Patient Interface Fitting Dave Henry RRT Respiratory Clinical Specialist 1
Objectives Assist the patient to pick the best interface to make the therapy work. Instruct the patient to the concept of interfaces and PAP therapy. Recognize when the patient is having difficulty and know what to do about it. 2
Preparing Patient for PAP Therapy Patient education on the interface previous to the titration can be extremely helpful The patient has to know up front that this is a life-long decision to wear CPAP It helps when a spouse is present during the explanation The clinician should try breathing with CPAP to have a better understanding of what the patient goes through 3
Question #1 4
Common Interface Problems When the mask is too tight or the wrong size is used, it can leave sores on the patient s face. Common areas with sores include: Bridge of the nose Forehead Irritated nostrils gum irritation Bruising of the upper lip ***Most cases of CPAP non-compliance will come from complications with the interface. 5
Common Interface Problems Excessive leaks around the eyes can cause dryness Nasal masks will be difficult to use on patients that remove their dentures at night It may be impossible to get a good seal on a patient with excessive facial hair It may be necessary for the patient to shave their facial hair for CPAP therapy to work 6
Common Complications Common complications that may arise are: Claustrophobia Skin Allergies Emotional Stress Fashion fears Nasal Allergies Should not be worn when severely congested 7
Claustrophobia Giving the patient a choice of mask helps (sometimes) Desensitizing the patient will take longer on some patients Standing at bedside with the patient is helpful Picking a mask that does not block their vision is preferable Dual airway or nasal pillows, for example 8
Question #2 9
Common Interface Problems (cont.) Skin allergies can arise due to the different materials masked are made of Most masks are now silicone (latex-free). Most headgear will be made of breathoprene. Some patients will be allergic to gel materials that some masks are made of What redness, sir? 10
Skin Allergies Latex-free vs. Silicone All silicones are not created equal Medical grade silicone masks are available, but some patients may be allergic to that as well (Rare) Marks on the patient s face may come from the mask being overtightened Nasal Pillows Interface may be useful because of it s design providing less contact with the face 11
Emotional Stress Wondering if a lack of support by spouse will be a problem Sleep apnea can affect the patient wanting to try something new CPAP equipment seems too complicated 12
Fashion Fears What will it do to my hair? Will I look like I am ready to go trick or treating? I don t like wearing masks! Can t they make an invisible mask? 13
Nasal Allergies If Nasal Allergies can not be controlled by checking filters and using a humidifier, the patient may have to talk to their doctor about getting treated for allergies Dr may order Decongestants Nasal steroids 14
Severe Nasal Congestion Although it may assist patients that have mild congestion, PAP therapy can cause severe ear discomfort when they are severely congested It is recommended not to wear PAP until severe congestion has cleared 15
Finding the Right Fit It helps when the patient can help choose the type of interface CPAP masks are NOT one size fits all Clinician must know the benefits each mask offers and their drawbacks 16
What Interface Is The Best? Not Any Certain ONE! 17
Picking The Right Interface Is An Important Step! 18 One patient may choose the full face mask and another may choose the nasal pillows The CPAP study is the best time to seek potential complications Their first exposure to CPAP may make or break their commitment
Question #3 19
What to do about Claustrophobia? For patients that can t handle the basic nasal mask, nasal pillows may work well Minimal straps Does not block the patient s vision (important) Provides direct pressure into the nostrils OR Dual Airway Interface Combination of Nasal pillows and mouth mask Low profile so doesn t block vision 20
Mouth Breathers? Dual Airway Interface Technology Although these are sometimes currently categorized as FULL FACE interfaces, they serve a dual nasal and oral purpose, yet do not cover as much of the face They are oral masks with nasal pillows 21
Question #4 22
Dual Airway Interface - Hybrid Dual-airway interface Consists of an oral cushion that covers the mouth and two nasal pillows Designed to be a universal interface for both patients and providers. Eliminates contact across the bridge of the nose and the forehead. Built-in chin flap gently supports the chin Ensuring that the mouth stays closed during therapy. 23
Benefits of Nasal Pillows Reduces "claustrophobic" sensation Patient can wear glasses Few points of contact on face Less dead space No forehead/overhead contact Allows use of mixed pillow sizes Patient can switch sides without changes Can be worn in different positions 24
Question #5 25
Nasal-Aire II Petite - FOR PEDIATRIC USE 26
Question #6 27
Nasal Mask vs. Nasal Pillows vs If the nasal pillows irritate the inside of the nostrils, the nasal mask will be a better idea The ease of putting the mask on and taking it off will make one more appealing 28
Question #7 29
Benefits Offered By The Nasal Mask EasyFit Adjustable forehead rest takes pressure off the bridge of the nose The direction of the exhalation port is many times adjustable Many of the parts are replaceable Pressure may feel more comfortable since the pressure is not as direct. Serenity Flexset 30
Mouth Breathers Some people have difficulty breathing through their nose at times Sinus Infection (Temporary) Nasal Allergies (Dust, Pollen, Dry Air, Pets) Some conditions that make it impossible to breathe with a nasal mask Blocked nasal passages (deviated septum) Cleft Palate Nasal Polyps Habitual Mouth Breathers 31
Mouth Breathers For patients that are physically able to breathe through their nose, a chin strap may work well Can be used as a temporary fix until the patient can breathe through their nose normally without it 32
When Nasal Breathing Isn t An Option! A full face mask may be a good option for some patients This allows patients to breathe through the nose and/or mouth easily 33
Education as a Sales Tool DeVilbiss Sleep Workshop What: 6 hour workshop (Interfaces, AutoAdjust, CPAP Adherence) Limited number approved for FY11 Who for: Primarily Sleep Techs but also RTs Who Performs: DeVilbiss Team Members How: Details on these workshops has not been completed and information will follow later on. Testimonial 34
Education as a Sales Tool DeVilbiss Interface Workshop What: 1 hour CEU program (Considered TRADITIONAL program by AARC) Who For: Sleep Techs and RT s Who Performs : Any sales associate can do this program How: Complete form from DeVilbiss Central and send to Dave Henry Testimonial 35
Interfaces - Take Home Message! Not any ONE interface meets ALL patient needs. Choose the interface that BEST meets the needs of the patient. When troubleshooting interface problems, LISTEN to patient and offer solutions that will IMPROVE PATIENT ADHERENCE. Thanks! 36