ResMed Stellar 100 User manual

GOSH- to –Home Long Term Ventilation Service
Garry Rendle & Victoria Robinson NIV CNS 27/03/2020
HOW TO SAFETLY CARE FOR A CHILD NEEDING NIV: A basic guide
INTRODUCTION TO THE VENTILATOR
Ensure you know why the patient needs Non Invasive Ventilatory support.
CPAP is Continuous Positive Airway Pressure. It provides a positive pressure of air through the nose
and mouth, stenting open the upper-airway, preventing the bronchioles and alveoli from collapsing
and maintaining adequate gaseous exchange. Measured in centimetres of water (cmH2O).
BIPAP is BI-level Positive Airway Pressure and this provides two pressures; an IPAP (Inspiratory positive
airway pressure) and an EPAP (Expiratory positive airway pressure). It assists inspiration to achieve an
optimal tidal volume, while preventing airway closure during expiration.
Three main Long Term NIV ventilators in the Trust
Stellar 100/150 Nippy Airsense 10
CPAP/BIPAP CPAP/BIPAP CPAP
How to connect to main power supply
Ensure the plug is securely in the socket at the back of the ventilator and the plug at the wall is
switched on.
If mains power is not connected
The Stellar 100 has a 2-4 hr internal battery depending on pressure needed and if humidification is
required. The vent will automatically switch to battery mode and alarm to inform you. Amount of
battery charge is shown on the top right of vent screen.
The Nippy has a 2-4 hour battery depending on pressure. The amount of battery charge is shown on
the top right of vent screen.
The Airsense 10 does not have a battery therefore cannot be used unless plugged into the mains. If a
child is more dependent on their ventilation they should be on either the Nippy or the Stellar
To note -the older the ventilator the less likely the ventilator will have a fully functional battery.
Always keep the ventilator plugged in and carry out a battery test if needed to be used.

GOSH- to –Home Long Term Ventilation Service
Garry Rendle & Victoria Robinson NIV CNS 27/03/2020
Setting up the NIV equipment
All the three machines in long term NIV will be attached to a single limb tube which may include a
standard bacterial filter in the circuit closest to the ventilator (if it is a loan device).
The single limb tube will not have an intentional leak port. The single limb tube will be fitted to a long
term NIV mask with an intentional leak port built in to allow carbon dioxide to escape the circuit.
Not all patients will need humidity. Please see humidity section.
A. Ignore- no intentional leak required in the vent tubing
B. Single Limb vent tubing
C. Bacterial filter may be required on a loan device
D. Long term NIV mask with Carbon dioxide exhalation port
Ventilator- with/without a humidifier
The Airsense 10-withoiut humidity The NIPPY- without humidity
The Stellar 100- with humidity

GOSH- to –Home Long Term Ventilation Service
Garry Rendle & Victoria Robinson NIV CNS 27/03/2020
How to deliver pressure
The Stellar 100
If the screen is not in standby mode, flick the black switch on the back of the ventilator near the plug.
Once the clock appears on the screen to turn on/off see below:
To turn off the press the ‘on’ button again then to confirm you wish the vent to stop press the top of the
scroll dial button.
The Nippy
To turn on/off please press the same button above. To note once turned on the Nippy goes straight
into treatment pressure.
The Airsense 10
Press the on button above the screen to deliver pressure.
On
button
Confirm
stop
On /off
button
On /off
button

GOSH- to –Home Long Term Ventilation Service
Garry Rendle & Victoria Robinson NIV CNS 27/03/2020
Mask safety check once ventilator is switched on.
All Long Term NIV masks have a carbon dioxide exhalation port
This must be checked once the ventilation pressure is started. The exhalation port must be clear and
not obstructed to ensure expulsion of CO2. This is checked by feeling for a pressure leak from
around the port.
Check there is no ramp feature set and if NIV is needed acutely this needs to be turned off.
Ramp feature is a comfort setting that allows the ventilator to start at small pressures and build up to
treatment pressure over a period of time. This may not be set on all ventilators.
The NIPPY- does not have a Ramp feature
The Stellar 100- Ramp can be turned off by scrolling the dial over the ramp bar on the front screen
(while there is no treatment pressure ), pressing the dial until the bar becomes yellow and scrolling
back to 0, press the dial again until the ramp bar goes blue to lock.
The Airsense 10- Using the scroll dial button navigate to the ‘My Options’ scroll right, press the top of
the scroll dial button and scroll down to ‘off’
Co2
Exhalation
port
Scroll dial
button and
‘My Options’

