CareFusion Infant Flow Training Workbook

Infant Flow® LP nCPAP system

Clinical training workbook

Table of contents

Infant nasal CPAP ..............................................................................................1– 6

CPAP over view .....................................................................................................1–3

CPAP modalities .......................................................................................................4

Variable flow technology ..........................................................................................5

Self assessment ........................................................................................................6

Infant Flow

Infant Flow LP system ...............................................................................................7

Infant Flow SiPAP configurations ..............................................................................8

Infant Flow SiPAP display screen ............................................................................... 9

Infant Flow CPAP and circuit set-up ........................................................................ 10

Humidification and nCPAP ......................................................................................11

Airway temperature probe placement ................................................................... 11

Infant Flow SiPAP sensor calibration .......................................................................12

Infant Flow SiPAP set-up guide ......................................................................... 13 –14

Respiratory abdominal sensor ................................................................................. 15

Self assessment ......................................................................................................16

Infant Flow SiPAP nCPAP driver ................................................................... 17–22

Modes of operation .......................................................................................... 17–18

BiPhasic mode strategy ..................................................................................... 19 –20

SiPAP exercises and self assessment.................................................................. 21–22

SiPAP driver overview ............................................................... 7–16

Infant Flow LP generator assembly ............................................................. 23–27

Infant Flow LP generator ........................................................................................23

Infant Flow LP interfaces ................................................................................... 24–25

Infant Flow LP fixation devices ................................................................................ 26

Self assessment ......................................................................................................27

Infant Flow LP patient set-up...................................................................... 28– 46

Infant Flow LP interfaces ................................................................................... 28 –29

Fixation devices ......................................................................................................30

Headgear application ............................................................................................. 31

Generator assembly preparation .............................................................................32

Generator assembly and interface attachment to headgear ............................. 33–34

Bonnet application .................................................................................................35

Generator assembly and interface attachment to bonnet ................................. 36 –37

Bonnet application (alternative method 1) .............................................................. 38

Bonnet application (alternative method 2) ..............................................................39

Incorrect application of fixation device and generator assembly ....................... 40 – 41

Incorrect application of generator assembly and interface ................................ 42– 43

Final inspection of nasal interface placement .........................................................44

Self assessment and return demonstration ...................................................... 45–46

Routine nCPAP care ....................................................................................... 47– 49

Initiating and maintaining

effective nCPAP therapy

is a critical step in helping

respiratory- compromised

infants achieve successful recovery and develop normal respiratory

function. When used according to your facility’s treatment protocols and with this training workbook, the Infant Flow

LP nCPAP system can effectively deliver nCPAP therapy to help improve patient outcomes.

Frequently asked questions .........................................................................50–54

Self assessment ......................................................................................................54

Glossary ..........................................................................................................55 –56

References ............................................................................................................57

Infant nasal CPAP

Introduction

Worldwide each year, approximately 15 million (1 out of every 10) babies are born prematurely.1 Premature or

low-birth weight (LBW) infants are at a high risk for respiratory problems due to underdeveloped lungs. Common

neonatal respiratory conditions include apnea of prematurity, respiratory distress syndrome, transient tachypnea

of the newborn (TTN), meconium aspiration syndrome, pulmonary edema and post-extubation support. These

1,2

conditions are often associated with decreased pulmonary compliance and functional residual capacity (FRC).

Several of these infants will require respiratory support.

Respiratory distress syndrome (RDS) is a condition that strains normal respiration due to the lack of natural

surfactant production. Approximately 50% of neonates born at 26 to 28 weeks gestation and 30% of neonates

born at 30 to 31 weeks gestation develop RDS.

CPAP overview

What is surfactant?

Surfactant is a phospholipid, which reduces surface tension

to increase lung compliance.

Artificial surfactant may be given to help reduce surface

tension, increase compliance and improve ventilation.

Without additional respiratory assistance, many infants have

difficulty establishing the adequate functional residual

capacity (FRC) required to maintain normal respiration.

