Care Fusion Infant Flow Installation guide

Infant Flow®LP nCPAP system
Clinical training workbook

Initiating and maintaining
effective nCPAP therapy
is a critical step in helping
respiratory- compromised
infants achieve successful
recovery and develop
normal respiratory
function. When used
according to your facility’s
treatment protocols and
with this training
workbook, the Infant Flow
LP nCPAP system can
effectively deliver nCPAP
therapy to help improve
patient outcomes.
Table of contents
Infant nasal CPAP ..............................................................................................1–6
CPAP overview .....................................................................................................1–3
CPAP modalities .......................................................................................................4
Variable flow technology..........................................................................................5
Self assessment ........................................................................................................6
Infant Flow®SiPAP driver overview............................................................... 7–16
Infant Flow LP system ...............................................................................................7
Infant Flow SiPAP configurations ..............................................................................8
Infant Flow SiPAP display screen...............................................................................9
Infant Flow CPAP and circuit set-up........................................................................10
Humidification and nCPAP...................................................................................... 11
Airway temperature probe placement ................................................................... 11
Infant Flow SiPAP sensor calibration .......................................................................12
Infant Flow SiPAP set-up guide......................................................................... 13–14
Respiratory abdominal sensor.................................................................................15
Self assessment ......................................................................................................16
Infant Flow SiPAP nCPAP driver................................................................... 17–22
Modes of operation.......................................................................................... 17–18
BiPhasic mode strategy..................................................................................... 19–20
SiPAP exercises and self assessment.................................................................. 21–22
Infant Flow LP generator assembly.............................................................23–27
Infant Flow LP generator ........................................................................................23
Infant Flow LP interfaces...................................................................................24–25
Infant Flow LP fixation devices................................................................................26
Self assessment ......................................................................................................27
Infant Flow LP patient set-up...................................................................... 28–46
Infant Flow LP interfaces...................................................................................28–29
Fixation devices ......................................................................................................30
Headgear application .............................................................................................31
Generator assembly preparation.............................................................................32
Generator assembly and interface attachment to headgear .............................33–34
Bonnet application .................................................................................................35
Generator assembly and interface attachment to bonnet.................................36–37
Bonnet application (alternative method 1) ..............................................................38
Bonnet application (alternative method 2)..............................................................39
Incorrect application of fixation device and generator assembly.......................40 –41
Incorrect application of generator assembly and interface................................42–43
Final inspection of nasal interface placement .........................................................44
Self assessment and return demonstration ...................................................... 45–46
Routine nCPAP care.......................................................................................47–49
Frequently asked questions .........................................................................50–54
Self assessment ......................................................................................................54
Glossary..........................................................................................................55–56
References............................................................................................................57

1
Infant nasal CPAP
Introduction
Worldwide each year, approximately 15 million (1 out of every 10) babies are born prematurely.1Premature or
low-birth weight (LBW) infants are at a high risk for respiratory problems due to underdeveloped lungs. Common
neonatal respiratory conditions include apnea of prematurity, respiratory distress syndrome, transient tachypnea
of the newborn (TTN), meconium aspiration syndrome, pulmonary edema and post-extubation support. These
conditions are often associated with decreased pulmonary compliance and functional residual capacity (FRC).1,2
Several of these infants will require respiratory support.
Respiratory distress syndrome (RDS) is a condition that strains normal respiration due to the lack of natural
surfactant production. Approximately 50% of neonates born at 26 to 28 weeks gestation and 30% of neonates
born at 30 to 31 weeks gestation develop RDS.2
What is surfactant?
Surfactant is a phospholipid, which reduces surface tension
to increase lung compliance.
Artificial surfactant may be given to help reduce surface
tension, increase compliance and improve ventilation.
Without additional respiratory assistance, many infants have
difficulty establishing the adequate functional residual
capacity (FRC) required to maintain normal respiration.
Respiratory support
Several options are available to help the clinician provide
respiratory support to the neonatal patient. Historically, the
initial treatment for infants with respiratory problems was
mechanical ventilation via an artificial airway. Intubation
presents a variety of challenges for any patient but
compounds problems with premature infants. Given the
potential complications of intubation, many physicians opt
for a less invasive approach for spontaneously breathing
infants that utilizes continuous positive airway pressure
(CPAP). As infants are preferential nose-breathers, nasal
CPAP (nCPAP) is the preferred method for treatment
delivery. CPAP enhances alveolar recruitment decreasing
pulmonary vascular resistance and intrapulmonary shunting,
stabilizes FRC and improves oxygenation. By increasing
surface area to alveolar gas exchange, CPAP decreases V/Q
mismatch. The goal of CPAP therapy is to maintain normal
lung volumes and oxygenation, while enabling the infant
to breathe on their own.3,4 Physiologic effects of CPAP are
represented in the organizational chart on page 2.
CPAP overview

