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Bipap machine for use with trach and/or trilogy 100 with bipap settings

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    Bipap machine for use with trach and/or trilogy 100 with bipap settings

    Anthony is in the hospital now. He has had two bouts of pneumonia and a major surgery for duodenum bleeding ulcer all happening in December and January. Anthony's Dr. wants Ant to have access to bipap at night when he comes home. Anthony has a trach. His Dr. wrote and order to case management to have him come home with with a Trilogy 100 vent but I think he put it to Bipap settings. The company that case management sent over the order to says they cannot accommodate him because the trilogy 100 is a non invasive machine, meaning it is to be used with a mask and FDA has not approved this machine for use with a trach because there are no alarm settings. Anthony does not need a vent to breath just a little help at night.

    I have called another DME and they said they actually have Bipap machines that they can set him up to use with his trach.

    I want to give the Dr. information on how the order should be written for Medicare to cover this. I was told by the 2nd DME that if the Dr. is ordering a trilogy and has it set to bipap settings then Medicare would probably not cover it.

    Anyway tomorrow is his last day for care and the only thing holding us up from bringing him home is getting whatever we need to get so he can have bipap at night. Has anyone with a trach had this problem and any advice on equipment and how the order should read for medicare?

    Is anyone on here with a trach and uses a bipap machine at home? What is your setup? How did you get it?
    Cindy Waters
    mom to Anthony, right c5, left c4 (24yo)
    injury march 2003

    #2
    The FDA has not approved any home bipap machines to be connected to a trach. Respironics used to have the Vision Bipap machine which was approved for this use but no longer makes it. I think you need to get the doctor to do a little more research on this, along with the respiratory therapists at the hospital, and most likely order ventilation (not just Bipap) instead, but then set it up for Bipap once you get him home. You may have problems with the HHA on doing this though.

    This has been done primarily in ALS patients. You may want to take a look at these two resources so you are better prepared to put the responsibility onto the healthcare team:

    http://www.tracheostomy.com/resources/more/bipap/

    http://www.ncbi.nlm.nih.gov/pubmed/19567181

    Refuse to take him home until the hospital gets this all arranged. It is their responsibility to send him home with a safe home program, not yours. You may need to ask for help from the patient advocate or even the hospital ethics team.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

    Comment


      #3
      Originally posted by SCI-Nurse View Post
      The FDA has not approved any home bipap machines to be connected to a trach. Respironics used to have the Vision Bipap machine which was approved for this use but no longer makes it. I think you need to get the doctor to do a little more research on this, along with the respiratory therapists at the hospital, and most likely order ventilation (not just Bipap) instead, but then set it up for Bipap once you get him home. You may have problems with the HHA on doing this though.

      This has been done primarily in ALS patients. You may want to take a look at these two resources so you are better prepared to put the responsibility onto the healthcare team:

      http://www.tracheostomy.com/resources/more/bipap/

      http://www.ncbi.nlm.nih.gov/pubmed/19567181

      Refuse to take him home until the hospital gets this all arranged. It is their responsibility to send him home with a safe home program, not yours. You may need to ask for help from the patient advocate or even the hospital ethics team.

      (KLD)
      I actually found that first article about the family using the Bipap for their son a couple of days ago when searching info regarding cpap vs. bipap and ventilator equipment. So I understand it is ok for people with trachs. The problem still is with yes finding a balance on how to either get a vent home and then someone being able to change the settings for us to Bipap. I know that so far I have not found any DMEs that will change the settings from what the Dr. orders from leaving the hospital. I guess worst case scenario is googling it and just doing it myself.

      I did find a DME that does have respiratory therapists and we had what I hope was a positive conversation. This DME already gives Ant his suction supplies. The respiratory therapist said that yes they can set up anthony with a Bipap to trach. Now I don't know if this company has done this before but it sounded like it. We'll see.

      If that doesn't work can't the Dr. just order the vent with "low" settings and then send new orders to the DME to change the setting to Bipap right when we get home? Although the DME thought that Medicare would not cover the vent with just bipap settings. But what else can you do if there are no FDA approved bipap machines equipped for ppl with trachs!! That's crazy.
      Cindy Waters
      mom to Anthony, right c5, left c4 (24yo)
      injury march 2003

      Comment


        #4
        Agree with SCI nurse that you should not have to do things to set up the proper home ventilation - don't take him home until the hospital is working on this issue.
        I was never a vent user until pneumonia in my 60's (polio para/quad). After 5 months of hospitalization and then weaning from vent, a DME company came to hospital to set me up with BiPap for overnight (they first tried CPap but it didn't work for me).

