Continuous Positive Airway Pressure (CPAP) Non-Invasive Ventilation

Important information:

Breathing

The air we breathe is made up of gases. When we breathe in (inhale), oxygen enters our lungs. The body keeps the oxygen and carbon dioxide is removed as we breath out (exhale). This is called gas exchange.

Certain conditions can make it hard to breathe and may require extra oxygen or support. The most common causes of respiratory problems are:

• Issues with the nervous system that may change the strength and how well the respiratory system works.

• Muscle problems that weaken breathing muscles. 

• Problems in the upper airway that prevent air from moving in and out of the lungs.

• Problems in the lower airway that affect normal breathing or gas exchange.

CPAP

Your healthcare provider has recommended CPAP to improve your child’s breathing. CPAP stands for continuous positive airway pressure. The pressure helps to push open the airway and is delivered by a machine through a nasal interface or full-face interface.

Understanding your equipment

Starting at the back of the machine and moving to the front, you will first see a:

Power cord: The CPAP machine needs to be plugged into an AC outlet. It is best to use a 3-pronged wall outlet, but an adapter can be used if only 2- pronged outlets are available in your home.

Extension cords should not be used with the CPAP machine. They reduce the amount of power getting to the machine and make it less effective.

CPAP machine (flow generator): On the machine, you will see:

• Buttons to program the air pressure settings. These settings are ordered by your child’s healthcare provider. Do not touch these buttons. If a change needs to be made, a person from the home care company (DME) will come to your house and do it.

• On/Off Switch

• Filters clean the air that is going to your child.

• Tubing is a lightweight hose that goes from the machine to the child and delivers air.

• Air output is an opening in the machine that holds the tubing and sends the air through the tubing to your child.

• Exhalation port is an opening on the tubing or the mask that allows your child to exhale. Never block this or have it under the covers.

• CPAP can be given to your child through a mask or nasal prongs (interface).

• Mask connects to the tubing, covers your child’s nose or face and delivers air to your child. The mask must fit properly to prevent skin irritation. As your child grows, they may need a larger or different type of mask. Each brand of mask is made a bit differently. Your home care representative, nurse, or respiratory therapist will teach you about the mask for your child.

• Nasal prongs connect to the tubing and are then inserted into your child’s nose to deliver air to your child.

• Head gear is a cap or a set of soft straps that keep the mask or nasal prongs in place.

Other equipment

• Humidifier: The air coming from the machine can be cold and dry, so we always use a humidifier to moisten the air. This keeps the upper airway and lungs from being too dry and uncomfortable. Some home machines have a humidifier built in. Other machines, like ventilators the home care company will provide, are used with an external humidifier. Sterile or distilled water must be added to the water chamber on a daily basis.

• Oxygen: Will be ordered by your child’s healthcare provider if it is needed. You will be taught how to add oxygen to the system.

• Pressure alarms: The machine may have alarms to alert you if your child is not receiving the air pressure ordered by their healthcare provider.

Patient instructions:

Refer to the instructions provided by your home care representative. Place nasal interface on your child’s face/nose, and secure in place using the headgear.

Fitting the mask or prongs

• Tighten the straps just enough to keep the interface in place but keep them as loose as possible without causing a leak.

• You should be able to fit 1-2 fingers under the straps/cap of the headgear without hurting your child.

• Do not allow any part of the mask, nasal prongs, or headgear to touch any part of the eyes or lips.

• Do not allow air to blow into your child’s eyes.

Changing the interface

• If your child needs to use CPAP for more than 16 hours a day, use a second type of interface.

•  This prevents the interface from pushing on the same parts of the face all the time, which can be harmful to your child.

• If your child uses CPAP more than 12 hours a day, it is best to change the interface every 8 hours to avoid skin injury and pressure sores. 

Preventing and recognizing skin breakdown

• Check for red or open areas on the skin when removing the interface.

• Check for red or open areas anywhere the interface touches the skin on the face.

• Check for red or open areas anywhere the headgear (cap or straps) touches the skin including ears, forehead, back of head, and cheeks. 

• If the redness goes away in less than one hour, remember to adjust the interface to be looser the next time you put them on.

• If the redness remains after one hour, call your healthcare provider.

• If there is an open sore anywhere the interface or headgear touches the skin, call your healthcare provider. Do not use the same interface the next night. Your child may need to be seen by their healthcare provider.

Cleaning instructions: 

• Wash your hands well.

• Clean the interface every morning so that all the parts are dry for nighttime use.