What is nasal CPAP (nCPAP)?
nCPAP is the application of positive pressure to
the airways of a spontaneously breathing infant
throughout the respiratory cycle. nCPAP is a continuous
flow of gas administered through nasal prongs inserted
in the nares or by a nasal mask placed around the
perimeter of the nose. The positive pressure, usually
4 cmH2O to 8 cmH2O, acts as a splint, which can help
prevent alveoli collapse.
BiPhasic CPAP alternates between two levels of CPAP
at a set time interval. The infant can breathe at both
CPAP settings. The BiPhasic mode helps increase the
infant’s tidal volume and may stimulate the respiratory
drive center.
Advantages of CPAP
• Increases FRC
• Maintains and increases lung volume
• Improves lung compliance
• Reduces work of breathing (WOB) and
airway resistance
• Provides a noninvasive procedure
• Allows small airways to develop
• Promotes the use of natural surfactant
• Promotes easy application
• Provides cost effectiveness
• Helps prevent extubation failure in some infants
• Stabilizes the airway diaphragm and chest wall
• Decreases incidence of chronic lung disease (CLD)
2
Nasal (nCPAP) is associated with improved respiratory mechanics and decreased chronic lung disease (CLD) rate.
Physiologic effects of nasal CPAP in neonates3–4,10
Infant nasal CPAP
Splint open airways Stretches lung
and pleura
Stimulates lung
growth
Stimulates the
J receptors and HIBR
Stabilizes chest wall
and diaphragm
Increases pharyngeal
cross section
Recruits alveoli
and prevents
alveoli collapse
Increases FRC
and lung volumes
Improves V/Q ratio
and increases
oxygenation
Decreases WOB
Decreases
obstructive apnea
Decreases
intrapulmonary
shunting
Improves
V/Q ratio
Conserves
surfactant
Maintains airway
patency
Reduces upper
airway resistance
Improves
breathing pattern
and decreases WOB
Reduces central
and
obstructive apnea

Indications for use2–5
• Abnormalities on physical examination
- Increased WOB
- Increased respiratory rate
- Intercostal and substernal recession
- Grunting and nasal aring
- Pale skin color
- Restlessness
• Deteriorating arterial/capillary blood gas values
(e.g., hypercapnea)
• Increased oxygen requirements to maintain a SaO2
greater than 92% with FiO2> 60%
• Atelectasis and inltration
• Clinical conditions
- Apnea of prematurity
- Chest infections (e.g., pneumonia)
- Transient tachypnea of the newborn (TTN)
- Mild meconium aspiration
• Weaning/Post-extubation support
Contraindications for use2–5
• Severe cardiovascular instability
• Respiratory failure dened as pH < 7.25 and
PaCO2> 60 mmHg torr
• Congenital malformations of the upper airway (cleft
palate, choanal atresia or tracheoesophageal stula)
• Congenital diaphragmatic hernia or untreated
bowel obstruction
• Poor respiratory drive unresponsive to CPAP therapy
(frequent apnea episodes associated with oxygen
desaturation and/or bradycardia)
What is work of breathing?
WOB describes the amount of effort required to breathe.
Any therapy that introduces incoming pressure to a
patient’s respiratory system potentially adds imposed
WOB. Infants with RDS experience elevated WOB levels,
and by expending additional effort to inhale and exhale
against pressurized gas, the infant consumes precious
calories overcoming the high WOB level. These calories
could otherwise be spent on vital recovery and growth
processes. In addition to helping the infant conserve energy,
a WOB reduction may reduce stress and anxiety levels.
3
Columella necrosis
Nasal dilation
Potential problems associated with CPAP therapy3,5,6
Clinicians should be aware of the possible hazards and
complications associated with CPAP, and take the
necessary precautions to ensure safe and effective
applications, such as:
• Possible loss of prescribed pressure and decreased FiO2
due to mouth breathing
• Increased intrathoracic pressure reducing venous return,
which may lower cardiac output
• Barotrauma leading to surgical emphysema/
pneumothoraces
• Aspiration
• Deterioration in the respiratory condition, requiring
immediate ventilation
• Patient discomfort from prong/mask intolerance
• Nasal septal injury (e.g., columella necrosis)
• Blanching of the nares
• Dry mouth and airways
• Gastric ination