        Comment


          #5
          Originally posted by triumph View Post
          Agree with SCI nurse that you should not have to do things to set up the proper home ventilation - don't take him home until the hospital is working on this issue.
          I was never a vent user until pneumonia in my 60's (polio para/quad). After 5 months of hospitalization and then weaning from vent, a DME company came to hospital to set me up with BiPap for overnight (they first tried CPap but it didn't work for me).
          Triumph do you have a trach? Tomorrow the resp. therapist from the hospital is supposed to go over with the DME RT to talk technical and try to get this ordered properly for him. It will be for a Bipap machine use with a trach. I have been looking online for used bipaps to see if the tubing can somehow just be rigged to go over his trach it just looks like instead of the end of the tubing attaching to a mask why couldn't it attached to the trach?
          Cindy Waters
          mom to Anthony, right c5, left c4 (24yo)
          injury march 2003

          Comment


            #6
            just today I finally got a hold of a case manager and she is going to have the respiratory therapist at the hospital contact the RT at the DME to try and get an actual Bipap machine the RT at the DME says they can do that.

            However if that does not work then I guess it would have to be the trilogy 100 with bipap settings. Does anyone know if to get approved from medicare the Dr. can write orders for true vent settings during the day and then only bipap settings at night? Anthony would only use at night that way the DME might not have a problem programming it for us with the bipap settings. The RT at the DME said she didn't think Medicare would approve him getting the Trilogy with just orders of bipap settings. Anthony has straight Medicare.
            Cindy Waters
            mom to Anthony, right c5, left c4 (24yo)
            injury march 2003

            Comment


              #7
              No, I don't have a trach. Just had it for 5 months during hospitalization for pneumonia. At the onset of the pneumonia I was unable to cough up the secretions and had the tracheotomy in the ER. They began the "shotgun approach" of numerous antibiotics to combat the pneumonia. This resulted in C-Dif, otherwise known as terminal diarrhea, which lasted for the next 4 months and with pretty severe debilitation. Early on they had me on a feeding tube and when removing it, it had caused bleeding in the back of my throat - had to have a blood transfusion - they didn't know how much blood I lost. After transfer to two more medical facilities, I went to a nursing home which was the best care. My husband and I actually tracked down an expert on Polio and venting and she suggested my trach hardware might be too large. I was having trouble weaning from trach, and sure enough, it was too large. They zipped me over to a 4th hospital for a 5 minute procedure to put in smaller size. Within a week my trach was removed. As for the C-Dif, the nursing home upped my dose of Vancomycin and it was soon gone. It was a nightmare, but with my paraplegic husband there every day with so much support, I finally recovered.
              I still use Respironics bipap overnight. I keep a pulse/oximetry handy to use as needed.
              Hang in there!
              Last edited by triumph; 4 Feb 2016, 8:50 AM.

              Comment


                #8
                I use a Respironics Trilogy 100 with a trach. I have a paralyzed diaphragm. I use it as a ventilator at night and sometimes during the day. The vent is set as "Assist Control". If you expect to be weaned off of the ventilator there is a setting called SIMV. My Trilogy 100 has a lot of settings. Of course, I use it as a vent. There are a lot of alarms that can be set for low pressure, high pressure, etc.

                I tried a Bipap with a trach first. It was awful. It was too hard to get the machine to stop pumping air into the lungs to allow for exhalation. The Bipap seems to maintain too much pressure. Remember, Bipap machines are designed to operate with a mask.
                Last edited by StarLord; 5 Feb 2016, 10:56 AM.

                Comment


                  #9
                  thanks all for the info. Finally anthony is going to be set up at home with the Trilogy 100 only at night. He will be discharged tomorrow morning

                  settings: PCFIMV TV 400, PEEP 5 PS 10 back up rate 8 pressure range 15/5 30% oxygen.

                  what ever all that means all i know right now is it just assists him; will be trained tomorrow as well. I was told by the DME RT that the Dr. can write orders for setting to wean him as well. Gonna take months for him to get back in the groove i suppose.
                  Cindy Waters
                  mom to Anthony, right c5, left c4 (24yo)
                  injury march 2003

                  Comment

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