GOSH- to –Home Long Term Ventilation Service
Garry Rendle & Victoria Robinson NIV CNS 27/03/2020
Checking the clinical Settings.
The Nippy- The clinical settings can be clearly seen on the home page.
The Airsense 10- Once treatment pressures are running, use the scroll dial button to ‘Sleep Report’ and
CPAP pressure will be displayed.
The Stellar 100- Press the 2 ticks using button on the right hand side of the screen
OXYGEN SUPPLY
Aware of expected oxygen saturation levels for the child
E.g 94% or above for non-cardiac patients, these parameters should be set by the medical team.
Administration of oxygen via a ventilator- up to 15l/m of Oxygen
The NIPPY- Oxygen can be given via the ventilation circuit closest to the ventilator either; via a
bacterial filter (with an oxygen port attached), or a bacterial filter attached to a standard oxygen
enrichment port.
The Airsense 10- as per NIPPY advice
The Stellar 100- the oxygen should go via the back of the machine using the white oxygen port. If this
is not available then use a green oxygen enrichment port and attach between the vent and the tubing
as per NIPPY advice.
Limitations to oxygen administration via Long Term NIV device- at best with 15l/m of oxygen via NIV the
oxygen concentration at the mask will be 60-70%.

GOSH- to –Home Long Term Ventilation Service
Garry Rendle & Victoria Robinson NIV CNS 27/03/2020
Filters
Can change the filter
Dust particle filters at the back of the ventilator on the Stellar 100, the Nippy and on the side of an Airsense
10.
They should be changed 3 monthly on manufacturer advice, check monthly, if very dirty discard and
replace, do not wash and re-use
Avoid keeping the ventilator on the floor.
Replacement filters can be sourced from the NIV team.
Acute use on a loan ventilator.
The filter should be placed at the front of the ventilator before the tubing. This should be an anti-bacterial
filter- this will require a weekly change on a dry circuit and every 3 days on a wet circuit.
ENSURE THAT A Heat Moisture Exchange (HME) IS NOT USED, THIS CAN INCREASE RESITANCE AND
INCREASE WORK OF BREATHING!

GOSH- to –Home Long Term Ventilation Service
Garry Rendle & Victoria Robinson NIV CNS 27/03/2020
MASK FIT
Where possible fit mask first then start ventilation once good placement of mask has been achieved
Fit the mask correctly
To fit the mask well, ensure the nostrils are not occluded and the mask is not in the eyes.
Nasal mask: place the mask at the tip of top lip and roll up to the nasal bridge
Fullface mask: start with base at the crease of the chin and roll up to sit below the eye.
You must check the mask visually
Can you feel exhalation port? The exhalation port must be kept clear at all time as this is where
the child is able to breathe out their CO2. It must be checked by visually ensuring the port is clean
and clear and by waving your hand over the port at the front of the mask to ensure you can feel
pressure release
Make sure nostrils are not blocked
Is the mask on too tight or lose? Check position of the headgear straps using 2 finger-tension that
the straps are not too tight. If straps become undone, tighten by standing in front of the child and
tighten both straps together.
Is the headgear on the right way round?
Do you have a good seal? Once the mask has been fitted, start pressure and use hands to check
for leak around the eyes, nasal bridge and below mask, if there is still a large leak and the child is
using a nasal mask check for oral leak using hands. If oral leak is noted, assist to close jaw or use a
dummy, contact a NIV CNS for mask review if unable to fix.
Is the mask clean- wipe it down daily!
Aware of what to do in the event of a pressure sore
Contact the NIV team straight away for any red marking, introduce Barrier dressing like Siltape or
switch mask if Grade 1, remove or switch mask if Grade 2 or above.

GOSH- to –Home Long Term Ventilation Service
Garry Rendle & Victoria Robinson NIV CNS 27/03/2020
HUMIDIFICATION
When humidification is required
If the child has thick secretions, neuromuscular patients with a weak cough and CF patients. Re-
occurring chest infections or oral and nasal dryness, 24 hr use of NIV.
The Airsesne 10
The Stellar 100
The NIPPY
An external humidifier is needed
With the Stellar 100 and Airsense 10
Never fill chamber when machine is on (it’s a messy experience!), Ensure the lid is closed properly, this
is a major cause for leak. Aim to have the humidifier below the patient to avoid rainout traveling
towards the airway. Aware that the ventilator should not be moved/tilted with the humidifier
attached.
Add water correctly- When in hospital distilled water should be used, when at home cool boiled water
to be added up to the max fill line.

