Best Practices for BiPAP with Tracheostomy at Home & Hospitals
Understanding the complexities of BiPAP (Bilevel Positive Airway Pressure) ventilation alongside a tracheostomy for yourself or a loved one can be daunting to begin with. It is encouraging to know that it is an effective method of supporting patients in need of mechanical ventilation at home, or in a medical setting outside of an Intensive Care Unit.
It is a noninvasive ventilation method, enabling an adaptable and often more comfortable method of respiratory support.
This article explores integrating BiPAP with a tracheostomy. Read on to find out about the fundamentals of both BiPAP and tracheostomy and how to maintain the equipment, including maintenance and troubleshooting. Whether you’re a patient, caregiver, or healthcare provider, it is important to understand the safe and effective application of BiPAP ventilation with a tracheostomy.
Understanding BiPAP and Tracheostomy
What is BiPAP?
BiPAP (Bilevel Positive Airway Pressure) is designed to help you breathe effectively. It is a form of non-invasive ventilation that is used when you can breathe independently but you are not getting enough oxygen or removing enough carbon dioxide. BiPAP delivers air through a mask on your face. It provides a higher pressure when you inhale (inspiratory positive airway pressure, or IPAP) and a lower pressure as you exhale (expiratory positive airway pressure, or EPAP). BiPAP can be used in emergencies at the hospital, when a patient needs help breathing. It is also used at home for patients with chronic conditions such as heart failure, chronic obstructive pulmonary disease, sleep apnea and respiratory failure.
Benefits of Tracheostomy
A tracheostomy is a procedure where a hole is made at the front of the neck to enable a tube to be inserted into the trachea to help you breathe. It is often a planned procedure however, sometimes a tracheostomy is carried out in an emergency.
It is carried out under general anesthetic and, once complete, enables the patient to breathe through the tracheostomy tube rather than through the nose and mouth. A tracheostomy is needed if your throat is blocked to remove excess fluid and mucus from your lungs or to deliver oxygen artificially.
Combining Both Therapies
Combining BiPAP with a tracheostomy allows patients to benefit from both airway stability provided by a tracheostomy and the breathing support of BiPAP. It has excellent therapeutic benefit for patients transitioning from long-term mechanical ventilation towards less invasive ventilation methods.
Invasive ventilation methods, including intubation, can have a significant risk of complications, including irreversible lung damage. BiPAP, for tracheostomy, is a method of noninvasive ventilation, enhances comfort and lowers the risk of complications linked to extended intubation. It also aids in ICU discharge, significantly improving the patient’s respiratory management and overall quality of life.
Setting Up and Managing BiPAP with Tracheostomy
In Hospital Settings
To begin with, the health care team will thoroughly examine the patient’s respiratory health and requirements, considering their medical history and presenting symptoms. Once all the information has been collated, it can help identify the correct BiPAP settings necessary for optimal therapeutic effect. This includes inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP), to ensure the patient receives the right ventilation support.
Tracheostomy tubes vary in size, and the correct size must be selected. This is to prevent air leaks and allow optimal function of the BiPAP machine. The tube must be adequately sealed and secured to the patient’s neck to maintain optimal airflow during treatment.
Respiratory therapists will ensure the BiPAP machine is set up correctly, configured, and connected to the tracheostomy tube. The healthcare team will monitor the patient’s vital signs, including oxygen saturation levels, at regular intervals to adjust the settings if necessary. The team will also educate the patient and their family on using and maintaining the equipment correctly.
At Home
Before the patient is ready to go home, their health care team, including respiratory therapist, will show the patient and the family how to use and maintain their equipment correctly. The correct use of the BiPAP machine is essential for optimal therapeutic effect, and you will be shown how to adjust settings and solve common problems.
At home, patients may only require BiPAP via tracheostomy during specific periods, for example in their sleep. They may use other respiratory aids, such as a tracheostomy collar or mask during the day. This allows patients to adapt the therapy to their requirements, continue with their daily activities and maintain a good quality of life.
It is important to adhere to the guidelines for maintaining your BiPAP device and tracheostomy tube. This helps prevent infections and maintain optimal functionality. It includes daily cleaning of the tracheostomy site and tube and frequent inspections of the BiPAP machine and its accessories.
Home care services, such as Intensive Care at Home, support patients with BiPAP and tracheostomy. First. they will help facilitate a smooth and safe transition from hospital to home.
At regular visits, they will make sure that the BiPAP machine and all the equipment is working correctly. They will monitor the patient’s condition and refer them to their healthcare provider or emergency services where necessary. Home care services reduce the need for hospital appointments, saving time and effort and enabling patients to continue with their daily lives more quickly.
Maintenance and Troubleshooting
Regular Cleaning and Disinfection
Regular cleaning and disinfection of the BiPAP device and the tracheostomy tube is essential for health and safety and prevents the buildup of dust and microorganisms. This is essential for preventing infections and ensuring the stoma remains clean and free of obstructions.
It is vital to clean the tracheostomy site, change the tracheostomy ties, and look for any blockages, such as thick secretions, mucous plugs, or blood clots. This should be done daily. It is also important to clean and maintain the BiPAP device and its accessories according to the manufacturer’s instructions.
Using a heated humidifier or Heat and Moisture Exchanger (HME) can help in humidifying the air inhaled via the tracheostomy tube. This promotes comfort and therapeutic effect and prevents the trachea and bronchi from becoming dry. It also helps reduce the risk of tube blockage.
Monitoring for Complications
It is essential to monitor the patient regularly to identify any complications which may arise from using BiPAP with a tracheostomy and resolve them quickly. This includes regular assessment of the patient’s vital signs, oxygen saturation levels, and overall comfort. Comfort is important for compliance; if patients are not comfortable with the machine, they will be reluctant to use it correctly, which can affect their health and well-being.
Symptoms that may indicate complications include tachypnea, increased work of breathing, noisy breathing, tachycardia, and a decrease in SpO2 levels. This could be as a result of a blocked or partially blocked tracheostomy tube, incorrect settings or machinery fault. It is important that this is addressed promptly or it can result in severe breathing difficulties and further complications.
Checking for machinery faults includes checking for mask leaks, ensuring proper fit and seal of the tracheostomy tube and assessing the airflow. Regular checks on the BiPAP device and its accessories helps prevent infections and ensure optimal performance.
Conclusion
Using BiPAP with a tracheostomy is a practical, non-invasive method for providing respiratory care for patients with chronic breathing difficulties at home and in hospitals. Proper setup, regular maintenance and continuous monitoring,g it can significantly improve a patient’s quality of life, health and well-being.
It is important to monitor and maintain the BiPAP device, accessories, and tracheostomy tube according to the manufacturer’s guidelines to prevent infection and allow optimal functionality. Patients and caregivers will be trained by healthcare providers, including the respiratory therapist, accordingly. It is important to recognize signs of complications and know how to troubleshoot common issues to prevent breathing difficulties or further complications.
Taking proactive steps in maintaining and troubleshooting the equipment, and seeking advice as required, will help in preventing complications and ensuring optimal respiratory health and overall well-being.