Name Grade Assessor

Date / / INFANT FLOW Si-PAP

Assessor’s
Performance Criteria Score Comments
Signature

1. Describe/demonstrate setting up Si-PAP, including pre-treatment set up

test and gas supply
Set up
2. Describe/demonstrate setting up the Infant flow Si-PAP with the following
settings
CPAP mode PEEP 8 cm H20, FiO2 0.5

3. Explain and demonstrate how to :-

- review and adjust alarm limits
- increase assisted PIP
Clinical Use
4. Interpret the following ABG and change ventilator settings appropriately:-
pH 7.46, PCO2 3.2, pO2 8.8, BE -2.0
(ST1-3 advice can be given for ABG interpretation)

Advanced
5. Demonstrate changing to trigger BiPAP
use

6. You see a flat line on the display screen, what does it mean? What do you
need to check and do?
Trouble 7. Explain what the following alarms mean and describe the appropriate
shoot response:-
- Low Pressure Alarm
- Apnoea Alarm
8. Acknowledge where operating instructions are kept.

Scoring

Below expectation for Borderline for completion Meets expectations for Above expectations for
Unable to Comment
completion of post of post completion of post completion of post

1 2 3 4 5 6 U/C

EQUIPMENT COMPETENCY, Nottingham Neonatal Service