NIV - "Focus" setup

Setting Up

1. Consultant/Senior Decision maker to commence NIV
2. NIV machine (Bipap Focus in CUH) + tube + CO₂ exhalation port + mask + head-cap
3. On the Bipap focus machine, the O₂ tubing can be attached into the port on the face mask or beside the exhalation port
4. Set EPAP at 4 – 5 cm H₂O and IPAP at 10 cm H₂O
5. Set back-up breathing frequency to 8 – 10 breaths/minute
6. Select appropriate size mask (full face in preference to nasal) to fit patient
7. Explain procedure to patient
8. Hold mask in place to allow patient to familiarize themselves
9. Attach pulse oximeter
10. Commence NIV, holding mask in place initially
11. Secure mask in place with straps/headgear to prevent leaks – do not attach too tightly!
12. Reassess patient after a few minutes
13. Check for leaks and refit mask if necessary
14. Add O₂ to maintain SpO₂ >85%
15. Instruct patient how to remove the mask and summon help
16. Increase IPAP gradually up to about 12 - 15 cmH₂O over 1 hr
17. Clinical assessment and, if appropriate, check ABG at 1 hour
18. If procedure fails, institute alternative management plan