4
CPAP modalities
What are the treatment options?
A variety of technologies have been employed in nCPAP
delivery throughout the years.
Conventional CPAP (V-CPAP): Utilizes a traditional mechanical
ventilator to deliver a constant flow of gas. CPAP is created
by changing the expiratory port orifice size. The ventilator
equipment is comprehensive and expensive.
Bubble CPAP (B-CPAP): Utilizes a constant flow of heated
and humidified gas. The level of pressure is controlled by
the depth of the exhalation tube inserted into a water
container. The pressure can increase if condensate collects
in the tubing, the flow rate changes or the water evaporates
from the container. B-CPAP lacks system alarms and
imposes a higher WOB due to the constant flow and
inability to entrain flow during inspiration.(16,18,19)
High flow nasal cannula (HFNC): Has not been cleared by
the FDA for nasal CPAP delivery. HFNC utilizes a constant
flow of heated, humidified gas that potentially delivers a
positive distending pressure. The level of therapy cannot
be measured and fluctuates depending on body position,
oral leaks, nasal secretions and the size and weight of the
patient. HFNC does not contain critical alarms that ensure
the safe delivery of therapy.
Variable flow CPAP (VF-CPAP): Incorporates a generator that
redirects the heated and humidified gas flow away from the
patient during exhalation and allows air entrainment during
periods of high inspiratory effort.
By redirecting the gas, VF-CPAP offers a lower imposed
WOB and less expiratory resistance compared to other
nCPAP technologies. Because the pressure is created and
measured at the nares, the variable flow technology
provides the most stable pressure, even in the presence of
leaks up to 6 LPM.
Pandt and Associates demonstrated that the Infant Flow
variable flow technology delivered a consistent level of
CPAP with little fluctuations. In contrast, the conventional
CPAP did not reach the desired level of 5 cmH2O, and
the pressure fluctuated significantly throughout the
breath cycle.9
Using a variable flow generator with a dedicated CPAP
driver provides a measurable therapy with system alarms
to help ensure safe and effective therapy.
Inspiration: Gas flow converted
to pressure reducing the WOB
and maximizing the pressure
stability at the patient interface.
Expiration: Gas flow
flipped away from the nasal
prongs to the expiratory
tube. The residual gas
pressure provided by the
continuous gas flow creates
a stable CPAP throughout
the respiratory cycle.
Moa, G., Nilsson, K. et al. Crit Care Med, 1988, 16(12):1238–1242.
Infant Flow variable ow
Infant Flow
8 Lts flow, 5 cmH2O
5 cmH2O
0 cmH2O
Time
System pressure
Conventional CPAP
17 Lts flow, 5 cmH2O with 5 Lts reservoir bag
5 cmH2O
Time
0 cmH2O
System pressure

What is variable ow technology?10,11
The Infant Flow LP patented dual-jet variable flow
generator utilizes fluidic technology to deliver a
constant CPAP at the airway proximal to the infant’s
nares. Without moving parts or valves, the generator
provides consistent performance. The level of CPAP
created is proportional to the flow provided by the
driver; for example, 9 LPM creates approximately
5 cmH2OCPAP. The variable flow generator uses
Bernoulli’s Principle via injector jets directed toward
each nare. If the infant pulls additional flow, the
venturi action of the injector jets entrains additional
flow from either the source gas or exhalation tube
reservoir. During exhalation, the incoming gas flow
redirects away from the infant. This action is referred
to as the “fluidic flip.” By redirecting the gas, variable
flow nCPAP reduces the imposed WOB. The infant
can exhale freely and conserve precious calories for
development. In summary, the direction of gas flow
in variable flow devices depends on the patient’s
respiratory cycle. The flow “flips” away from the
nares when the infant exhales and then, “flips” back
as the exhalation phase ends. The response is almost
instantaneous as it occurs at the patient’s nares.
What is vortices technology?10,12
The patented Infant Flow LP generator is a new form of
variable ow that uses vortices technology to reduce the
imposed WOB during inhalation. Similar to the single- jet
technology, the ow entrainment reduces the WOB
on inhalation by meeting the patient’s inspiratory ow
demand and during exhalation gas ow ips away from
the patient reducing resistance.
Four low-momentum jets (two per nare) impinge inside
the generator to create a consistent and measurable
positive airway pressure within the generator head.
During inhalation, the dual jets entrain ow to meet
the patient’s inspiratory demand. During exhalation, the
jets easily deect to disrupt the gas ow. This disruption
of ow creates vortice shedding that spirals outwardly,
combining with the exhaled breath to create an
organized, efcient ow path toward the exhaust ports.
5
Variable ow technology
Impinging
jets
Patient
Pressure
line
Drive
line
Exhaust
tube
Inhalation
Dual jets
Exhalation
Patient nare
Fluidic flip
Exhaust tube
Vortice shedding
Patient nare
Flow direction Flow direction

