Quick setup guide: Deliver BIPAP with the Phillips V60

By Adem Lewis / in , , , , , , , , , , , , , , , , , , /

Hi this is a three or four minute video that will show you how to set up the V60 NIV ventilator that we have in Addenbrookes Emergency Department Before I get into it though, I have to say this video is intended for doctors and nurses who are already competent in managing patients with respiratory failure and only need a reminder in how to set up this device. Lets look at the hardware first On button here, battery indicator light here. The battery does last several hours but you are going to need it for transfer to the ward, so please keep the device plugged in when its in use. Power cabling Oxygen tubing goes in the main ports in the wall There is an oxygen cylinder on the base for transfer Patient circuit attaches here and pressure monitor tubing attaches here. It’s a touchscreen device, but there is a dial pad as a backup just in case you can’t use the touch screen There is a specialised circuit that comes for the device that is not compatible with any of the other ventilators. It comes with an HME filter in the packaging. Goes on here and your pressure sensor tubing goes on here. There is also a T-piece packaged separately that can fit on here and that will allow you to attach a nebuliser chamber so you can keep giving nebulisers to the patient Finally, starting it up. The V60 has got several modes and lots of options. I’ll show you one way to safely provide NIV to a typical patient with type 2 respiratory failure. When you turn it on, it’ll start working straight away with the settings it was running last. You can press standby to temporarily stop it It takes a couple of cycles just to quieten down Then, select modes for BIPAP We want S/T, that’s ‘spontaneous/timed’ If it’s already in S/T setting it will have ‘Batch’ above it And now, here is your settings screen. Set your IPAP initially to 15 Accept it. Your EPAP initially to 5 And accept it The rate, of course, is just a backup rate The machine will deliver a breath any time the patient triggers it. This is just in case of a period of apnoea The I-time: a safe start is one second. That’s the duration of the inspiratory pressure delivery And Rise: Rise sets how rapidly the machine goes from expiratory pressure to inspiratory pressure. And as you increase the number the rise is more slow It does reduce the tidal volume a little bit but a slow rise is more comfortable for a patient who is having difficulty syncing with the machine. But I’d recommend you start it at somewhere middle of the road like 2 Ramp we tend not to use in the emergency department I wouldn’t bother with it Oxygen: set your FiO2. Accept it and then press activate And now the machine is ready to deliver it. If you connect the circuit to your patient at that point it will detect flow and it will start triggering breaths. Alternatively you can just press restart. Ok, Next steps: Once you’ve got the patient up and running on NIV you need to gradually increase the inspiratory pressures over the next half an hour or so to get the patient somewhere between 20 to 30 centimetres of water You need the patient on continuous monitoring while they are in resus Do check the Trust’s respiratory failure policy because, obviously, there is an awful lot more to the management of a patient in respiratory failure than what I’ve discussed here. And that’s it, really. OK, all the best.

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