• Clean the tubing at least once a day by following the instructions below.

Interface

1.  Disconnect the mask from the tubing, valve, and any other pieces.

2. With a soft cloth, gently wash the mask in a solution of clean, warm, water and mild dish detergent. Never clean any part of the mask with alcohol, solutions containing alcohol, or vinegar. 

3. Rinse thoroughly. If the mask is oily, wash it again. If this procedure does not make it clean, call your home care representative.

4. Allow parts to air-dry on a clean cloth or paper towel.

5. Your home care representative will teach you to clean any other pieces if necessary.

Tubing

1. Disconnect the tubing from the CPAP machine or valve.

2. Soak the tubing in warm water and mild dish detergent.

3. Rinse the tubing thoroughly.

4. Hang the tubing and let it air dry.

Head gear 

Hand wash with mild soap and cool water as often as needed and let air dry.

Disinfecting supplies weekly

You should disinfect the non-fabric pieces:

1. Mix together equal amounts of white vinegar and water.

2. Soak supplies in this mixture for 30 minutes.

3. Rinse all parts well with water.

4. Allow parts to air-dry on clean cloth or paper towel.

5. Put the pieces back together. Run the equipment for about 10 minutes before your child uses it. This will get any extra moisture out of the system.

Filter

Your machine has a filter which can be disposable (discard when discolored; replace with new) or permanent (which needs to be cleaned). Check weekly. 

If you need to clean the filter in your machine, follow these steps:

1. Remove the filter from the CPAP machine.

2. Wash the filter once a week with warm water and a mild dish detergent. 

3. Rinse well with water.

4. Allow to dry on a clean cloth or paper towel.

5. Replace the filter as you were taught by your home care representative.

CPAP Machine

1. Unplug the machine before you clean it. Never place the machine in water.

2. Use a damp cloth with mild dish detergent and wipe the outside of the CPAP machine.

3. Let the CPAP machine dry completely before you plug it in.

Humidifier

• Use distilled water or boil water and let it cool before adding it to the humidifier. Change water daily. 

• Clean the water container with soap/water daily (fragrance-free soap) and allow to air dry to prevent infections.

• Disinfect weekly. 

Troubleshooting instructions:

No air flow

• Remove the mask/nasal pillow/prongs from your child’s face.

• Is the machine plugged in and turned on?

• Is the tubing connected to the mask?

• Is the tubing connected to the machine?

• Is there power in the rest of the house?

High pressure alarm: Not found on every machine

• Check your child first! 

• Check to be sure the interface is not blocking the nostrils.

• Remove the mask/nasal pillows/prongs from your child’s face.

• If your child is in distress, follow the emergency instructions given to you by the hospital staff or your home care representative.

• If your child is fine, check the equipment, start at the interface and work toward the machine.

• Is the exhalation port attached and open?

• Is there water in the tubing or pressure lines?

• Call your home care company.

Apnea

• Check that your child is breathing!

• Check your child and make sure they are breathing okay

• Call 911 if they are not breathing

• If they are breathing and the alarm goes off again and you witness them have a pause in breathing call your doctor

• If they are breathing and the machine is alarming, make sure the interface is on well and you do not feel any leaks around it.

• Assess the tubing for any leaks or disconnects

• Call your home care company or healthcare team

Low pressure alarm/leak

• Check your child first!

• Check mask position for leaks and adjust if necessary.

• Check to make sure the interface is securely on your child's face and not leaking around it.

• If your child is in distress, follow the emergency instructions given to you by the hospital staff or your home care representative.

• Check for holes or leaks in the tubing starting from the interface back towards the machine. If found replace filter/tubing and or humidifier.

• If your child is fine, check the equipment, start at the interface and work toward the machine.

• Is the tubing disconnected from the machine or the mask/prongs?

• If you have pressure alarm tubing, is it disconnected?

• Is the machine plugged in and turned on?

• Call your home care company. 

Safety precautions

• If you have any questions, always check your child first. 

• It is best to plug the power cord into a grounded electrical outlet.

• Do not use the machine near water.

• Do not take the machine apart or try to repair it. 

• With oxygen use, turn your machine on first, then oxygen.

• With oxygen use, turn off oxygen first, then machine.

Reordering supplies and equipment

• Call your home care company when supplies are getting low, before you run out. It can take 1-2 weeks for insurance approval and delivery.

• You can order a new interface from the home care company.

 

Reviewed September 2024 by William Glenn BHS, RRT-NPS