6
Self assessment
1. Describe RDS:
2. List three indications for nCPAP therapy:
3. List three benets of nCPAP therapy:
4. List three potential complications to nCPAP therapy:
5. State four methods used to deliver nCPAP therapy:
6. Discuss the advantage of variable ow technology compared
to other CPAP modalities:
7. Discuss the importance of low work of breathing:
8. Match the generator parts to the diagram:
Pressure line
Impinging jets
Exhaust tube
Drive line
Patient
Notes:
b
e
a
d
c

Infant Flow SiPAP
driver overview
7
Infant Flow LP system
The Infant Flow LP nCPAP system is a comprehensive system for delivering unique nCPAP therapy.
The system consists of:
• Infant Flow SiPAP driver
• Infant Flow LP generator assembly
• Infant Flow LP fixation—bonnet or headgear
• Infant Flow LP nasal interfaces—mask or prongs
This chapter discusses the set-up and operation of the Infant Flow SiPAP Plus driver.
Note: Refer to the Infant Flow SiPAP
operator manual for additional instructions
on the set-up, operation and maintenance
of the Infant Flow SiPAP Plus driver.
Alarm LED
Indicates alarm situation as visual and
audible notification color varies according
to alarm level
Patient circuit
connection
Connects patient
breathing circuit to
gas outlet port.
Power LED
Indicates power on
and AC connection
Touch screen display
Adjusts settings and
displays patient parameters
and alarms.
Pressure low flow meter
Adjusts low CPAP level.
CPAP supplied to patient
directly relates to flow rate
from the nCPAP driver.
Pressure high flow meter
Adjusts high CPAP level. CPAP
supplied to patient directly relates
to flow rate from nCPAP driver.
% O2blender control
Adjusts FiO2.
Transducer LED
Indicates
transducer
connected.
Pressure line
connection
Connects patient
pressure line to device.
Transducer
connection
Connects to
transducer interface.

8
The Infant Flow SiPAP driver is sold globally and is available
in different configurations. The two main models are Infant
Flow SiPAP Plus and Infant Flow SiPAP Comprehensive.
The Comprehensive model offers an additional ventilation
mode, BiPhasic trigger, which is not available in the U.S.
In select areas, additional languages or an international icon
overlay may be used in place of the English text. The operation
and maintenance of the Infant Flow SiPAP driver is the
same regardless of the specific configurations. Refer to the
Infant Flow SiPAP operator manual for more specific details.
Infant Flow SiPAP congurations
Description English text ICON symbol
Press to access the user calibration menu and language options.*
Press to return to the start-up screen.
Press to switch between the graphical and numerical monitoring screen.
Press to change the operation mode.
Press to deliver a manual breath. The breath delivers at the pressure high setting for
the set time high duration.
Indicates user should refer to the operator manual for additional information.
Indicates battery status and turns red if the battery charge is less than 40%.
Indicates the screen is locked. Press to unlock the screen.
Adjust the low flow rate setting for the baseline CPAP level.
Adjust the high flow rate setting for BiPhasic high CPAP level.
*Language option not available on all SiPAP models.

9
Infant Flow SiPAP display screen
Mode, control settings and function buttons
Monitored
parameters
Pressure/Time graphics
or monitored
parameters display
Control/Setting
indicators
Mode
indicator
FiO2
Battery
charge
Alarm priority/alarm
silence indicator
Operational
information
Soft key color code
White letter
Key enabled
Faded letter
Key inactive
Yellow letter
Solid: Pending confirmation
Flashing: Low-priority alarm
Red letter
Flashing: High-priority alarm
Solid: Reduction in another parameter
caused by an adjustment
Alarm management
High priority
• Series of 10 tones sound every 10 seconds
• Parameters display, and limits flash red
Medium priority
• 3 audible tones sound every 15 seconds
• Parameters display, and limits flash yellow
Low priority
• 2 audible tones sound every 30 seconds
• Parameters display, and limits change to yellow