GOSH- to –Home Long Term Ventilation Service
Garry Rendle & Victoria Robinson NIV CNS 27/03/2020
General humidity tips.
What to do if the child has nasal congestion?-Increase humidity level to help loosen nasal secretion
What to do if the tubing is getting water build up ( rain out )- Reduce the humidity level and ensure it
is not kept near a window or cold space, empty the water in the tubing back into the humidifier
Learn the circuit if adding a humidifier to Stellar 100
Attach humidifier to vent, mask and tubing, press the ticks button 3 times and use dial to press learn
circuit, leave the circuit open until a smiley face appears on the screen
ALARMS
Always use a patient to ventilator approach to assessing alarms
The Airsense 10- There are no alarms on a Airsense 10
The NIPPY
High flow alarm- Should only sound when the ventilator detects to much leak from the vent circuit:
1. Check the mask is on correctly –refit the mask and resolve leak
2. Check there is no oral leak –close mouth, use dummy or chin strap, use full face mask if
appropriate
3. Check there is no hole or tear in the tubing
4. Check the humidifier os attached properly
5. Nebuliser is attached to the tubing –if not in use remove from the circuit
Low flow alarm- when there is blockage t flow in the circuit:

GOSH- to –Home Long Term Ventilation Service
Garry Rendle & Victoria Robinson NIV CNS 27/03/2020
1. Ensure the airway is patent
2. Check the exhalation port on the mask is clear
3. If the patient has a loan machine, ensure the filter is correct ( not wet, not HME)
4. Ensure the tubing is patent and no kinked
5. Ensure no water in the tubing.
6. If using high levels of oxygen via the circuit this alarm may sound as the ventilator detects flow
The Stellar 100
High Leak Alarm-Should only sound when the ventilator detects a leak of over 25ltr/min for more than 25
seconds.
1. Check the mask is on correctly –refit the mask and resolve leak
2. Check there is no oral leak –close mouth, use dummy or chin strap, use full face mask if
appropriate
3. Check there is no hole or tear in the tubing
4. Check the humidifier lid is closed properly
5. Nebuliser is attached to the tubing –if not in use remove from the circuit
Non Vented Mask Alarm / Blocked Tube
1. Ensure the airway is patent
2. Check the exhalation port on the mask is clear
3. If the patient has a loan machine, ensure the filter is correct ( not wet, not HME)
4. Ensure the tubing is patent and no kinked
5. Ensure no water in the tubing.
6. If using high levels of oxygen via the circuit this alarm may sound as the ventilator detects flow
7. If no obvious reason, learn the circuit. (Have the circuit attached to the vent and off the patient,
press the ticks button 3 times and select “learn circuit” with dial. Start learn circuit and wait for
the smiley face to appear on screen. No re apply the mask and ventilate.
All alarms with stop automatically when the problem has been rectified, to stop alarm manually, press
the orange button on the left of the screen
CLEANING AND MAINTENANCE
How to keep mask and tubing clean and risks
Wiped down every day and ensure the mask is dry when going on the face, wash whole mask and
headgear once a week with warm soapy water/rinse with clear water and leave to air dry. A wet and dirty
mask is one of the major causes of pressure ulcer.
Servicing requirements
PAT testing needs to be done yearly but a full servicing on the Stellar 100 and Airsense 10 needs to be
done every 5 years. To be aware that the battery on the Stellar 100 may deplete after 2 year

GOSH- to –Home Long Term Ventilation Service
Garry Rendle & Victoria Robinson NIV CNS 27/03/2020
NEBULISERS
Reasons for giving nebulisers
Mucolytics and saline for clearing secretions or antibiotic use for bacterial colonisation
We would not use nebulisers via an NIV circuit unless the patient was 24/7 dependant
Nebulisers are not as efficient via a NIV circuit as via a face mask and should be avoided if possible,
they exhalation port on the mask can become blocked with saline and cause the non-vented mask
alarm to sound. It is also not ideal as medication has been found inside the ventilators on children
who have regular nebs.
How to set up a nebulisers in the NIV circuit
T-Piece via the NIV circuit should be attached at the patient end in between the mask and the tubing
and should be help horizontal

GOSH- to –Home Long Term Ventilation Service
Garry Rendle & Victoria Robinson NIV CNS 27/03/2020
Unlocking the clinical settings menu to change pressure settings
This should be done under the guidance of a medic as ventilation pressure is a medical
prescription
The Stellar 100
Re Lock by holding down the scroll dial and the 2 ticks button.

GOSH- to –Home Long Term Ventilation Service
Garry Rendle & Victoria Robinson NIV CNS 27/03/2020
The NIPPY
The Airsense 10
While the ventilator is on. Hold the
2 buttons down together for 5 secs.
The machine will alarm and the
padlock will be unlocked.
Highlight the clinical settings that
needs to be changed and use the
same initial 2 buttons to increase or
decrease as requested.
The Ventilator must be relocked
once finished
While the ventilator is on. Hold the
2 buttons down together for 3 secs.
The padlock on the display will
appear unlocked.
Press the top of the scroll dial
button. Once in settings menu scroll
down to ‘Set Pressure’ and scroll
up/down to the desired pressure.