Post
by archangle » Sat Feb 28, 2015 1:59 pm
Sounds like someone trying to protect their job and generate revenue.
"It takes hospital resources."
"Our technicians cannot be educated on how to use all these different machines," You mean, teach them where the on/off button is, and to check the exhale vent to see that the machine is blowing air? Your staff isn't going to be adjusting the CPAP pressure and settings. Maybe you should just have a bunch of red arrow stickers that you stick on the on-off button for CPAP machines and teach the staff how to feel the airflow coming out of the CPAP mask.
Do you realize the amount of time and effort it's going to take to find the correct pressure settings, and get a qualified person to set up the "standard hospital based machine" to the correct settings for the individual patient? Do you realize that CPAP is not just a simple, standard machine you hook up and forget? How many patients are you going to harm because you didn't get the right settings? Once you set up your hospital-based CPAP machine, aren't you going to have a respiratory therapist do the mask fitting and check that the machine is working correctly? Don't forget that you're going to have to disinfect the hospital-based CPAP equipment before you use it on the next patient.
Can anyone be this stupid? If you've ever worked with CPAP patient, you would know that it often takes a long time and many attempts to find a mask that works, and that the patient can tolerate. Even if you find the right mask, there is often a lot of tinkering to adjust the headgear correctly. You're going to spend a lot of time getting the adjustment right for the patient and then monitoring the patient and adjusting when there are leaks or other problems. Not really. You're just going to slap a mask on the patient and ignore any problems that occur. Or maybe put on a full face mask and tighten it down so tight to stop leaks that you cut off blood flow to the patient's scalp. Even with the "correct" settings, there's often a lot of tinkering needed to get the CPAP machine set right.
"staff time for processing and inspection". Inspection? You mean checking that the power cord isn't frayed and looking for the UL or other certification on the power brick? Do you really think that's going to take more effort than disinfecting a "hospital based machine," configuring it to the patient's needs, fitting a mask, trying it on, etc.?
"Contamination is another concern ... from hospital-acquired microbes coming home with patients on their machines after surgery." If your hospital has a risk of MRSA and other infections, isn't it likely that you'll infect the patient directly from the "standard hospital based machine" while he's in the hospital? If you're going to contaminate the patient's CPAP, aren't you going to contaminate the hospital-based CPAP machine? Or simply infect the patient directly instead of from your hospital contaminating his CPAP machine? If you're worried about "infecting" the non-porous, plastic CPAP machine, and then having that machine infect the patient later, you're probably a dozen times more likely to infect the patient while he's in your hospital.
However, it is probably a good idea to recommend a good cleaning of the mask and hose after the patient goes home,
"But usually if the patient is arousable, we can wake them up and encourage deep breathing with supplemental oxygen. Then their oxygen saturation levels return to their baseline." You mean, instead of CPAP, you're going to keep the patient awake?
So instead of being able to nap in the recovery room, you're going to 1) let the oxygen monitor go off, 2) wait for the nurse to notice and come in, 3) Wake the patient up and tell them to breathe. You realize that the instant the patient goes back to sleep, he's going to have another apnea. You also realize that many untreated apneacs have events 30 times an hour or so, don't you? Do you also realize that supplemental O2 doesn't help many apneac because they're not breathing? So basically, you're planning to keep the patient awake the whole time, and tie up a nurse to keep him awake and telling him to breathe. I watched them do this to my Dad in the recovery room. Basically, a nurse sat there and wouldn't let him sleep.
Tell me again how it's going to be more expensive to inspect and handle the patient's CPAP machine than it is to have the nurse waking the patient up every time he dozes off.
"Contamination is another concern, either from CPAP machine to hospital patients and staff" Gee, don't you think the patient is a lot more likely to contaminate your hospital patients and staff? If some bug is on the CPAP machine, it's probably already on the patient as well. Doesn't your staff decontaminate after handling a patient or medical equipment attached to the patient? Don't forget that CPAP machines are mostly non-porous plastic. If you're spreading infections around from the patient's CPAP, you're going to spread it around from the hospital-based CPAP machine once it's been contaminated by being used on a patient.
"If there is an acute event where the patient is unstable, then you may need more invasive measures like intubation,"
So if the patient needs to be intubated, you can't use CPAP as a substitute. I'm SHOCKED, SHOCKED to hear that a CPAP isn't a substitute for being intubated. Or did you think that you could use a CPAP machine on an intubated patient? Don't most of your patients hang around and sleep for a while after your remove the breathing tube?