10
Circuit set-up
1. Gather the nCPAP supplies:
• Infant Flow SiPAP driver
• Single-limb, heated breathing circuit
• Infant Flow LP generator kit
• Infant Flow LP xation device
• Humidier and chamber
• Sterile water bag
2. Attach the water chamber to the humidier and
connect it to the water feed system. Follow the
manufacturer instructions for the proper set-up.
3. Connect the gas delivery tubing (A) to the ow
driver outlet port (I) and humidier chamber port (II).
4. Connect the elbow connector on the heated
breathing circuit (B) to the humidier chamber.
Insert the heater wire plug into the wire socket.
Securely insert the temperature probe in the port on
the circuit elbow (III). Insert the second temperature
probe (IV) into the airway port at the distal end of
the breathing circuit.
5. Connect the non-heated section (C) to the drive line
of the generator assembly (D).
6. Connect the proximal pressure line (E) to the
proximal port on the driver (V) and the pressure
line on the generator.
Temperature probe
When inserting the temperature probe into the
circuit, ensure the probe tip is in the middle of the
gas stream. This allows the gas temperature to be
measured accurately. If the probe is not properly
seated, the temperature measurement accuracy may
be compromised, leading to excessive condensation.
Cover the temperature probe with a reective shield
when used under a radiant warmer or bilirubin light.
Infant Flow SiPAP and circuit set-up
A
B
I
II III
IV
V
C
E
D

11
Humidication and nCPAP
Humidication
Heated humidification is recommended for nCPAP therapy.
The normal functions of the nose and air passages of
the respiratory tract are too warm, moisten and filter
the inhaled gases before they reach the lungs. In normal
respiration, the nasal mucosa and upper airways provide
75% of the heat and moisture supplied to the smaller
airways and alveoli. By the time air reaches the alveoli,
the inspired gas warms to 37 °C at 100% relative humidity
(RH).13 With nCPAP, the upper airways are not bypassed,
but the high gas flows may be drying to the airways,
especially to a neonate’s underdeveloped lung. Adequate
humidification is essential to maintain airway clearance,
optimize ventilation and improve patient comfort.
The International Organization for Standardization (ISO) and
American Association for Respiratory Care (AARC) clinical
Airway temperature probe placement
Open bed or crib
When the infant is placed on an open bed warmer or
crib, it is recommended to remove the unheated section.
This places the temperature probe next to the
generator assembly.
If the infant is under a radiant warmer or bilirubin light,
the temperature probe should be covered with a light
reflective shield to prevent heating the probe. If the probe
is not covered, it could interfere with the operation of the
humidifier and cause excessive condensation to form.
practice guidelines recommend gas temperature
between 34 and 41 °C to provide a humidity level of
33 to 44 mgH2O/L with artificial airways.14 Be cautious
using higher temperatures, as condensation may reduce
the mucous viscosity and interfere with the mucous
clearance. Extended exposure of gas temperatures over
41 °C may cause cellular damage to the airways.14
The higher temperature settings may not be required to
deliver adequate humidification, since an artificial airway
is not used with nCPAP. Start with a temperature setting
of 36 °C to 37 °C and adjust the humidifier settings to
maintain adequate humidification; if condensate occurs,
reduce the humidifier temperature setting.
Isolette or incubator
When the infant is in an isolette or incubator, the
non-heated section should be used with the temperature
probe placed outside of the isolette. Make sure that the
rest of the unheated section remains in the isolette.
If condensation is observed, remove the non-
heated (A) section and place the temperature probe
inside the isolette.
A

