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VAP/IVAP Therapy


AVAP (Average Volume Assured Pressure Support) IVAP (Intelligent Volume Assured Pressure Support)

Policy- AVAP/IVAP is therapy that provides two levels of pressure and volume, and is used on patients to augment their breathing. It is used on spontaneously breathing patients to treat sleep disorders, correct arterial hypoxemia, decrease work of breathing, decrease atelectasis. A specific physician order is needed to use this therapy.

Procedure –

  1. Initiate therapy
    1. Unit must be set up by PEL/Respiratory Therapist. Verify physician orders.
    2. Wash hands, don universal precaution barriers as indicated.
    3. Verify resident identity, introduce self and explain procedure.
    4. Perform basic resident assessment including vital signs and breath sounds.
  1. Check equipment/initiate therapy
    1. Turn unit on, check that all connections on unit are secured.
    2. Connects to oxygen source if indicated (MD order).
    3. Fits mask to patient, check for proper fit and seal.
    4. Initiates therapy, instructs patient on proper breathing technique.
    5. Adjust circuit (tubing/connections) and/or mask as needed.
  1. Assess patient
    1. Assess patient for adverse reaction (ie difficulty breathing). Activate ‘ramp’ button on machine for patient comfort. Ramp will deliver a smaller pressure and ‘ramp’ up pressure over several breaths, thus letting patient adjust.
    2. Terminate therapy if patient does not adjust.
    3. Reassess vitals and breath sounds.
  1. Terminating therapy
    1. Therapy should be terminated if patient does not tolerate (see above)
    2. Therapy should be terminated at appropriate time (morning)
    3. Remove mask, turn machine off. Apply 02 if ordered.
    4. Re-assess vitals
    5. Document


  1. Unstable facial fractures
  2. Extensive facial lacerations
  3. Pre-existing pneumothorax or pneumomediastinum
  4. Pre-existing bullous disease
  5. Allergies or hypersensitivity to mask
  6. Frequent emesis
  7. Laryngeal trauma
  8. Recent gastric surgery
  9. Sinus or middle ear infection

Side effects: (typically found in higher pressures)

  1. Gastric Distention
  2. Decreased cardiac and urinary output
  3. Skin abrasions or breakdown
  4. Patient discomfort (facial or ear)
  5. Acute sinusitis or middle ear infection
  6. Hypotension


  1. Advise patient to immediately report any chest discomfort, shortness of breath or headache
  2. When using a mask, recommend patient not to eat 2-3 hours prior to using unit
  3. Whisper swivel (by mask) must not be occluded, as it’s the only exhalation port.
  4. Pressure settings should be re-evaluated by Respiratory Therapist when there is a change in patient’s condition.