Respiratory support

Several options are available to help the clinician provide

respiratory support to the neonatal patient. Historically, the

initial treatment for infants with respiratory problems was

mechanical ventilation via an artificial airway. Intubation

presents a variety of challenges for any patient but

compounds problems with premature infants. Given the

potential complications of intubation, many physicians opt

for a less invasive approach for spontaneously breathing

infants that utilizes continuous positive airway pressure

(CPAP). As infants are preferential nose-breathers, nasal

CPAP (nCPAP) is the preferred method for treatment

delivery. CPAP enhances alveolar recruitment decreasing

pulmonary vascular resistance and intrapulmonary shunting,

stabilizes FRC and improves oxygenation. By increasing

surface area to alveolar gas exchange, CPAP decreases V/Q

mismatch. The goal of CPAP therapy is to maintain normal

lung volumes and oxygenation, while enabling the infant

3,4

to breathe on their own.

Physiologic effects of CPAP are

represented in the organizational chart on page 2.

Physiologic effects of nasal CPAP in neonates

3–4,10

Infant nasal CPAP

Splint open airways

Recruits alveoli

and prevents

alveoli collapse

Increases FRC

and lung volumes

Improves V/Q ratio

and increases

oxygenation

Decreases WOB

Nasal (nCPAP) is associated with improved respiratory mechanics and decreased chronic lung disease (CLD) rate.

Conserves surfactant

Maintains airway

Increases pharyngeal

cross section

patency

Decreases

obstructive apnea

Reduces upper

airway resistance

Stabilizes chest wall

and diaphragm

Improves

breathing pattern

and decreases WOB

Decreases

intrapulmonary

shunting

Improves V/Q ratio

Stretches lung

Stimulates the

J receptors and HIBR

Reduces central

and

obstructive apnea

and pleura

Stimulates lung

growth

What is nasal CPAP (nCPAP)?

nCPAP is the application of positive pressure to

the airways of a spontaneously breathing infant

throughout the respiratory cycle. nCPAP is a continuous

flow of gas administered through nasal prongs inserted

in the nares or by a nasal mask placed around the

perimeter of the nose. The positive pressure, usually

O to 8 cmH2O, acts as a splint, which can help

4 cmH

prevent alveoli collapse.

BiPhasic CPAP alternates between two levels of CPAP

at a set time interval. The infant can breathe at both

CPAP settings. The BiPhasic mode helps increase the

infant’s tidal volume and may stimulate the respiratory

drive center.

Advantages of CPAP

• Increases FRC

• Maintains and increases lung volume

• Improves lung compliance

• Reduces work of breathing (WOB) and

airway resistance

• Provides a noninvasive procedure

• Allows small airways to develop

• Promotes the use of natural surfactant

• Promotes easy application

• Provides cost effectiveness

• Helps prevent extubation failure in some infants

• Stabilizes the airway diaphragm and chest wall

• Decreases incidence of chronic lung disease (CLD)

Indications for use

2–5

• Abnormalities on physical examination

- Increased WOB

- Increased respiratory rate

- Intercostal and substernal recession

- Grunting and nasal aring

- Pale skin color

- Restlessness

• Deteriorating arterial/capillary blood gas values

(e.g., hypercapnea)

• Increased oxygen requirements to maintain a SaO

greater than 92% with FiO

> 60%

• Atelectasis and inltration

• Clinical conditions

- Apnea of prematurity

- Chest infections (e.g., pneumonia)

- Transient tachypnea of the newborn (TTN)

- Mild meconium aspiration

• Weaning/Post-extubation support

• Congenital malformations of the upper airway (cleft

palate, choanal atresia or tracheoesophageal stula)

• Congenital diaphragmatic hernia or untreated

bowel obstruction

• Poor respiratory drive unresponsive to CPAP therapy

(frequent apnea episodes associated with oxygen

desaturation and/or bradycardia)

What is work of breathing?

WOB describes the amount of effort required to breathe.

Any therapy that introduces incoming pressure to a

patient’s respiratory system potentially adds imposed

WOB. Infants with RDS experience elevated WOB levels,

and by expending additional effort to inhale and exhale

against pressurized gas, the infant consumes precious

calories overcoming the high WOB level. These calories

could otherwise be spent on vital recovery and growth

processes. In addition to helping the infant conserve energy,

a WOB reduction may reduce stress and anxiety levels.

