Hyperinflation Therapy Equipment PDF

Chapter 4 Hyperinflation Therapy Equipment 1  Hyperinflation Therapy Goal = hyperinflation/lung expansion Ways to hyper expand – Inhalation Pt produces negative pressure, draws in larger volume to recruit atelectatic/consolidated areas...

Chapter 4 Hyperinflation Therapy Equipment 1  Hyperinflation Therapy Goal = hyperinflation/lung expansion Ways to hyper expand – Inhalation Pt produces negative pressure, draws in larger volume to recruit atelectatic/consolidated areas Incentive spirometer Positive pressure adjuncts – Exhalation PEP (Positive Expiratory Pressure) 2  Physics of Hyperinflation Therapy Equipment Measurement of Inspired Volumes – I.S. relies on voluntary effort to perform a hyperinflation maneuver – Prevention of atelectasis – Cough promotion – Methods: Flow dependent Volume displacement Photoelectric measurement 3 Indications for Incentive Spirometry and Positive Airway Pressure Adjuncts AARC’s Clinical Practice Guidelines – Goal = hyperinflation/lung expansion – Incentive spirometry (a.k.a. SMI) Indications – Predisposed to/presence of atelectasis – Upper-abdominal surgery – Thoracic surgery – COPD + surgery – Presence of restrictive lung defect w/ quadriplegia/dysfunctional diaphragm Contraindications – Pt cannot be supervised or instructed – Inability of pt to use device properly – VC < 10mL/kg, IC < 1/3 of predicted 4 Flow-Dependent IS 5 6 Volume Displacement 7 Photoelectric Measurement 8  Incentive Spirometry Equipment Voldyne TrifloTM II Volurex Monaghan Spirocare 9  Voldyne (Hudson RCI) Disposable Applies sub-ambient P above a piston Converts flow to volume Marker on side sets goal for pt. 10 Voldyne IS 11  Triflo II (Hudson RCI) Disposable Flow-dependent (like Voldyne) 800 mL/sec = 1 float, 1000mL/sec = 2 floats, 1200mL/sec = 3 floats Goal is 3 floats for 3 seconds 12 Triflo II 13  Volurex (DHD Medical) Disposable Operates using true volume displacement Uses a flexible bellows that fills as pt inspires 14  Monaghan Spirocare 2 models (battery-powered or 110-volt) Operates using photoelectric principle Spinning turbine interrupts flow of light; speed of turbine is converted into inspiratory flow which is converted into volume 15 Spirocare 16 Not an incentive spirometer. 17  Video Learn to Use an Incentive Spirometer - YouTube 18  Patient Instruction Sitting position Exhale fully Create seal around mouthpiece Slow deep inspiration – Keep an eye on coaching indicator Once at full capacity, hold breath for 5 seconds Repeat x 10 breaths 19  Other Therapies Positive airway P adjuncts to bronchial hygiene therapy (CPAP, PEP, EPAP) – Indications reduce air trapping (asthma, COPD) Help mobilize secretions (CF, chronic bronchitis) Prevent/reverse atelectasis Optimize delivery of bronchodilators – Contraindications No absolute contraindications, but consider: – Unable to tolerate increased WOB?, ICP > 20 mmHg, Hemodynamic instability, Facial, oral, skull surgery/trauma, Acute sinusitis, Epistaxis, Esophageal surgery, Active hemoptysis, Nausea, Tympanic membrane issues, Untreated pneumo 20 Positive-Expiratory-Pressure and Flutter Valve Therapy Equipment Positive-Expiratory-Pressure Therapy Equipment Flutter Valve Therapy Inspiratory Muscle Training Devices 21  Positive-Expiratory Pressure Therapy Equipment Consists of: mouthpiece, 1-way valves, T- assembly, manometer, adjustable resistance valve (optional: nebulizer & reservoir) PEP adjusted by diameter or Resistance valve Method: deep breath, exhale actively (10- 