EzPAP (Positive Airway Pressure Therapy System)
Section:
Cardiopulmonary Services
Category:
Care of Patients
Policy Number:
Page No.:
PURPOSE:
To expand the lung by increasing functional residual capacity (FRC). Increasing FRC contributes to
prevention and reversal of atelectasis.
POLICY:
The EzPAP device consist of a pressure port cap, pressure monitoring port, gas inlet port, and ambient air
inlet with a 22mm connection. It’s use is in conjunction with a medical need for lung expansion therapy to
prevent atelectasis.
PROCEDURE:
1.
Assemble unit in accordance with the directions included with device.
2.
Connect on end of the tubing to a 0-15 lpm air or oxygen flowmeter, the other end to the EzPAP
device’s gas inlet port.
3.
Connect on end of the second tube to the pressure port and the other end to a pressure monitoring
device (pressure manometer). This is recommended for the initial setup to become aware of the
pressures transmitted to the patient. If pressure is not being done, seal port with attached cap.
4.
Attach the mouthpiece or facemask to the rounded end of the device.
5.
Instruct the patient to relax while performing diaphragmatic breathing.
6.
Set the initial flow rate to 5 lpm on the wall air or oxygen flowmeter.
7.
Place mouthpiece in patient’s mouth being sure patient maintains a tight seal on the mouthpiece
and instruct patient to breathe easily against the pressure from the device. If using a mask, apply
mask tightly but comfortably over nose and mouth.
8.
While monitoring airway pressure, slowly adjust flowmeter until desired expiratory airway
pressure is reached (10-20 cmH2O).
9.
Slow inhalation and exhalations by the patient will maintain adequate airway pressure during
breathing cycle.
10.
Maintain breathing through the EzPAP to accomplish clinical goals. Several repetitions may be
needed to ensure that individual patient needs are being met. EzPAP is intended to be used on an
intermittent basis (not for prolonged periods of time).
11.
Document pressure, flow, tolerance, and any significant events.
NOTE: For flowmeter setting:
The greater the expiratory flow through the device = the higher the airway pressure.
The greater the inspiratory flow through the device = the lower the airway pressure.
CONTRAINDICATIONS:
Although no absolute contraindications to the use of PAP Therapy have been reported, the following
should be carefully evaluated before a decision is made to initiate therapy:
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Inability to tolerate increased WOB
Intracranial pressure (ICP) > 20 mmHg
Hemodynamic instability
Acute sinusitis
Recent facial, oral, or skull surgery or trauma
Epistaxis
Esophageal surgery
Active hemoptysis
Untreated pneumothorax
Nausea
Known or suspected tympanic membrane rupture or other middle ear pathology
ADVERSE REACTIONS:
Adverse reactions may include, but are not limited to:
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Increased WOB that may lead to hypoventilation and hypercarbia.
Increased intracranial pressure
Cardiovascular compromise
Decrease venous return
Air swallowing with increased likelihood of vomiting and aspiration
Claustrophobia, skin breakdown and discomfort from mask.
Pulmonary barotrauma
WARNINGS:
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Use of this device at excessive pressures may have adverse effects especially when used with an
artificial airways, caution should be used with these types of patients in using minimal pressures.
If using compressed oxygen as the gas supply, do not exceed the clinically prescribed oxygen flowrate.
Do not occlude ambient air inlet.
Do not exceed 15 lpm gas inlet or 60 psi compressed gas input.
REFERENCE:
AARC Clinical Practice Guideline: Use of PAP Adjuncts to Bronchial Hygiene Therapy. Respir Care 1993:38:516-520.
EzPAP package insert on Suggested Instructions for Use, DHD Healthcare Corporation.