Contraindications for use

2–5

• Severe cardiovascular instability

• Respiratory failure dened as pH < 7.25 and

> 60 mmHg torr

PaCO

Potential problems associated with CPAP therapy

3,5,6

Clinicians should be aware of the possible hazards and

complications associated with CPAP, and take the

necessary precautions to ensure safe and effective

applications, such as:

• Possible loss of prescribed pressure and decreased FiO

due to mouth breathing

• Increased intrathoracic pressure reducing venous return,

which may lower cardiac output

• Barotrauma leading to surgical emphysema/

pneumothoraces

• Aspiration

• Deterioration in the respiratory condition, requiring

immediate ventilation

• Patient discomfort from prong/mask intolerance

• Nasal septal injury (e.g., columella necrosis)

• Blanching of the nares

• Dry mouth and airways

• Gastric ination

Columella necrosis

Nasal dilation

CPAP modalities

What are the treatment options?

A variety of technologies have been employed in nCPAP

delivery throughout the years.

Conventional CPAP (V-CPAP): Utilizes a traditional mechanical

ventilator to deliver a constant flow of gas. CPAP is created

by changing the expiratory port orifice size. The ventilator

equipment is comprehensive and expensive.

Bubble CPAP (B-CPAP): Utilizes a constant flow of heated

and humidified gas. The level of pressure is controlled by

the depth of the exhalation tube inserted into a water

container. The pressure can increase if condensate collects

in the tubing, the flow rate changes or the water evaporates

from the container. B-CPAP lacks system alarms and

imposes a higher WOB

inability to entrain flow during inspiration.

due to the constant flow and

(16 ,18 ,19)

High flow nasal cannula (HFNC): Has not been cleared by

the FDA for nasal CPAP delivery. HFNC utilizes a constant

flow of heated, humidified gas that potentially delivers a

positive distending pressure. The level of therapy cannot

be measured and fluctuates depending on body position,

oral leaks, nasal secretions and the size and weight of the

patient. HFNC does not contain critical alarms that ensure

the safe delivery of therapy.

Variable flow CPAP (VF-CPAP): Incorporates a generator that

redirects the heated and humidified gas flow away from the

patient during exhalation and allows air entrainment during

periods of high inspiratory effort.

provides the most stable pressure, even in the presence of

leaks up to 6 LPM.

Pandt and Associates demonstrated that the Infant Flow

variable flow technology delivered a consistent level of

CPAP with little fluctuations. In contrast, the conventional

CPAP did not reach the desired level of 5 cmH

O, and

the pressure fluctuated significantly throughout the

breath cycle.

Using a variable flow generator with a dedicated CPAP

driver provides a measurable therapy with system alarms

to help ensure safe and effective therapy.

Infant Flow

8 Lts flow, 5 cmH2O

System pressure

5 cmH2O

0 cmH

Time

Conventional CPAP

17 Lts flow, 5 cmH2O with 5 Lts reservoir bag

System pressure

5 cmH2O

By redirecting the gas, VF-CPAP offers a lower imposed

WOB and less expiratory resistance compared to other

nCPAP technologies. Because the pressure is created and

measured at the nares, the variable flow technology

Infant Flow variable ow

Inspiration: Gas flow converted

to pressure reducing the WOB

and maximizing the pressure

stability at the patient interface.

0 cmH

Moa, G., Nilsson, K. et al. Crit Care Med, 1988 , 16(12):1238 –1242 .

Expiration: Gas flow

flipped away from the nasal

prongs to the expiratory

tube. The residual gas

pressure provided by the

continuous gas flow creates

a stable CPAP throughout

the respiratory cycle.

Time

Variable ow technology

Inhalation

Dual jets

Flow direction Flow direction

Patient nare

What is variable ow technology?

10,11

The Infant Flow LP patented dual-jet variable flow

generator utilizes fluidic technology to deliver a

constant CPAP at the airway proximal to the infant’s

nares. Without moving parts or valves, the generator

provides consistent performance. The level of CPAP

created is proportional to the flow provided by the

driver; for example, 9 LPM creates approximately

5 cmH

O CPAP. The variable flow generator uses

Bernoulli’s Principle via injector jets directed toward

each nare. If the infant pulls additional flow, the

venturi action of the injector jets entrains additional

flow from either the source gas or exhalation tube

reservoir. During exhalation, the incoming gas flow

redirects away from the infant. This action is referred

to as the “fluidic flip.” By redirecting the gas, variable

flow nCPAP reduces the imposed WOB. The infant

can exhale freely and conserve precious calories for

development. In summary, the direction of gas flow

in variable flow devices depends on the patient’s

respiratory cycle. The flow “flips” away from the

nares when the infant exhales and then, “flips” back

as the exhalation phase ends. The response is almost

instantaneous as it occurs at the patient’s nares.

