Jump to content


Photo

Bipap On Transport


  • Please log in to reply
9 replies to this topic

#1 kamiller

kamiller

    Newbie

  • Members
  • Pip
  • 3 posts

Posted 02 October 2010 - 11:24 PM

For all the RT's out there, either ground or air, what device are you using for BiPap, specifically for the asthmatic pt who needs an in-line neb?? We have an LTV 1200 and run a mini-heart on the insp side...the problem, aside from there must be a better BiPap device out there besides the LTV, you need 2 gas sources, one for the low-flow to the vent (our stretcher tank) and one to low-flow the neb. Could stop it for the transition period out of the hospital to the rig, but any other options?? Is there a better device that's more user and pt. friendly? It's asthma season again in Chicago......
  • 0

#2 LearRRT-CCEMTP

LearRRT-CCEMTP

    Advanced Member

  • Members
  • PipPipPip
  • 272 posts

Posted 03 October 2010 - 01:01 PM

For all the RT's out there, either ground or air, what device are you using for BiPap, specifically for the asthmatic pt who needs an in-line neb?? We have an LTV 1200 and run a mini-heart on the insp side...the problem, aside from there must be a better BiPap device out there besides the LTV, you need 2 gas sources, one for the low-flow to the vent (our stretcher tank) and one to low-flow the neb. Could stop it for the transition period out of the hospital to the rig, but any other options?? Is there a better device that's more user and pt. friendly? It's asthma season again in Chicago......




Why are you running the LTV-1200 on low flow? It has a 50 Psi high pressure diss connection that allows the internal FiO2 blender to operate and allow you to dial in the exact FiO2. In CCT it is not optimum to utilize the low flow system. That is a homecare feature on the LTV not critical care. With the high pressure system you would simple utilize a tank with a diss connection on the regulator thus hooking the LTV to the high pressure outlet and leaving the low pressure regulator for running you BVM or nebulizer. The only disadvantage to running nebs through the LTV on volume ventilation is that you have to take a moment and do the math and calculate the added volume from the neb and then compensate the VT for it. In BiLevel NiPPV (BiPAP is a brand not a mode) you would not need to compensate since pressure is measured at the proximal airway. But to answer your question, there is no better way to deliver NiPPV during CCT other than a Vent such as the EnVe, LTV-1200, I-Vent201 etc. Your only other option is to purchase a separate NiPPV unit which will be worse because you would have to run low pressure with it where with the LTV when set up optimally, it would be much more simple. If interested we will be cover this and much more in the workshop.
  • 0
David W. Garrard, BHS, RRT, RCP, CCEMTP, PNCCT, CFC
Vice President and Program Director
AeroMD
Dedicated to the Speed of Life!
Charlotte Amalie, St. Thomas, United States Virgin Islands
Toll Free: 1-844-AeroMD-1

#3 jkihl

jkihl

    Advanced Member

  • Members
  • PipPipPip
  • 45 posts

Posted 05 October 2010 - 11:34 PM

David,

What is the best way to run BiLevel NPPV on the LTV 1000?, I know you will go over this in the Workshop..

AND what is your perfered Bilevel Mask to use with the LTV 1000 circuit? if you would need to stock the
facemask setup yourself..

Thank you..
  • 0

#4 kamiller

kamiller

    Newbie

  • Members
  • Pip
  • 3 posts

Posted 06 October 2010 - 03:43 PM

Why are you running the LTV-1200 on low flow? It has a 50 Psi high pressure diss connection that allows the internal FiO2 blender to operate and allow you to dial in the exact FiO2. In CCT it is not optimum to utilize the low flow system. That is a homecare feature on the LTV not critical care. With the high pressure system you would simple utilize a tank with a diss connection on the regulator thus hooking the LTV to the high pressure outlet and leaving the low pressure regulator for running you BVM or nebulizer. The only disadvantage to running nebs through the LTV on volume ventilation is that you have to take a moment and do the math and calculate the added volume from the neb and then compensate the VT for it. In BiLevel NiPPV (BiPAP is a brand not a mode) you would not need to compensate since pressure is measured at the proximal airway. But to answer your question, there is no better way to deliver NiPPV during CCT other than a Vent such as the EnVe, LTV-1200, I-Vent201 etc. Your only other option is to purchase a separate NiPPV unit which will be worse because you would have to run low pressure with it where with the LTV when set up optimally, it would be much more simple. If interested we will be cover this and much more in the workshop.


