Key takeaways
- Standard settings for the disposable T-piece resuscitator are PEEP at 5 cmH₂O and PIP at 20 cmH₂O.
- Gas flow should be configured to range from 5 to 15 liters per minute, connected to a flowmeter ideally integrated with a gas mixer/blender per NRP guidelines.
- PEEP ranges by flow rate are approximately: 2 cmH₂O at 5 LPM, 6 cmH₂O at 8 LPM, 9 cmH₂O at 10 LPM, and 15 cmH₂O at 15 LPM.
- Two manometer options are available: a Lower Range Color-Coded Manometer (0-40 cmH₂O) and an Original Color-Coded Manometer (0-60 cmH₂O).
- Applying pressures exceeding 40 cmH₂O in neonatology is considered an extreme measure and must strictly follow institutional protocols and NRP guidelines.
References
- NRP (Neonatal Resuscitation Program)
Disposable T-piece resuscitation
Disposable T-piece resuscitation
Source: https://www.mercurymed.com
Components of the Disposable T-piece Resuscitator
Components of the Disposable T-piece Resuscitator
- Variable PEEP Knob
- PEEP Knob Hole
- Face Mask
- Protective Cap
- Built-In Color-Coded Manometer
- PIP Controller With Adjustable Pressure Knob
- Circuit/Tubing
- Pressure Relief Override Button
- Oxygen Tubing
- Clear Round Or Anatomical Face Masks
- Connector Adapter
- Universal Round O, D.I.S.S. Connector
Key Controls: Manometer, PEEP, and PIP
Key Controls: Manometer, PEEP, and PIP
- Manometer
- Peep
- PIP
Adjust PEEP to 5 cmH₂O and PIP to 20 cmH₂O.
Step 1: Gas Source and Flow Rate & Step 2: Preliminary PIP Position
Step 1: Gas Source and Flow Rate
Connection: Attach the tubing to a flowmeter, ideally integrated with a gas mixer/blender, in accordance with NRP guidelines.
Adjustment: Configure the gas flow to range from 5 to 15 liters per minute.
Step 2: Preliminary PIP Position
Adjustment: Rotate the Peak Inspiratory Pressure (PIP) control knob to the 10 o’clock position, similar to the orientation on an analog clock.
Step 3: Modify Peak Inspiratory Pressure (PIP)
Step 3: Modify Peak Inspiratory Pressure (PIP)
Occlusion: maintain the red protective cap on the end of the circuit (or utilize a test lung or employ two fingers as illustrated in the figure).
Measurement: use your finger to cover the small hole in the T-piece (PEEP hole) to mimic inhalation. The objective is to achieve a reading of 20 cmH₂O on the manometer.
Adjustment: if the pressure gauge needle fails to reach 20 cmH₂O when the hole is covered, adjust the PIP controller until it attains that mark.
Demonstration: Adjusting the PIP Controller
Demonstration: Adjusting the PIP Controller
Hands adjusting the manometer and PIP controller knob (color-coded LOW/MED/HI dial) connected to the wall flowmeter and medical air outlet.
Step 4: Modify the Positive End-Expiratory Pressure (PEEP)
Step 4: Modify the Positive End-Expiratory Pressure (PEEP)
Adjustment: while maintaining the red cap secured, rotate the orange PEEP knob (as illustrated) until the pressure gauge displays a stable reading of 5 cmH₂O.
Manometer Options and PEEP Ranges by Flow Rate
Two Manometer Choices Are Available
- Lower Range Color-Coded Manometer: 0-40 cm H₂O
- Original Color-Coded Manometer: 0-60 cm H₂O
PEEP Ranges
- @ 5 LPM up to approx. 2 cm H₂O
- @ 8 LPM up to approx. 6 cm H₂O
- @ 10 LPM up to approx. 9 cm H₂O
- @ 15 LPM up to approx. 15 cm H₂O
Step 5: Operation and Specialized Care
Step 5: Operation and Specialized Care
Ready for use: remove the protective cap and affix the anatomical mask.
Sealing: employ the “CE grip” technique to hold the mask, taking care not to apply pressure on the soft tissue beneath the baby’s chin. Observe the pressure gauge to confirm that the mask is securely sealed.
Automatic Return to Safe Lane
Automatic Return to Safe Lane
There is no need to press the red button again if you wish to restore the pressure to normal levels.
To reactivate the safety lock, simply rotate the PIP controller counterclockwise. An audible click will be heard once the button descends past the 40 cmH₂O mark, signaling that the safety lock has been automatically reengaged.
Safety Note: The application of pressures exceeding 40 cmH₂O in neonatology constitutes an extreme measure and must always adhere strictly to the protocols established by the healthcare institution and the guidelines set forth by the NRP (Neonatal Resuscitation Program).
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Frequently asked questions
What are the standard PEEP and PIP settings for a disposable T-piece resuscitator?
Adjust PEEP to 5 cmH₂O and PIP to 20 cmH₂O.
How do you set the initial PIP position before fine adjustment?
Rotate the PIP control knob to the 10 o’clock position, similar to the orientation on an analog clock, as a preliminary step before fine-tuning to 20 cmH₂O.
How do you adjust the PIP on a disposable T-piece resuscitator?
Maintain the red protective cap on the end of the circuit (or use a test lung or two fingers), cover the small PEEP hole in the T-piece to mimic inhalation, and adjust the PIP controller until the manometer reads 20 cmH₂O.
How is PEEP adjusted on the device?
While keeping the red cap secured, rotate the orange PEEP knob until the pressure gauge displays a stable reading of 5 cmH₂O.
What gas flow rate should be used with the T-piece resuscitator, and how does flow rate affect PEEP?
Configure the gas flow to range from 5 to 15 liters per minute; PEEP achievable varies by flow rate, reaching approximately 2 cmH₂O at 5 LPM, 6 cmH₂O at 8 LPM, 9 cmH₂O at 10 LPM, and 15 cmH₂O at 15 LPM.