Fluidic flip

Exhalation

Exhaust tube

Vortice shedding

Patient nare

What is vortices technology?

10,12

The patented Infant Flow LP generator is a new form of

variable ow that uses vortices technology to reduce the

imposed WOB during inhalation. Similar to the single- jet

technology, the ow entrainment reduces the WOB

on inhalation by meeting the patient’s inspiratory ow

demand and during exhalation gas ow ips away from

the patient reducing resistance.

Four low-momentum jets (two per nare) impinge inside

the generator to create a consistent and measurable

positive airway pressure within the generator head.

During inhalation, the dual jets entrain ow to meet

the patient’s inspiratory demand. During exhalation, the

jets easily deect to disrupt the gas ow. This disruption

of ow creates vortice shedding that spirals outwardly,

combining with the exhaled breath to create an

organized, efcient ow path toward the exhaust ports.

Exhaust tube

Impinging jets

Drive line

Pressure line

Patient

Self assessment

1. Describe RDS:

2. List three indications for nCPAP therapy:

3. List three benets of nCPAP therapy:

4. List three potential complications to nCPAP therapy:

8. Match the generator parts to the diagram:

Pressure line

Impinging jets

Exhaust tube

Drive line

Patient

Notes:

5. State four methods used to deliver nCPAP therapy:

6. Discuss the advantage of variable ow technology compared

to other CPAP modalities:

7. Discuss the importance of low work of breathing:

Infant Flow SiPAP driver overview

Infant Flow LP system

The Infant Flow LP nCPAP system is a comprehensive system for delivering unique nCPAP therapy.

The system consists of:

• Infant Flow SiPAP driver

• Infant Flow LP generator assembly

• Infant Flow LP fixation—bonnet or headgear

• Infant Flow LP nasal interfaces—mask or prongs

This chapter discusses the set-up and operation of the Infant Flow SiPAP Plus driver.

Power LED

Indicates power on and AC connection

Touch screen display

Adjusts settings and displays patient parameters and alarms.

Pressure low flow meter

Adjusts low CPAP level. CPAP supplied to patient directly relates to flow rate from the nCPAP driver.

Alarm LED

Indicates alarm situation as visual and audible notification color varies according to alarm level

Note: Refer to the Infant Flow SiPAP operator manual for additional instructions on the set-up, operation and maintenance of the Infant Flow SiPAP Plus driver.

Transducer LED

Indicates transducer connected.

% O

blender control

Adjusts FiO

Pressure high flow meter

Adjusts high CPAP level. CPAP supplied to patient directly relates to flow rate from nCPAP driver.

Transducer connection

Connects to transducer interface.

Patient circuit connection

Connects patient breathing circuit to gas outlet port.

Pressure line connection

Connects patient pressure line to device.

Infant Flow SiPAP congurations

The Infant Flow SiPAP driver is sold globally and is available

in different configurations. The two main models are Infant

Flow SiPAP Plus and Infant Flow SiPAP Comprehensive.

The Comprehensive model offers an additional ventilation

mode, BiPhasic trigger, which is not available in the U.S.

In select areas, additional languages or an international icon

overlay may be used in place of the English text. The operation

and maintenance of the Infant Flow SiPAP driver is the

same regardless of the specific configurations. Refer to the

Infant Flow SiPAP operator manual for more specific details.

Description English text ICON symbol

Press to access the user calibration menu and language options.*

Press to return to the start-up screen.

Press to switch between the graphical and numerical monitoring screen.

Press to change the operation mode.

Press to deliver a manual breath. The breath delivers at the pressure high setting for

the set time high duration.

Indicates user should refer to the operator manual for additional information.

Indicates battery status and turns red if the battery charge is less than 40%.

Indicates the screen is locked. Press to unlock the screen.

Adjust the low flow rate setting for the baseline CPAP level.

Adjust the high flow rate setting for BiPhasic high CPAP level.

*Language option not available on all SiPAP models.

