Respiratory Cloud Clinical Skills Library

Skills Assessment Report

Date:

Skill Assessment - Intermittent Positive-Pressure Breathing (IPPB)

Notes
  • Shared interskill preparation structure retained from the existing library; procedure-specific clinical content is supported by peer-reviewed literature.
  • IPPB is not first-line for routine lung expansion or aerosol delivery when other techniques can meet the prescribed objective.
  • Initial settings and subsequent titration must follow the specific device instructions, authorized order, and institutional protocol.
  • A suggested lung-expansion outcome is an individualized increase in delivered volume and clinical response; fixed targets must not supersede patient tolerance or the authorized care plan.
  • A conventional nebulizer or metered-dose inhaler with an appropriate spacer is generally preferred for routine aerosol therapy in spontaneously breathing patients.
  • Shared interskill follow-up structure retained from the existing library; follow facility policy, scope of practice, authorized orders, supervising-clinician direction, and device instructions for use.
Step Pass Unsatisfactory
Knowledge
States Contraindications and Relative Contraindications of procedure.
Preparation
Clinical Standards for Procedures and Interventions.
Assessment
Verifies an authorized order or approved protocol; confirms the therapeutic objective and that less invasive or less resource-intensive alternatives are ineffective, unsuitable, or cannot be performed reliably.
Reviews the medical record, imaging, pulmonary function or ventilatory mechanics, oxygenation and ventilation data, medications, recent response to therapy, and patient-specific risks.
Screens for untreated tension pneumothorax and evaluates all relative contraindications before beginning therapy; obtains prescriber or supervising-clinician direction when risk is present.
Obtains baseline respiratory rate and pattern, work of breathing, breath sounds, pulse and rhythm, blood pressure, oxygen saturation, mental status, pain or dyspnea, cough effectiveness, secretion burden, and tidal volume, vital capacity, or peak flow when indicated.
Preparation
Selects and obtains the IPPB device, validated circuit, machine-outlet filter, prescribed gas source, appropriate mouthpiece, lip seal, mask, or artificial-airway connector, volume-measuring device, oxygen analyzer when indicated, suction equipment, sputum receptacle, personal protective equipment, and backup ventilation equipment.
Assembles the circuit according to the device instructions; verifies connections, exhalation valve, pressure relief, trigger, cycling, pressure and flow controls, aerosol generator when used, and absence of leaks or unintended auto-triggering before patient connection.
Implementation
Positions the patient to optimize ventilation, explains the goal and sensations of pressure-assisted inspiration, establishes an effective interface seal, and confirms that the patient can coordinate with the device.
Begins with a low inspiratory pressure and moderate flow, sets trigger sensitivity so the patient can initiate a breath without auto-triggering, and uses the prescribed fraction of inspired oxygen.
Instructs the patient to initiate a gentle inspiration and allow the device to augment the breath; coaches slow, coordinated breathing with adequate expiratory time and avoids rapid breathing, forced inhalation, and breath stacking.
Titrates pressure, flow, sensitivity, inspiratory time, and interface to the prescribed volume or clinical objective while measuring delivered tidal volume and avoiding discomfort, excessive pressure, overdistention, and air trapping.
If aerosol medication is specifically ordered for delivery through the IPPB circuit, verifies the drug, dose, diluent, device compatibility, and aerosol output before administration.
Monitoring & Modifications
Monitors trigger sensitivity, peak pressure, flow, delivered tidal volume, inspiratory and expiratory time, fraction of inspired oxygen, respiratory rate, pulse and rhythm, blood pressure, oxygen saturation, breath sounds, mental status, dyspnea, pain, patient-device synchrony, and subjective tolerance as clinically indicated.
Observes for barotrauma or pneumothorax, worsening hypoxemia, hemodynamic compromise, hypocarbia, hypo- or hyperventilation, gastric distention, hemoptysis, secretion impaction, air trapping or auto-PEEP, anxiety, and increased work of breathing; stops therapy and escalates immediately for a serious adverse response.
Encourages effective cough and secretion clearance during and after lung expansion; assesses sputum quantity and character and performs suctioning only when indicated and authorized.
Post-Intervention
Reassesses the patient using the relevant baseline measures, including symptoms, vital signs, breath sounds, oxygenation, delivered volume, vital capacity or peak flow, cough effectiveness, secretion clearance, and need for continued or modified therapy.
Documents the indication, interface, gas source and fraction of inspired oxygen, settings, delivered volumes, medication and dose when applicable, duration, pre- and post-assessment, patient tolerance, secretions, adverse events, and communications or changes to the care plan.
Processes reusable equipment and disposes of single-patient items according to infection-control policy and manufacturer instructions; changes circuits and nebulizers between patients, when visibly soiled, or as required by institutional policy.
Post-Intervention Management Steps.
References

Summary Performance Evaluation

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