Tuesday, June 25, 2013

Can you BiPAP without ABG?

Question: I work with MDs that routinely order bipap for floor patients without an ABG. As an RT, I'm uncomfortable with this situation. What are your thoughts?

Answer: I think it depends on the situation and the patient. If the patient is in respiratory distress, it is sometimes necessary to treat before test results are performed (i.e., before ABGs, x-rays, labs, etc.) For example, a patient in obvious heart failure may benefit from the decreased preload BiPAP can provide. For a COPD patient, the BiPAP can help witho oxygenation (FiO2 & EPAP) and ventilation (IPAP). Also, with noninvasive testing such as SpO2 and ETCOT, he could base his decision on those, as opposed to the ABG. Personally, I think ABGs are over ordered, and a VBG would be all that is necessary to get a pH.

I have had this happen where I work to, where the patient does not meet any of the above criteria.  I have also had a physician, many times, order BiPAP just based on the ABG results, when there was no indication for BiPAP.  For example, the CO2 is 50.

I provide this answer not knowing the assessment nor history of the patient.  .

Thoughts?

1 comment:

Sara said...

I see it ordered too often when the pt has one of two things happening. First, pt extubated post surgically too soon, and struggling to wake up. Second, over medicated, and could use Narcan to better effect than Bipap.

My hospital is at least trying to correct the second. All our pts on PCA devices now also have ETCO2 monitoring, which will shut down the pump if the pt's respiration rate slows too greatly, or the CO2 numbers rise to high.

There's been a learning curve, but now that our nurses are seeing that fewer rapid responses are being called for over medication, they are becoming much more receptive. And as RT's were just glad to see fewer pts in trouble for something that was preventable.