12
Infant Flow SiPAP sensor calibration
Two-point oxygen sensor calibration
Two-point oxygen sensor calibration should be performed
before initially using the Infant Flow SiPAP driver and with
each circuit change. To avoid unwanted alarms, occlude the
prongs or mask and set the low pressure flowmeter to
9 LPM prior to turning on the Infant Flow SiPAP driver on.
When the Infant Flow SiPAP driver is turned on, a power on
self-check automatically performs.
To perform two-point calibration:
1. Press the CAL button to enter the calibration menu.
2. Set the pressure low flowmeter to 9 LPM and the pressure high flowmeter to 2 to
3 LPM. Note: The pressure high flowmeter must be set during set-up to enable the
manual breath button.
100
PPROX
90
Infant Flow
SiPAP
Pres High
NCPAP/
Pres Low
XDCR
1
2
3
4
5
L/min
80
70
60
50
40
30
21
2
L/min
4
6
8
10
12
14
100
PPROX
90
Infant Flow
SiPAP
Pres High
NCPAP/
Pres Low
XDCR
1
2
3
4
5
L/min
80
70
60
50
40
30
21
2
L/min
4
6
8
10
12
14
3. Adjust the oxygen control to 21%. Allow time for the reading in the oxygen display
window to stabilize.
100
PPROX
90
Infant Flow
SiPAP
Pres High
NCPAP/
Pres Low
XDCR
1
2
3
4
5
L/min
80
70
60
50
40
30
21
2
L/min
4
6
8
10
12
14
100
PPROX
90
Infant Flow
SiPAP
Pres High
NCPAP/
Pres Low
XDCR
1
2
3
4
5
L/min
80
70
60
50
40
30
21
2
L/min
4
6
8
10
12
14
4. Press the flashing question mark button located under the 21% icon. The question
mark changes to a static hourglass. When calibration is complete, a static green
check mark icon appears and the oxygen display window reads 21%.
5. Adjust the oxygen control to 100%. Allow time for the reading in the oxygen display
window to stabilize.
100
PPROX
90
Infant Flow
SiPAP
Pres High
NCPAP/
Pres Low
XDCR
1
2
3
4
5
L/min
80
70
60
50
40
30
21
2
L/min
4
6
8
10
12
14
100
PPROX
90
Infant Flow
SiPAP
Pres High
NCPAP/
Pres Low
XDCR
1
2
3
4
5
L/min
80
70
60
50
40
30
21
2
L/min
4
6
8
10
12
14
6. Press the flashing question mark button located under the 100% icon. The question
mark changes to a static hourglass icon. When calibration is complete, the hourglass
icon changes to a static checkmark. The oxygen display window
reads 100%.
7. If oxygen calibration fails, a red X displays on the button of the screen, the alarm
sounds and an Error code displays on the top-left corner. Turn the driver off and
then, back on. Repeat the calibration procedure.
Disable the oxygen sensor
The internal oxygen sensor may be disabled by pressing the O2 disable button on the
calibration screen. This disables oxygen monitoring and the audible oxygen alarm. An
error code displays to indicate the oxygen monitor is inoperative. An external oxygen
monitor must be used whenever the oxygen sensor is disabled.
Leak test
While occluding the patient interface, set a flow of 9 LPM on the pressure low flowmeter.
A CPAP of 5 cmH2O ± 1 should display on the SiPAP screen. If pressure is not reached,
check the system for leaks. Release the occlusion, and the displayed pressure should be
≤ 2 cmH2O. Wait for 15 seconds, and a disconnect alarm should sound. If the pressure
does not fall, check the circuit for occlusions.

13
Infant Flow SiPAP set-up guide
Set-up menu screen
1. Adjust the pressure low flowmeter until the desired
nCPAP pressure displays on the screen. Press the flashing
question mark icon, which changes to a static checkmark
to confirm the setting.
2. Adjust the oxygen control dial to set the desire FiO2%.
Press the flashing question mark icon. A checkmark
appears to confirm the setting.
3. Adjust the pressure high flowmeter until the pressure
displays 2 to 3 cmH2O above the set nCPAP pressure.
Press the flashing question mark icon. A static checkmark
appears to confirm the setting.
4. To use the low breathing rate/apnea monitor, connect
the transducer interface to the Infant Flow SiPAP driver.
Press the flashing question mark under the infant
respiratory sensor icon. This will change to a static
checkmark to confirm the setting. This does not confirm
that you want to use the respiratory monitoring option
but ensures that all modes are available for later use.
5. After completing the above steps, the screen changes
and displays the nCPAP mode. The infant can now be
connected to the Infant Flow SiPAP system.
Alarm set/conrm screen
Press the nCPAP button or alarm bar for three seconds
to set the alarm limits and move to the next screen. If no
button is pressed within two minutes, the alarm limits
automatically set and the screen changes to the mode
select screen.
Mode select screen
All available modes display at the bottom of the screen.
1. For low breath rate/apnea modes, attach the abdominal
respiratory sensor to the transducer and properly place
it on the infant’s abdomen.
2. Select the desired mode of operation by pressing the
corresponding button (mode select screen). The parameter
adjust screen displays, and the new mode displays in the
upper-left corner (parameter adjust screen).
3. Make the desired setting changes, and press the
selected mode to confirm the settings and activate
the new mode.
4. If no selection is made within two minutes and no
alarms sound, the screen locks to prevent entries. The
mode buttons go blank, except for the last button on
the right (locked screen). To unlock the screen, press
the lock icon.
Set-up menu screen
Alarm set/confirm screen
Mode select screen Parameter adjust screen Locked screen