  • 0

#5 kamiller

kamiller

    Newbie

  • Members
  • Pip
  • 3 posts

Posted 06 October 2010 - 03:54 PM

on our ground transports, we load the pt. on a stretcher which is equiped with only a small little D-cylinder with no high-pressure capabilities - no quick-connect - and for our purposes, we have no issues with fi02....mask seal, pt. comfort and acceptance, etc., are more the concerns we have been having. the LTV just isn't as user-friendly as i would want and seems like there should be something more out there. thanks for the feedback, guess we are using what seems to be the only device for BiPap as of now.
  • 0

#6 SerendepitySaki

SerendepitySaki

    Advanced Member

  • Members
  • PipPipPip
  • 1176 posts

Posted 06 October 2010 - 03:57 PM

i am more than a little sure that LTV would be happy to chat about it further with you....if you e-mail me with contact info and restating problem, i will try to put you in touch...
  • 0
LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#7 LearRRT-CCEMTP

LearRRT-CCEMTP

    Advanced Member

  • Members
  • PipPipPip
  • 272 posts

Posted 07 October 2010 - 01:00 AM

on our ground transports, we load the pt. on a stretcher which is equiped with only a small little D-cylinder with no high-pressure capabilities - no quick-connect - and for our purposes, we have no issues with fi02....mask seal, pt. comfort and acceptance, etc., are more the concerns we have been having. the LTV just isn't as user-friendly as i would want and seems like there should be something more out there. thanks for the feedback, guess we are using what seems to be the only device for BiPap as of now.



First, I believe for CCT you will find that the LTV works best witha 50 PSI FiO2. How do you control you FiO2 on low flow or deliver high FiO2's. Low flow is just meant for home care usage or as a backup if you loose high pressure or if it's not available. I would highly recommend your program spend the $100.00 to purchase a regulator with a quick connect high pressure source. You will be much happier! Second, what type of mask are you using? You do know that you MUST utilize a closed system mask and not a standard BiLevel NiPPV Mask. A great deal of the units on the market used in hospitals have slits or holes called whisper valves in their masks in order to allow CO2 washout. The LTV or any other ventilator being used for NiPPV utilizes a actual expiration valve! Due to this fact it must be a closed system just as if you were ventilating via a ETT. For this reason I HIGHLY recommend programs purchase their own masks and not utilize hospital masks when picking up patients. There are all types of closed system masks available on the market ranging from inexpensive to hundreds of dollars each. I have actually used many times with great success simple Resuscitation Masks (the ones with the hooks)and the rubber H-Frame Anesthesia Straps. If you are not using closed system masks then this may account for comfort issues as well as poor operations. The constant leak would cause the LTV to attempt compensation by blowing greater amounts of gas into the circuit. Furthermore it would have difficulties cycling into expiration if a leak is present since it utilizes flow triggering. As for other comfort issues, I would recommend adjusting the rise time percentage and/or the flow termination percentage. These features are key settings of spontaneous pressure modes whether invasive PSV or BiLevel NiPPV. They are located in the special ops menu. If you are not familiar with the Rise Time or Flow Termination Percentage in the special ops menu then I high suggest you review you owners manual. There is a great section on special ops features within it.
  • 0
David W. Garrard, BHS, RRT, RCP, CCEMTP, PNCCT, CFC
Vice President and Program Director
AeroMD
Dedicated to the Speed of Life!
Charlotte Amalie, St. Thomas, United States Virgin Islands
Toll Free: 1-844-AeroMD-1

#8 JPatterson

JPatterson

    Advanced Member

  • Members
  • PipPipPip
  • 47 posts

Posted 21 October 2010 - 06:09 PM

I have been using the LTV 1000 and 1200 for the last 4 years on CCT's and have had mixed results with the NIPPV mode. I haven't found a patient yet that has been able to tolerate it without me changing the back menu items; specifically the Rise profiles, leak compensation, and the flow term. If you are using the LTV 1200 and do not fully understand the back menu, what it means, how to change it, and what those changes do physiologically to your patient, then you need to call your sales rep and set up an inservice.

IMHO only a NIPPV machine or very nice hospital ventilator will deliver comfortable Non-Invasive Ventilation. The transport vents that I have used over the last 8 years all can do NIPPV, but none of them can do it as well as our in hospital machines. My guess for this is the issue of having a closed circuit on the vent and trying to cram every mode of ventilation into something that you can carry around with you. It is not the ventilators fault, it is just the nature of the beast.

Anyway, I STRONGLY reccomend getting an inservice on the back menu and to pracice making the changes while wearing the mask in NIPPV mode. You will learn to appreciate what your patient is going through and why they have a hard time adjusting to the LTV 1200.

Jeff Patterson NREMT-P, FPC
  • 0
Jeff Patterson NREMT-P

#9 jmalia1

jmalia1

    Member

  • Members
  • PipPip
  • 20 posts

Posted 23 December 2015 - 09:44 PM

Try out the Hamilton T1. It can do biPap with an inline neb pretty easily. It auto-compensates for a lot of the leak you get when kids are all over the place too.


  • 0

#10 SerendepitySaki

SerendepitySaki

    Advanced Member

  • Members
  • PipPipPip
  • 1176 posts

Posted 23 December 2015 - 09:47 PM

i am familiar with both jmalia1 AND the T1.  I concur wholeheartedly. 


  • 0
LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup