COUGH ASSIST (NIPPY)pptx

COUGH ASSIST. [image] OYOUS ONSULTANCY A Step ahead in learning..

AIMS & OBJECTIVES. Defining Cough Assist Indications Contraindications Management Risk Troubleshooting and Complications.

DEFINING COUGH ASSIST.

[image] 0.0. DEFINING COUGH ASSIST. The cough assist helps to clear secretions by applying a positive pressure to fill the lungs, then quickly switching to a negative pressure to produce a high expiratory flow rate and simulate a cough. It is known as ‘manual insufflation-exsufflation’ and can be applied via a mask, mouthpiece, endotracheal or tracheostomy tube..

WHAT IS IT?. [image]. The NIPPY Clearway is a pressure-controlled machine which mechanically controls in and out breaths to assist in producing a cough..

HOW DOES IT WORK?. useful in pts with an ineffective cough due to muscle weakness in conditions such as: neuromuscular, spinal injuries or lung disease may find it difficult to cough and clear secretions and maintain lung volumes independently..

uses positive pressure to inflate the lungs (insufflation) which then rapidly changes to negative pressure to assist in helping you cough (exsufflation)..

BENEFITS. To keep your rib cage moving freely and to stretch the muscles used in breathing and coughing. 2. To increase lung volumes. 3. To improve the effectiveness of your cough. 4. To assist with taking deeper breaths which can help clear your chest and help to prevent chest infections..

ANATOMY. [image] Respiratory Systern Main (right.

DIFFERENT DEVICES USED. [image]. Philips assist Device airway clearance.

WATCH NOW> E70 COUGH ASSIST. WATCH NOW> E70 COUGH ASSIST.

OTHER CONDITIONS. conditions such as spinal cord injury or neuromuscular disease, an individual may require assistance to cough using manual techniques or a medical device. Manual assisted cough is the compression of the diaphragm by another person to replace the work of abdominal muscles in order to facilitate a cough. A medical device can be used to assist coughing effort by a positive pressure breath followed by a rapid change to negative pressure..

WHEN TO USE YOUR NIPPY CLEARWAY:. The frequency per day will be advised by the prescribing physiotherapist. This will be recommended as numbers of cycles and how many times each day. It is recommended that you use your NIPPY Clearway every day to keep your chest clear of secretions and maintain lung volumes..

• Pneumothorax/punctured lung • Facial trauma • Recent or existing pressure trauma to lungs • Bullous emphysema • Spinal instability • Acute pulmonary oedema • Acute lung injury.

INDICATIONS.

INDICATIONS. A patient unable to clear secretions effectively due to muscle weakness Peak cough flows of <180 L/min are unlikely to be effective at clearing secretions Can be useful in preventing respiratory complications due to secretion retention and poor tidal volumes.

INDICATIONS- CLINICAL PRESENTATION. Hypoxemia Non-productive cough Poor inspiratory effort.

CONTRAINDICATIONS.

CONTRAINDICATIONS. Manual assisted cough Cough assist device Direct pressure should be avoided to rib fractures or surgical sites. Undrained pneumothorax Frank haemoptysis Vomiting Facial fractures CVS instability Raised intracranial pressure (ICP} Recent upper GI surgery Lung abscess.

Manual assisted cough Cough assist device Immediately following surgery Paralytic ileus Rib fractures Raised ICP Un-drained pneumothorax Osteoporosis Pain Unstable spine Oxygen dependency Bronchospasm Emphysema Patient compliance Airway obstruction.

RISK.

CAUTIONS. SIDE EFFECTS. Cardiovascular instability Coagulopathy High Oxygen requirements Asthma or air trapping Full tummy!.

TROUBLESHOOTING & COMPLICATIONS.

Nippy Cough Assist Troubleshooting. Pressure Line Disconnection Low Memory Battery.

MANAGEMENT.

Positioning: It is best to use the NIPPY Clearway in an upright position to allow you to take the deep breaths to make it as effective as possible..

OPERATING THE MACHINE. • Plug in the machine to mains power. • Turn the machine on by holding the power button down. • Manual mode: Positive and negative pressures are applied using the manual switch on the front of the machine or with a remote handheld switch..

• Auto mode: cycles between insufflation and exsufflation followed by a pause, for a maximum of 20 cycles..

General Information. • Press the help button at any time for on screen help on a variety of topics. • Check the machine and all parts for any damage before using. • Check there are no parts missing to the breathing circuit/filter. If you have any concerns do not use the cough assist machine..

INFECTION CONTROL.

Device Cleaning and Disinfection. Single-Patient Use.

• Change the filter on the circuit monthly (or sooner if it becomes discoloured or soiled)..