14
Infant Flow SiPAP set-up guide (continued)
Parameter adjust screen
1. To change the settings during set-up and normal
operation, touch the desired parameter button.
2. Press the up or down arrows to adjust the parameter
to the desired setting.
3. Confirm the change by re-pressing the parameter button.
The main screen displays.
Note: nCPAP and BiPhasic pressure levels are set by
adjusting the flow.
Main screen and monitored parameter screen
1. To monitor therapy, use the main screen or
monitored parameter screen. The main screen
graphically displays the delivered pressure. The
monitored parameter screen displays numerical
values for the delivered pressure.
2. Press the Change Screen button to switch the
screen display.
Alarm reset/silence
1. Press the alarm bar to silence the active alarms
for 30 seconds.
2. Press the alarm bar for three seconds to clear resolved
and low-priority alarms and to reset alarm limits. Smart
alarm technology automatically sets high pressure, low
pressure and % oxygen thresholds.
Flow pressure nomogram
The Infant Flow SiPAP LP system is subject to a direct
relationship between the controlled gas flow and airway
pressure. For example, 9 LPM of gas flow provides
approximately 5 cmH2O CPAP.
Tip: Manual breath: The high pressure flowmeter must be
set to deliver a manual sigh/breath during CPAP. The boost
in pressure delivers for the time high that was entered during
the set-up process.
Parameter adjust screen
Main screen Monitor parameter screen
Main screen with active alarm
2.0
4.0 6.0 8.0 10.0 12.0 14.0 16.0
18.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
Pressure (cmH
2
O)
Flow (LPM)

15
breathes, the most movement is between the lowest
rib and the abdomen.
2. If the infant is supine, place the capsule midway
between the umbilicus and xiphisternum, which is the
notch at the center of the two lower ribs. On larger
infants, an alternative site is the upper chest to detect
intercostal movement.
3. If the infant is prone, place the sensor laterally over the
lower rib and abdomen. The sensor tubing should be
directed over the back.
4. Tape the sensor firmly into position using a non-
allergenic microprobe tape. Position the sensor line
perpendicular to the tape. Only use tape that is
approved by your facility’s protocol.
5. Verify correct placement. The transducer LED should
illuminate on expiration, and the SiPAP front panel LED
on inspiration.
6. If the LED does not illuminate, try repositioning the
sensor and adding a second piece of tape making an
“X” over the sensor.
Figure 1: Abdominal sensor placement
Respiratory abdominal sensor
Respiratory abdominal sensor (optional)
For use only with the Infant Flow SiPAP Plus and
Comprehensive nCPAP drivers. The respiratory abdominal
sensor enables the clinician to monitor for apnea/low breath
rate in both nCPAP and BiPhasic modes. The accessories
include the reusable transducer and single-patient-use
abdominal sensor. In the BiPhasic trigger mode, the
respiratory abdominal sensor and transducer allow
patient-triggered pressure assists with breath rate
monitoring (not available in the U.S.).
Respiratory transducer connection
1. Connect the transducer cable to the transducer port
on the front panel.
2. Connect the abdominal sensor pressure line to the
transducer interface.
3. Compress the sensor pad gently, repeating this several
times while observing the transducer LED.
Infant set-up
To apply the sensor to the infant using suitable tape
(figure 1):
1. Visually identify the optimum outward movement of
the abdomen during inspiration. When the infant

16
Self assessment
1. Where should the circuit airway temperature probe be
placed if the infant is in an isolette/incubator?
2. If condensation occurs in the breathing circuit, what
should you do?
3. Explain how to disable the oxygen sensor:
4. Demonstrate how to reset the alarm limits when the
device is in operation:
5. To deliver a CPAP of 5 cmH2O, what would the ow rate be?
6. Where is the best placement for the respiratory
abdominal sensor?
7. While in nCPAP, you press the manual breath button,
but nothing happens. What would prevent a manual
breath from being delivered?
8. When should you perform an oxygen sensor
calibration on the Infant Flow SiPAP?
Notes:

