CP 4.10: CPAP, BiPAP, Oxygen Therapy, and Oximetry

Updated: April 2026
Reviewed: 

Purpose

To assist the health care team in observing and documenting recently diagnosed/chronic sufferers of obstructive sleep apnea or other conditions requiring oxygen therapy to ensure proper ventilation of the patient for the purpose of avoiding long term pathologic outcomes and to ensure that patients are aware of the proper functioning of equipment. 

Policy Statements

In response to a referral from a health authority or primary health care provider, the Community Paramedic (CP) will follow guidelines outlined on the Request for Service form and care plan for follow up on patients requiring CPAP, BiPAP, or oxygen therapy. 

It is expected that the CP will document findings and report them to the primary health care provider and collaborate with other health care team members to provide support as appropriate. 

Definitions

BiPAP (Bilevel Positive Airway Pressure): 
Supports spontaneous respiration by delivering two levels of positive airway pressure throughout the breathing cycle: a higher pressure during inspiration (IPAP – inspiratory positive airway pressure) and a lower, but still positive, pressure during expiration (EPAP – expiratory positive airway pressure). Pressure is maintainedduring both phases of respiration, with IPAP set higher than EPAP to assist ventilation. 

CPAP (Continuous Positive Airway Pressure): 
Supports spontaneous respiration by providing a single, continuous level of positive airway pressure during both inspiration and expiration. This pressure helps maintain airway patency by stenting open obstructive airways throughout the respiratory cycle. 

Sleep Apnoea: 
A common sleep disorder characterised by repeated pauses in breathing or episodes of shallow breathing during sleep. These pauses may last from a few seconds to several minutes and can occur multiple times per hour, resulting in disrupted sleep and subsequent daytime sleepiness. 

Obstructive Sleep Apnoea (OSA): 
The most common form of sleep apnoea, occurring when the upper airway collapses or becomes obstructed during sleep despite ongoing respiratory effort. Central sleep apnoea is less common and occurs when the brain fails to send appropriate signals to the breathing muscles, resulting in temporary absence of respiratory effort. More information can be found here: https://www.healthlinkbc.ca/healthwise/sleep-apnea#hw-condition-basics 

Procedure

1. OBTAIN and REVIEW patient’s health history and care plan prior to appointment.
2. REFER to Request for Service form and care plan for direction with respect to assessment and patient teaching required.
3. REVIEW equipment usage including equipment care, cleaning, and use of distilled water for humidification with patient/caregiver as required.
4. MONITOR for hemodynamic instability (i.e., changes in vital signs, capillary refill, urine output, etc) if the patient has recently been diagnosed or is new to using CPAP/BiPAP. 
5. CONDUCT assessment:
   • Vital signs including RR, SpO₂, and pulse (check for signal strength on the oximeter, ensuring the SpO₂ and heart rate correlate with pulse rate)
   • Assess sleep habits (shift work? irregular work schedule?)
   • Assess alcohol/recreational drug use
   • Assess use of medication that may affect oxygenation such as benzodiazepines, OTC sleep aids, etc.
6. ASSESS quality-of-life and whether there are noticeable changes after usage.
7. COMMUNICATE immediately with health care provider or health care team if concerns arise.
8. INSPECT equipment and TROUBLESHOOT if necessary, including ensuring proper fit of mask and use of machine, as well as general condition of machine.
9. ENSURE that patient is connected with necessary resources (oxygen supply company, etc.)
   
   

Documentation

DOCUMENT findings and details of the visit on the CP progress notes and notify primary health care provider or health care team of findings and any concerns.

References

1. Eagle County Paramedic Services. Community Paramedic Protocols Manual. 2013. [Link]
2. Tri-County Health Care Emergency Medical Services. Community Paramedic Policy & Procedure Manual. 2016. [Link]
3. Vancouver Coastal Health. Oximetry Management Guidelines for Community Settings & Residential Care. 2013.