Infant Flow SiPAP display screen

Mode, control settings and function buttons

Mode indicator

Monitored parameters

FiO

Alarm priority/alarm silence indicator

Operational information

Battery charge

Pressure/ Time graphics or monitored parameters display

Control/Setting indicators

Soft key color code

White letter

Key enabled

Faded letter

Key inactive

Yellow letter

Solid: Pending confirmation

Flashing: Low-priority alarm

Red letter

Flashing: High-priority alarm

Solid: Reduction in another parameter

caused by an adjustment

Alarm management

High priority

• Series of 10 tones sound every 10 seconds

• Parameters display, and limits flash red

Medium priority

• 3 audible tones sound every 15 seconds

• Parameters display, and limits flash yellow

Low priority

• 2 audible tones sound every 30 seconds

• Parameters display, and limits change to yellow

Infant Flow SiPAP and circuit set-up

Circuit set-up

1. Gather the nCPAP supplies:

• Infant Flow SiPAP driver

• Single-limb, heated breathing circuit

• Infant Flow LP generator kit

• Infant Flow LP xation device

• Humidier and chamber

• Sterile water bag

2. Attach the water chamber to the humidier and

connect it to the water feed system. Follow the

manufacturer instructions for the proper set-up.

3. Connect the gas delivery tubing (A) to the ow

driver outlet port (I) and humidier chamber port (II).

4. Connect the elbow connector on the heated

breathing circuit (B) to the humidier chamber.

Insert the heater wire plug into the wire socket.

Securely insert the temperature probe in the port on

the circuit elbow (III). Insert the second temperature

probe (IV) into the airway port at the distal end of

the breathing circuit.

5. Connect the non-heated section (C) to the drive line

of the generator assembly (D).

III

6. Connect the proximal pressure line (E) to the

proximal port on the driver (V) and the pressure

line on the generator.

Temperature probe

When inserting the temperature probe into the

circuit, ensure the probe tip is in the middle of the

gas stream. This allows the gas temperature to be

measured accurately. If the probe is not properly

seated, the temperature measurement accuracy may

be compromised, leading to excessive condensation.

Cover the temperature probe with a reective shield

when used under a radiant warmer or bilirubin light.

Humidication and nCPAP

Humidication

Heated humidification is recommended for nCPAP therapy.

The normal functions of the nose and air passages of

the respiratory tract are too warm, moisten and filter

the inhaled gases before they reach the lungs. In normal

respiration, the nasal mucosa and upper airways provide

75% of the heat and moisture supplied to the smaller

airways and alveoli. By the time air reaches the alveoli,

the inspired gas warms to 37 °C at 100% relative humidity

With nCPAP, the upper airways are not bypassed,

(RH).

but the high gas flows may be drying to the airways,

especially to a neonate’s underdeveloped lung. Adequate

humidification is essential to maintain airway clearance,

optimize ventilation and improve patient comfort.

The International Organization for Standardization (ISO) and

American Association for Respiratory Care (AARC) clinical

practice guidelines recommend gas temperature

between 34 and 41 °C to provide a humidity level of

33 to 44 mgH

O/L with artificial airways.14 Be cautious

using higher temperatures, as condensation may reduce

the mucous viscosity and interfere with the mucous

clearance. Extended exposure of gas temperatures over

41 °C may cause cellular damage to the airways.

The higher temperature settings may not be required to

deliver adequate humidification, since an artificial airway

is not used with nCPAP. Start with a temperature setting

of 36 °C to 37 °C and adjust the humidifier settings to

maintain adequate humidification; if condensate occurs,

reduce the humidifier temperature setting.

Airway temperature probe placement

Open bed or crib

When the infant is placed on an open bed warmer or

crib, it is recommended to remove the unheated section.

This places the temperature probe next to the

generator assembly.

If the infant is under a radiant warmer or bilirubin light,

the temperature probe should be covered with a light

reflective shield to prevent heating the probe. If the probe

is not covered, it could interfere with the operation of the

humidifier and cause excessive condensation to form.

Isolette or incubator

When the infant is in an isolette or incubator, the

non-heated section should be used with the temperature

probe placed outside of the isolette. Make sure that the

rest of the unheated section remains in the isolette.

If condensation is observed, remove the non-

heated (A) section and place the temperature probe

inside the isolette.