20x), then forcefully cough 22 PEP Mask Device 23 Thera-PEP 24 BEST DEPOSITION 25  Oscillating PEP Therapy Devices 2 types on the market: – Flutter valve – Acapella 26  Flutter Valve Therapy Single weighted ball valve – Rapidly opens/closes w/ exhalation – Creates +P in AW’s & oscillating P wave 10-20x then encourage vigorous cough 27 Flutter Valve 28  Acapella Oscillating PEP Therapy Device Counterweighted lever & magnet adjusts the frequency & amplitude of expiratory P wave Proximity of magnet to lever adjusts R (controlled by adjustable knob) 10-20x, encourage vigorous cough 29 Acapella Oscillating PEP Therapy Device 30  Inspiratory Muscle Training Devices Strengthen inspiratory muscles by providing variable R to gas flow during inspiration – Varies size of orifice to vary R to flow – orifice size = R to flow Nose clips discourage “cheating” 31 Inspiratory Muscle Trainer 32  Intermittent Positive Pressure Breathing (IPPB) Therapy Intermittent Positive Pressure Breathing Utilizes positive pressure on inspiration and expiration Augments breath taken on insp Stents open on exp. Indications – SEE CPG IN BOOK – Pts unable to do IS – Short-term therapy 33  Intermittent Positive Pressure Breathing (IPPB) Equipment Bird IPPB Ventilators – Bird Mark 7 and Mark 7A – Bird Mark 8 Bennett IPPB Ventilators – AP-5 – PR-2 34  Puritan Bennet Low P reducing valve – Utilizes spring tension & diaphragm – 0 to 45 cmH2O 35  Bird Mark 7 Magnetic attraction opposing gas P – P control moves magnet closer/farther from metal clutch plate, varying magnetic attraction 36  Percussionaire Corporation IPV® Ventilators Definition – High frequency pulsed gas delivery in combination with delivery of a dense aerosol Ventilators – IPV®-2 – IPV®-1C 37  Percussors Used for Chest Physiotherapy Percussors – Vibramatic – Flimm Fighter – MJ Percussor 38  Vibramatic Percussor Electrically powered Timer/frequency controls – Frequency control allows for variations in pt. tolerance 39  Flimm Fighter Electrically powered Primarily intended for home use Suitable for self-therapy (vest, velcro) Limited controls: on/off only 40  MJ Percussor Pneumatically powered off of 50 psi – Air is recommended (1 case of fire) Electrically powered timing mechanism – Uses 9v battery 41  Adjunctive Equipment for Manual Chest Percussion DHD Healthcare Palm Cups® – 4 sizes – Soft vinyl rubber – Adds consistency to technique for manual CPT Ballard® Manual Percussor for Neonatal Use – Soft vinyl on plastic wand – Alleviates fatigue – You can “make your own” w/ a tongue blade 42 Palm Cups 43 Ballard Neonatal Percussors 44  High Frequency Chest Wall Oscillation (HFCWO) Therapy Application of external chest wall compression using a self-inflating/deflating pneumatic vest Components – Air-pulse generator – Two hoses – A vest that the patient applies 45  The Vest Frequencies of 5 to 25 per second Pt controls f & amplitude for comfort/effectiveness Indications – Mucous plugging, retained secretions, disease Contraindications – Unstable thoracic cage injuries Foot switch must be depressed! 46 The Vest 47  The Emerson Coughassist MI-E Device Electrically powered pneumatic insufflation/exsufflation device – Assists with providing inspired volumes – Assists with providing expiratory flow – Generates pressures of +/-60 cmH2O – Maximum flow of 10 LPS – Mouthpiece, mask, or connect to artificial AW – Indicated primarily for neuromuscular disorders & quadriplegia 48 Emerson Coughassist MI-E 49 https://www.youtube.com/watch?v=oUMyb 9h2-2w 50