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Using BCPAP

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With mask CPAP, adequate guidance of the patient of great importance. The patient should be told that – at least initially – a face mask may be unpleasant because of the positive pressure and because of the claustrophobic feelings it may provoke. Try to instill confidence and tell the patient what to expect. Being close to the patient, especially initially, will aid patient acceptance. Our experience shows that once the patient senses that mask CPAP decreases dyspnea, he will gladly accept the associated discomforts. It is important to check the duration of BCPAP therapy. If BCPAP needs to be administered for more than 2h, it is likely that the patient has an oxygenation problem that is not caused by cardiac asthma (alone).

Necessary equipment

  • fixation straps
  • face mask – select best size (adolescent, small, medium, large) 
  • Boussignac CPAP valve
  • oxygen bottle and glow meter​

Initiating Boussignac CPAP

  • Connect a pulse-oxymeter for monitoring of oxygen-saturation
  • Inform the patient
  • Place the patient in a sitting or half-sitting position
  • Connect the tube from the Boussignac valve to the oxygen-flowmeter on the oxygen bottle.
  • Open the flow at 15 L/min
  • Place the fixation straps horizontally under the head of the patient
  • Now connect the fixation straps to the mask that is put over the patient’s mouth and nose. 
  • Connect the straps to the four small fixation pins on the mask
  • Check the positioning of the mask

Monitoring

Visual checks
  • Patient fully awake or (sub)comatose
  • Distress of the patient
  • Breathing pattern and frequency
  • Sputum retention
  • Adequate upright position
Instrumental checks
  • Pulse oxymetry
  • Blood pressure
  • Auscultation (crackles, crepitations or rhonchi)

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