BiPap and nebulizer

My doctor suggested that I hook up my nebulizer to my BiPap machine . So I got splitters extra hoses hooked it all up to the thing that holds the medicine ( those that use a nebulizer will know what I am talking about )and found out that there is not enough pressure to to work the medicine container.
Has anyone tried this?
I also have a machine I call the cough-a-later It forces air into my lungs then sucks it out. It works like a cough
for those that do not have the muscles to cough.
Rodc

When connecting a neb tx to a BiPAP, it is handy to have a special adaptor for connecting in-line. Here is a link to a brochure for one. I'm not sure where you could buy one at, but using this brochure will allow you to know what to ask your DME to order for you. http://www.hudsonrci.com/Products/docs/88081-20.pdf

The best position for the neb is to place closest to your mask....no need for extra splitter hoses or anything. Just use the neb adaptor and connect between your regular BiPAP hose & your mask....hold the neb cup upright while doing the tx. Turn on both your nebulizer and your BiPAP as usual and take your tx. The extra pressure for from BiPAP will help in depositing the meds deeper into your lungs. I've done this with pts in the hospital before. It really helps.

The cough-assist device works great, esp. when you are not able to achieve an adequate cough.

sorry that I've not registered yet....I'm not on my home computer right now, but will register later.

I have been reading this board for the past few weeks to gain insight into my patient's problems/concerns with CPAP....sometimes they don't want to complain or ask many questions. It's helped me to understand better. Thanks!

I've spent 10 years in ERs/hospitals and recently starting working in Home Health/DMEs.

Denise in GA

What pressure is your machine at? Normally the nebs we use in the field don't require a certain pressure but do require a flow at a certain rate.
We do use CPAP in the field and also use them with nebulizers with great success. However the CPAP units we use in the field are powered off of oxygen from an oxygen bottle.
It's been a while since I set one up so I will have to look at it and see how it's done. There are several different CPAP's on the market for use by emergency responders.

Gerryk wrote:Normally the nebs we use in the field don't require a certain pressure but do require a flow at a certain rate.

Driving pressure is equally important as flow in order to make a nebulizer work properly. Hospital oxygen and air systems operate at about 50 PSI, as do portable oxygen cylinders. Portable compressors (such as the DeVilbiss PulmoAide) operate at 12-18 PSI with a maximum of 30 PSI.

In contrast, a background pressure of 10 cmH2O (as may be seen in a typical xPAP system) supplies only 0.14 PSI.

So, you need a separate compressor to run the nebulizer, such as like



SAG

We do not use a portable compressor to run the nebulizer we use an oxygen bottle. We also do not use a cpap that uses any type or power to operate they operate off of pressure from an oxygen bottle.

Yes, this will use more oxygen that just a nebulizer would. We did extensive research for our own department and our regional medical directors also did research. We found that the units were much more portable and less we had to carry in our already over capacity ambulances.

Most people have no idea what is carried in today's Advanced Life Support Ambulance. You would never guess that in the field we can do a 12 lead EKG, read that EKG and transmit it via fax to a hospital if the Doc wants to see it himself. Many cardiac pt's completely bypass the Emergency room today now going right to the cath lab saving time.

Gerryk wrote:You would never guess that in the field we can do a 12 lead EKG, read that EKG and transmit it via fax to a hospital if the Doc wants to see it himself.

A "fax"?

That is so Flintstone!

You should get a Lifepak 12, put a Medtronics Lifenet RS Receiving Station in the ED and upload the results into your GE Marquette MUSE CVIS. Then all the departments within the organization can view results online.

SAG

PS - They're oxygen "cylinders", not "bottles".

First off we can't put anything in the ED. Second it took the hospital that we normally transport to almost a year before the docs would even look at the 12 leads our guys did in the field.

I would love to put every piece of equipment on the market on our rigs but there are weight and space considerations plus the cost. Sending a fax is simple yes, it may be stone age but our lifepack 12's hook up to our cell phones whith one wire and send a fax. That means no expenses for other equipment and failure of other equipment. If the cell phone fails grab a different on.

You must sell medical equipment those are the only people I have ever met suggest throwing away something that works. If it aint broke don't fix it.

Well, sending a "fax" does not qualify as a "diagnostic quality" ECG, which is what you need if you say that

Gerryk wrote:Many cardiac pt's completely bypass the Emergency room today now going right to the cath lab saving time.

The difference is that Lifenet RS receives the entire data file, so that

The LIFENET® RS Receiving Station works together with the LIFEPAK® 12 defibrillator/monitor to identify suspected ST-elevated MI and transmit a diagnostic-quality ECG to the ED or directly to the cardiology department/cath lab.

http://www.physio-control.com/learning/ ... -hospital/

Now, if what you're telling me is that what you're doing is better than nothing, then fine, but I seriously doubt that it represents the Standard of Care for PAMI even in -sws' state.

SAG

StillAnotherGuest wrote:...but I seriously doubt that it represents the Standard of Care for PAMI even in -sws' state.

Hear, hear regarding that well-placed comment about PAMI...