Infant Flow SiPAP sensor calibration

Infant Flow

SiPAP

Pres High

NCPAP/ Pres Low

L/min

Infant Flow

SiPAP

Pres High

NCPAP/ Pres Low

L/min

Infant Flow

SiPAP

Pres High

NCPAP/ Pres Low

L/min

100

Infant Flow

SiPAP

Pres High

NCPAP/ Pres Low

L/min

Two-point oxygen sensor calibration

Two-point oxygen sensor calibration should be performed

before initially using the Infant Flow SiPAP driver and with

each circuit change. To avoid unwanted alarms, occlude the

9 LPM prior to turning on the Infant Flow SiPAP driver on.

When the Infant Flow SiPAP driver is turned on, a power on

self-check automatically performs.

prongs or mask and set the low pressure flowmeter to

To perform two-point calibration:

1. Press the CAL button to enter the calibration menu.

2. Set the pressure low flowmeter to 9 LPM and the pressure high flowmeter to 2 to

3 LPM. Note: The pressure high flowmeter must be set during set-up to enable the

manual breath button.

3. Adjust the oxygen control to 21%. Allow time for the reading in the oxygen display

window to stabilize.

4. Press the flashing question mark button located under the 21% icon. The question

mark changes to a static hourglass. When calibration is complete, a static green

check mark icon appears and the oxygen display window reads 21%.

100

5. Adjust the oxygen control to 100%. Allow time for the reading in the oxygen display

window to stabilize.

6. Press the flashing question mark button located under the 100% icon. The question

mark changes to a static hourglass icon. When calibration is complete, the hourglass

icon changes to a static checkmark. The oxygen display window

reads 100%.

7. If oxygen calibration fails, a red X displays on the button of the screen, the alarm

sounds and an Error code displays on the top-left corner. Turn the driver off and

then, back on. Repeat the calibration procedure.

Disable the oxygen sensor

The internal oxygen sensor may be disabled by pressing the O2 disable button on the

calibration screen. This disables oxygen monitoring and the audible oxygen alarm. An

error code displays to indicate the oxygen monitor is inoperative. An external oxygen

monitor must be used whenever the oxygen sensor is disabled.

Leak test

While occluding the patient interface, set a flow of 9 LPM on the pressure low flowmeter.

A CPAP of 5 cmH

O ± 1 should display on the SiPAP screen. If pressure is not reached,

check the system for leaks. Release the occlusion, and the displayed pressure should be

≤ 2 cmH

does not fall, check the circuit for occlusions.

O. Wait for 15 seconds, and a disconnect alarm should sound. If the pressure

100

Infant Flow SiPAP set-up guide

Set-up menu screen

1. Adjust the pressure low flowmeter until the desired

nCPAP pressure displays on the screen. Press the flashing

question mark icon, which changes to a static checkmark

to confirm the setting.

2. Adjust the oxygen control dial to set the desire FiO

Press the flashing question mark icon. A checkmark

appears to confirm the setting.

3. Adjust the pressure high flowmeter until the pressure

displays 2 to 3 cmH

O above the set nCPAP pressure.

Press the flashing question mark icon. A static checkmark

appears to confirm the setting.

4. To use the low breathing rate/apnea monitor, connect

the transducer interface to the Infant Flow SiPAP driver.

Press the flashing question mark under the infant

respiratory sensor icon. This will change to a static

checkmark to confirm the setting. This does not confirm

that you want to use the respiratory monitoring option

but ensures that all modes are available for later use.

Alarm set/conrm screen

Press the nCPAP button or alarm bar for three seconds

to set the alarm limits and move to the next screen. If no

button is pressed within two minutes, the alarm limits

automatically set and the screen changes to the mode

select screen.

Set-up menu screen

5. After completing the above steps, the screen changes

and displays the nCPAP mode. The infant can now be

connected to the Infant Flow SiPAP system.

Mode select screen

All available modes display at the bottom of the screen.

1. For low breath rate/apnea modes, attach the abdominal

respiratory sensor to the transducer and properly place

it on the infant’s abdomen.

2. Select the desired mode of operation by pressing the

corresponding button (mode select screen). The parameter

adjust screen displays, and the new mode displays in the

upper-left corner (parameter adjust screen).

Alarm set/confirm screen

3. Make the desired setting changes, and press the

selected mode to confirm the settings and activate

the new mode.

4. If no selection is made within two minutes and no

alarms sound, the screen locks to prevent entries. The

mode buttons go blank, except for the last button on

the right (locked screen). To unlock the screen, press

the lock icon.