17
nCPAP mode
nCPAP mode delivers constant, stable positive pressure
to infant airways to help restore the FRC in assisting the
correction of hypoxemia. Adjust the flow rate setting to
deliver CPAP up to 11 cmH2O.
CPAP parameters:
• CPAP pressure (set by low pressure flowmeter)
• Oxygen percentage
Initial settings:
• CPAP 4 to 6 cmH2O
nCPAP + low breath rate (LBR)/Apnea
The mode allows the delivery of CPAP pressures up to
11 cmH2O and breath rate monitoring via respiratory
abdominal sensor and transducer interface. For the SiPAP
Plus system, the LBR setting is determined by LBR time (TLBR)
setting from 10 to 30 seconds. For the SiPAP Comprehensive
system, the Apnea setting is determined by the apnea time
(T-apnea) setting from 10 to 30 seconds. If the apnea alarm
is triggered, the device delivers one breath at the high
pressure setting. The high pressure flowmeter must be set.
BiPhasic mode
This mode cycles between high/low CPAP levels on a timed
basis. Small incremental pressure increases of 2 to 3 cmH2O
above CPAP creates a “sigh” breath, and augments FRC
and decreases WOB. The switch to the high CPAP level can
Infant Flow SiPAP nCPAP driver
be set for a duration of 0.1 to 3 seconds to produce
a “sigh.”
Note: This is not the same as pressure support. In
pressure support, the pre-set pressure supports the
inspiratory effort and the patient’s breathing pattern
determines the inspiratory time. In the BiPhasic mode, the
infant can breathe spontaneously at either pressure level.
The time high setting determines the cycle time between
the two levels of CPAP.
BiPhasic parameters:
• Baseline CPAP (set by low pressure flowmeter)
• High CPAP (set by high pressure flowmeter)
• Time high (T-high)
• Rate (cycle rate between pressures)
• Oxygen percentage
Initial settings based on respiratory conditions:9
• Baseline CPAP 4 to 6 cmH2O
• Pressure high (PHigh) 1 to 3 cmH2O above CPAP level
• T-high 1.0 sec
• Rate 6 cycles/minute
In this study, a
3 cmH2O shift in
pressure on an
average increased
FRC by 5.5 mL/kg.
Pandit, P. Pediatric,
2001, 108(3):682–685.
Modes of operation
10 Ti = 0.2 s
Time (s)
Seconds
9
8
7
6
5
5
4
4
3
3
2
2
1
0
6
5
4
3
2
1
0
01
Pressure (cmH2O)
cmH2O
12
16
8
4
0
0246810
CPAP pressure
Volume change (ml/kg)
5.5 ml/kg
10 Ti = 0.2 s
Time (s)
Seconds
9
8
7
6
5
5
4
4
3
3
2
2
1
0
6
5
4
3
2
1
0
01
Pressure (cmH2O)
cmH2O
12
16
8
4
0
0246
81
0
CPAP pressure
Volume change (ml/kg)
5.5 ml/kg

18
BiPhasic + LBR/apnea mode
This mode is the application of BiPhasic therapy with low
breath rate detection via the respiratory abdominal sensor
and transducer interface. For SiPAP Plus, the LBR setting is
determined by the TLBR setting from 10 to 30 seconds. For
SiPAP Comprehensive, the Apnea setting is determined by
T-apnea setting from 10 to 30 seconds.
SiPAP Comprehensive BiPhasic tr* mode
This mode utilizes the respiratory abdominal sensor and
transducer interface to synchronize pressure high breaths
with the infant’s respiratory efforts. It allows patient-
triggered pressure assists with breath rate monitoring
enabled, adjustable apnea time interval, apnea alarm and
adjustable apnea backup rate. The upper level pressure
delivers based on operator set T-high and PHigh flow rate
settings. The maximum pressure setting is 15 cmH2O. If the
respiratory efforts are not detected, the infant receives the
low CPAP setting and the apnea alarm initiates the delivery
of the set backup rate.
BiPhasic tr parameters:
• Baseline CPAP (set by low pressure flowmeter)
• Peak inspiratory pressure (PIP) (set by high
pressure flowmeter)
• T- high
• Backup respiratory rate
• Apnea time
• Oxygen percentage
Initial settings: Initial settings should be tailored to the
infant’s respiratory condition.
• Baseline CPAP at clinical indicated level (4 to 6 cmH2O)
• PIP: 2 to 3 cmH2O above set CPAP level. Set by the
PHigh flowmeter.
• T-high: ≤ 0.3
• Rate (Rb): Set rate is active only if Tapnea (sec) threshold
is surpassed. Generally, set it close to the infant’s own
respiratory rate.
• Apnea time (tapnea): 10 to 30 seconds. The apnea
alarm triggers when no breaths are detected within
the selected apnea timeout.
Timed BiPhasic breaths are given at the set backup rate, PHigh
and T-high. If the infant triggers within the next time-out
period, the alarm silences and triggered-BiPhasic resumes.
If no breaths are detected after the next apnea timeout,
the audible alarm resumes until the operator intervenes.
*BiPhasic tr mode available in comprehensive
configurations only. Not available in the U.S.
10 Ti = 0.2 s
Time (s)
Seconds
9
8
7
6
5
5
4
4
3
3
2
2
1
0
6
5
4
3
2
1
0
01
Pressure (cmH2O)
cmH2O
12
16
8
4
0
0246810
CPAP pressure
Volume change (ml/kg)
5.5 ml/kg