I was just getting ready to say that Illinois should take better care of Patterned Analysis and Machine Intelligence. Beat to the punch again...

LOL! Got to get up pretty early in the morning to sneak one by ol' -sws!

The point is, ECG quality is critical if you're going to activate the PAMI Team from the field.

http://www.monoc.org/admin/docs/news/ge ... 103008.pdf

SAG

BTW, so as not to totally jack ron's thread:

Rodc wrote:I use an oxygen concentater.

Are you presently "bleeding in" oxygen to the BiPAP system?

You could try using the oxygen concentrator to power the medication nebulizer. The output pressures of oxygen concentrators seem to vary quite a bit, and some of them are quite low, but the output pressure of the Respironics Millennium M10 Oxygen Concentrator, for instance, is listed at 10 - 30 PSI, so that one should work.

However, trying to adjust the medication nebulizer output by changing the oxygen flow could result in some MAJOR changes to your overall therapy, so you should run that plan by your physician before you start wingin' those dials.

As an aside, the more supplemental flows you add to your BiPAP system, the less sensitive the "assist trigger" becomes. If you add oxygen from the concentrator and compressed air from a portable compressor, it may not be able to trigger at all.

SAG

StillAnotherGuest wrote:Well, sending a "fax" does not qualify as a "diagnostic quality" ECG, which is what you need if you say that

First off the people I have in the field have been trained to read these and not all the docs want a copy. Second when a copy is faxed the machine diagnosis is faxed along with it, but I would go by what the medics see over what a machine says.

Gerryk wrote:Many cardiac pt's completely bypass the Emergency room today now going right to the cath lab saving time.

The difference is that Lifenet RS receives the entire data file, so that

The LIFENET® RS Receiving Station works together with the LIFEPAK® 12 defibrillator/monitor to identify suspected ST-elevated MI and transmit a diagnostic-quality ECG to the ED or directly to the cardiology department/cath lab.

http://www.physio-control.com/learning/ ... -hospital/

Now, if what you're telling me is that what you're doing is better than nothing, then fine, but I seriously doubt that it represents the Standard of Care for PAMI even in -sws' state.

SAG

No matter what anyone says. We have documented that peoples lives have been saved by this equipment. Either using the 12 lead in the field or the cpap and delivering breathing treatments with cpap to drive the meds.

I am not going to argue and hijack someone elses post.

You're right, this really does beg for a whole new thread. Since the chance of cardiovascular catastrophe (stroke, MI, etc., see the Yale Yaggi Study) is a real risk in OSA patients, maybe it would be a good idea to make a list of Things To Look For In A Good EMS and ED. Types of equipment, expertise in procedures, staff competencies.

Cause when you need "EMS", that's not the time to hear your EMT say

It's been a while since I set one up so I will have to look at it and see how it's done.

SAG

Still another guest You know, I asked if you were a rep but you never answered. All you have done is rip on me. I will tell you this, I have been in the fire service for 27 years and been serving the public and saving lives. I do not deal with this equipment on a daily basis the paramedics do. Apparently you don't know much or you would know that an EMT is basic not a paramedic level. I am on these committees because I put in my own time to privide for the public not because I am making money selling equipment.

I still haven't heard what you do for a living that you know so much about this equipment.
I work for one of the best trained and best equiped departments in the area. The department I work for is in one of the most advanced EMS regions in the state of Illinois.

I was trying to help someone out.

Since you are an expert on this please elaborate for everyones benefit. Please give us some of your vast knowledge.

Oh as far as your last comment about me now knowing the equipment settings. I don't need to know I don't use it on a daily basis anymore. I will tell you this. I do have the credentials and I have many many certified saves. I don't even count but it sure means something when a doctor tells a family member that if it weren't for what this one individual did your loved one would be dead.

I still haven't heard what you do that you are so knowledgeable.

Please speak up and teach us all.

Gerryk wrote:Still another guest You know, I asked if you were a rep but you never answered. All you have done is rip on me. I will tell you this, I have been in the fire service for 27 years and been serving the public and saving lives. I do not deal with this equipment on a daily basis the paramedics do. Apparently you don't know much or you would know that an EMT is basic not a paramedic level. I am on these committees because I put in my own time to privide for the public not because I am making money selling equipment.

I still haven't heard what you do for a living that you know so much about this equipment.
I work for one of the best trained and best equiped departments in the area. The department I work for is in one of the most advanced EMS regions in the state of Illinois.

I was trying to help someone out.

Since you are an expert on this please elaborate for everyones benefit. Please give us some of your vast knowledge.

Oh as far as your last comment about me now knowing the equipment settings. I don't need to know I don't use it on a daily basis anymore. I will tell you this. I do have the credentials and I have many many certified saves. I don't even count but it sure means something when a doctor tells a family member that if it weren't for what this one individual did your loved one would be dead.

I still haven't heard what you do that you are so knowledgeable.

Please speak up and teach us all.

Gerry

SAG runs a sleep center & is pretty tight on sleep studies & processes. Don't worry too much about disagreement between what works for you vs SAG's intended good advice on process.

His input is usually well intended & reflects his expertise.

Cheers

DSM