Mode select screen

Parameter adjust screen

Locked screen

Infant Flow SiPAP set-up guide (continued)

18.0

16.0

Pressure (cmH

Flow (LPM)

Parameter adjust screen

1. To change the settings during set-up and normal

operation, touch the desired parameter button.

2. Press the up or down arrows to adjust the parameter

to the desired setting.

3. Confirm the change by re-pressing the parameter button.

The main screen displays.

Note: nCPAP and BiPhasic pressure levels are set by

adjusting the flow.

Main screen and monitored parameter screen

1. To monitor therapy, use the main screen or

monitored parameter screen. The main screen

graphically displays the delivered pressure. The

monitored parameter screen displays numerical

values for the delivered pressure.

Parameter adjust screen

2. Press the Change Screen button to switch the

screen display.

Alarm reset/silence

1. Press the alarm bar to silence the active alarms

for 30 seconds.

2. Press the alarm bar for three seconds to clear resolved

and low-priority alarms and to reset alarm limits. Smart

alarm technology automatically sets high pressure, low

pressure and % oxygen thresholds.

14.0

12.0

10.0

8.0

6.0

4.0

2.0

4.0 6.0 8.0 10.0 12.0 14.0 16.0

Main screen

Monitor parameter screen

Main screen with active alarm

Flow pressure nomogram

The Infant Flow SiPAP LP system is subject to a direct

relationship between the controlled gas flow and airway

pressure. For example, 9 LPM of gas flow provides

approximately 5 cmH

O CPAP.

Tip: Manual breath: The high pressure flowmeter must be

set to deliver a manual sigh/breath during CPAP. The boost

in pressure delivers for the time high that was entered during

the set-up process.

Respiratory abdominal sensor

Respiratory abdominal sensor (optional)

For use only with the Infant Flow SiPAP Plus and

Comprehensive nCPAP drivers. The respiratory abdominal

sensor enables the clinician to monitor for apnea/low breath

rate in both nCPAP and BiPhasic modes. The accessories

include the reusable transducer and single-patient-use

abdominal sensor. In the BiPhasic trigger mode, the

respiratory abdominal sensor and transducer allow

patient-triggered pressure assists with breath rate

monitoring (not available in the U.S.).

Respiratory transducer connection

1. Connect the transducer cable to the transducer port

on the front panel.

2. Connect the abdominal sensor pressure line to the

transducer interface.

3. Compress the sensor pad gently, repeating this several

times while observing the transducer LED.

Infant set-up

To apply the sensor to the infant using suitable tape

(figure 1):

1. Visually identify the optimum outward movement of

the abdomen during inspiration. When the infant

breathes, the most movement is between the lowest

rib and the abdomen.

2. If the infant is supine, place the capsule midway

between the umbilicus and xiphisternum, which is the

notch at the center of the two lower ribs. On larger

infants, an alternative site is the upper chest to detect

intercostal movement.

3. If the infant is prone, place the sensor laterally over the

lower rib and abdomen. The sensor tubing should be

directed over the back.

4. Tape the sensor firmly into position using a non-

allergenic microprobe tape. Position the sensor line

perpendicular to the tape. Only use tape that is

approved by your facility’s protocol.

5. Verify correct placement. The transducer LED should

illuminate on expiration, and the SiPAP front panel LED

on inspiration.

6. If the LED does not illuminate, try repositioning the

sensor and adding a second piece of tape making an

“X” over the sensor.

Figure 1: Abdominal sensor placement

Self assessment

1. Where should the circuit airway temperature probe be

placed if the infant is in an isolette/incubator?

2. If condensation occurs in the breathing circuit, what

should you do?

3. Explain how to disable the oxygen sensor:

4. Demonstrate how to reset the alarm limits when the

device is in operation:

7. While in nCPAP, you press the manual breath button,

but nothing happens. What would prevent a manual

breath from being delivered?

8. When should you perform an oxygen sensor

calibration on the Infant Flow SiPAP?

Notes:

5. To deliver a CPAP of 5 cmH

6. Where is the best placement for the respiratory

abdominal sensor?

O, what would the ow rate be?

+ 42 hidden pages

CareFusion Infant Flow Training Workbook

Specifications and Main Features

Frequently Asked Questions

User Manual