAP Flex Trunk SHOULD NOT extend pass the infant’s head
Selecting Prong of Mask Size
Use the sizing guide. The nasal prongs should be large enough to create a seal without causing blanching
F&P BCPAP assembly
The water chamber is placed on the heater
The pressure manifold and oxygen tubing is placed on one side of the opening of the water chamber
The oxygen tubing is connected to an oxygen blender
The inspiratory limb is placed on the other side of the water chamber
The CPAP generator is placed on a bracket positioned below the water chamber
Water is added to the fill line located on the chamber
BCPAP wick is emerge into the water to the ordered setting at the top of the water chamber. There is a groove on the wick which will keep the wick in the proper/ordered place
Troubleshooting
Check for leaks on the F&P BCPAP system
Set the flow from the oxygen blender to 10 L/min
Connect the inspiratory limb to the expiratory limb via the enclosed adapter
Emerge the BCPAP wick to 7cm
The water in the chamber will bubble if no leaks are present
Dampening of the BCPAP bubbling can be caused by:
Excessive water in the expiratory limb of the circuit
Prongs or mask are not attach to the FlexiTrunk interface correctly
Flow from the oxygen blender to the BCPAP system is to low
There is a disconnect somewhere in the BCPAP circuit
Silverman Score
used to assess severity of respiratory distress in newborn and preterm infants
Factors that make up the Silverman score
Chest movement
Intercostal Retractions
Xiphoid Retractions
Nasal Flaring
Expiratory Grunt
Each of the 5 factors are graded on a scale of 0-2, 2 being the most severe
The numbers from each factor are combined to give the Silverman Score
Initiate when the oxygen is 40% or less and lung expansion is between T8-T9
The goal of the Silverman Score is to titrate the BCPAP pressure from 7cm H20 to 5 cmH2O, while maintaining lung expansion and an FIO2 less than 30%