General Information • Change the tubing of the circuit only if soiled. • To clean, wipe the exterior of the case with a soft cloth moistened with water. • Oxygen cannot be used with the NIPPY clearway. • DO NOT place any form of cover over the machine, especially near the air intake. • If liquids are allowed to enter the unit, serious damage could occur. If you spill any liquid into the NIPPY Clearway, consult qualified service personnel (contact information will have been provided for you by the Oxford Sleep and Ventilation Service)..

COVID AWARENESS.

Infection Control Measures. Enhanced Cleaning Protocols.

MANUAL ASSISTED COUGH.

TECHNIQUE/TREATMENT. Gain consent Carry out any chest physio techniques prior to cough assist to optimise treatment and position patient as indicated. Explain the procedure and accustom patient to mask with machine off. Switch the machine on and allow the patient to feel with their hand Set pressures low to begin with (10-15cmH2O) to allow the patient to acclimatise Choose manual or automatic mode and build up pressures as tolerated to gain adequate secretion removal. Always start with the inspiratory phase.

Oxygen can be entrained via nasal specs or t-piece if needed. Encourage patient to cough with the breath out 5 breaths in and out at a time followed by 30-60 sec rest. Repeat up to 10 times as needed. Usually, 3-5 ‘cycles’ are enough to produce a cough Cough assist is for intermittent use and should not be used for >5 mins Observe post-treatment and reassess for improvement Document treatment details and effects.

MANUAL ASSISTED COUGHING. Ensure you have enough people to assist in the procedure. Consider: Spinal stability (does the patient require a shoulder hold?) The size of the patients' chest (is a second person required?) Thickness of the patients' secretions (is a second person required?) Whether the patient is in bed or in a wheelchair (will assistance be needed to stabilise the chair) The experience of the available staff (is a second person required?) The upper body strength of the member of staff (is a second person required?).

MANUAL ASSISTED COUGHING. Ensure the bed is at a height where you can use your body weight to maximum effect hence minimising effort involved. Take care not to lower the bed too far allowing any traction weights to touch the floor. If the patient is sitting in a wheelchair decide on the best technique for yourself and the patient and position yourself accordingly..

SELF-ASSISTED COUGH. Patients performing self-assisted cough without supervision should have been assessed as competent to perform this and should possess relevant knowledge and skills related to:  Proper technique  Possible hazards and complications  Technique modification in response to outcomes of therapy  Assessment of outcomes of cough with regard to sputum, quantity, colour and other relevant characteristics  Appropriate response to changes in sputum production.

METHOD. There are many techniques that can be used to assist a patient's cough. The principle of a coordinated forceful well timed effort replacing absent or weak expiratory muscles should be followed. The following list is not exhaustive and experienced staff may develop their own techniques for maximum effectiveness. Staff wishing to develop their own method should ensure the exceptions and contraindications are taken into account so that the general principles of assisted coughing are adhered to..

ONE PERSON TECHNIQUE (A). Clear verbal direction and co-ordination between the person helping and the patient is essential for cough assist techniques to be successful. 1. PIace the heels of your hands underneath the ribs as illustrated. 2. As the patient attempts to cough push inwards and upwards..

ONE PERSON TECHNIQUE (B). Clear verbal direction and co-ordination between the person helping and the patient is essential for techniques to be successful. Place one forearm across the upper abdomen of the patient with your hand curved around the opposite side of the chest..

ONE PERSON TECHNIQUE (C). Clear verbal direction and co-ordination between the person helping and the patient is essential tor techniques to be successful. Spread your hands anteriorly around lower rib cage so that the heels of your hands are on the upper abdomen..

2. With your elbows extended push the heels of your hands inwards and upwards with both arms as the patient attempts to cough. Arms must be kept extended for this technique to work effectively- it may therefore not be appropriate to use if the patients' bed does not lower to a suitable height.

2 PERSON TECHNIQUE (A). Methods for assisted coughing – in bed. Two person techniques: Clear verbal direction and co-ordination between the person helping and the patient is essential for techniques to be successful. Stand on either side of the bed. Each person should place one forearm across the upper abdomen of the patient.

With your hand curved around the opposite side of the chest. Your other hand is placed on the near side of the chest. As the patient attempts to cough, push simultaneously inwards and upwards with your forearms, squeezing and stabilising with the other hand.

2 PERSON TECHNIQUE (B). Clear verbal direction and co-ordination between the person helping and the patient is essential for techniques to be successful. 1. Stand on either side of the bed. Place your forearms across the patient's chest with your hands curved around the opposite side of the chest wall. Your arms should alternate,.

2 PERSON TECHNIQUE (C ). Clear verbal direction and co-ordination between the person helping and the patient is essential for techniques to be successful. Stand on either side of the bed. Each person places their hands on the upper and lower ribs of the same side with their fingers spread and pointing upwards.