- Equipment preparation. While respiratory care departments have
standard protocols regarding preventive maintenance and calibration
of equipment, it is the RCP's responsibility to ensure that all components
are in proper working order prior to any patient use. For example, it
is important to check the patency of the patient's breathing circuit
prior to each use. The RCP merely needs to aseptically occlude the patient
connector, manually triggering a breath at a low flow setting. If the
system pressure rises and the machine cycles off, the circuit is free
of any major leaks.
- Patient orientation. Prior to treatment, the RCP must provide
the patient with an explanation (tailored to meet the individual patient's
level of understanding) of the what is about to take place. At very
least, the explanation should address the following:
To avoid intimidating the patient, the RCP should bring the IPPB device
to the bedside only after confirming that the patient adequately understands
the procedure and the importance of cooperation. For some patients,
a simulated demonstration of the procedure may be needed to successfully
implement the treatment.
- why the physician ordered the treatment
- what the treatment does
- how it will feel
- what the expected results are
- Patient positioning. To assure effective delivery of IPPB therapy,
patients should be positioned in as close to an upright posture as possible.
- Adjusting parameters. When the treatment has commenced and
the patient's basic ventilatory pattern has been established, settings
can be adjusted and monitored according to the goals of the individual
- Discontinuance and follow-up. Depending on the goals of therapy
and condition of the patient, IPPB treatments typically last from 15
to 20 minutes. Followup activities include post-treatment assessment
of the patient, documentation, and equipment maintenance. Specific follow-up
assessments provide information relevant to evaluating progress toward
achieving the goals of therapy.
Monitoring and Troubleshooting
Monitoring of IPPB therapy involves both machine performance
and patient response. The information gathered during monitoring directs
the RCP's troubleshooting efforts to adjustment the therapy, and can aid
in the identification of common problems. The monitoring of IPPB therapy
includes the following:
- Peak pressure
- Flow setting
- Inspiratory time
- Expiratory time
- I:E ratio
- Breathing rate and expired volume
- Peak flow of FEV1/FVC%
- Pulse rate and rythm (from EKG if available)
- Sputum characteristics
- Mental function
- Skin color
- Breath sounds
- Blood pressure
- SpO2 (when hypoxemia is suspected)
- Chest X-ray
- Subjective responses to therapy
Machine performance. Large negative pressure swings early in inspiration
indicate an incorrect sensitivity or trigger setting on the machine. A
flow that is set too high can cause the device to cycle off prematurely.
Leaks can also be a problem, and to troubleshoot leaks, the RCP should
differentiate between the machine and patient interface.
Patient response. RCPs monitoring patient response must take into
account both the goals of the therapy and the patient's clinical conditions.
If any significant adverse responses are encountered, RCPs should follow
the triple-S rule: stop, stay, stabilize. Stop the treatment; stay
with the patient, calling for help if needed; and, don't leave until the
patient's condition is stabilized.