Application for HFCO therapy in airway clearance
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Transcript of Application for HFCO therapy in airway clearance
Application for HFCO therapy in airway clearance
Theory and Indications
Metaneb TM is indicated for the mobilization of secretions ,
lung expansion therapy , and the treatment and prevention of atelectasis. Patients with conditions/disease states that may benefit : Bronchiolitis Asthma Chronic Bronchitis Bronchiectasis Neuromuscular disorders/deficits Emphysema/COPD Post operative management and management of hypoventilation Airway management , lung expansion therapy in an acute setting
( ED )
Absolute Contraindications
* Untreated pneumothorax
* Unskilled operator of the Metaneb device
Relative Contraindications
Subcutaneous emphysema Broncho-pleural fistula Myocardial infarction Vomiting Pulmonary hemorrhage Recent pneumonectomy Untreated pneumothrax , or history of pneumothorax Plateau pressures > 30 cm H20
Cautions
Read User manual before usingCircuit is single patient use onlyDo not occlude entrainment orifices **Do not use non-invasive application on
uncooperative patientsUse only with nebulizer unit providedCPEP mode is not to be confused with CPAPDispose of Metaneb circuit appropriately
Modes of operation
3 selections / 2 modes
Can be run on Aerosol only
CPEP : Continuous positive expiratory pressure
CHFO : Continuous High Frequency Oscillation
Circuit assembly and function check
Connect to 50 psi gas sourceConnect circuit to power box Set mode to CHFO , select
“HIGHER” impact setting Adjust green selector
ring to 3 dots Flip master switch on Observe/ time CHFO rate to
13-23 pulses in 5 seconds Set mode to CPEP , with
selector ring at 3 : Occlude patient patient port Observe manometer for pressure of 20 cm and not > 32 cm H20
METATHERAPY TM
Protocol and Procedure
Frequency : common strategy advocated in
acute care setting is 2-4 times a day. Patient response should direct frequency adjustments
Procedure for non-invasive application
1. Check MD order
2. Obtain medications and verify in MAR 3. Proper hand-washing or foam 4. Introduce yourself to patient , check 2 patient
identifers. 5. Perform patient assessment 6 Connect MetaNeb tm circuit to powerbox , fill nebulizer cup with prescribed medications. 7. Set mode selector to CPEP TM
8. Set entrainment selector ring to “2” orifice indicator dots.
9. Connect to gas source and flip Master switch “ ON” 10. Occlude pt port and adjust CPEP flow level until
manometer reads 10 cm H20 pressure. 11. Attach interface ( mouthpiece or mask )
Procedure for non-invasive application
12. Instruct patient to breath in and out through mouthpiece. 13. Encourage slow exhalation : 3-4 seconds. 14. Adjust entrainment selector ring from 1 dot to 3 dots ( least to greatest resistance) , as tolerated by patient. 15. Continue CPEP mode for approximately 2 ½ minutes . 16. Instruct patient that mode will change to a pulsatile delivery of gas. Instruct the patient to inhale and exhale through pulsations. Encourage the patient to keep lips and cheeks splinted Switch to “HIGHER” impact setting. Change mode to CHFO TM . Encourage patient to breathe through pulsations and exhale slowly.17. Continue CHFO for approximately 2 1/2 minutes . Alternate between CPEP and CHFO until therapy session complete 10 minutes or until nebulization complete.18. After treatment , turn off unit , and store circuit for future use. Re-assess patient Decontaminate with hand-washing or foam Complete documentation of therapy
Assessment of Outcome
1. Decrease in secretion/mucous production to
< 5 ml per 24 hr treatment period. 2. Evidence of resolved issues with atelectasis ( radiologic exam) , or retained secretions by chest exam, CXR or bronchoscopy.
MetaNeb TM
In-line / Ventilator Protocol
1. Follow organizational infection control standards 2. Connect Metaneb gas hose to 50 psi gas source 3. Connect Metaneb circuit to powerbox 4. Place spring loaded “tee” one-way valve into the inspiratory limb of circuit. 5. Maintain patient position with HOB > 30 degrees elevated if tolerated. 6. Perform patient assessment 7. Prepare MeteNeb handset :
Use 15mmOD X 15mmOD and 15 mm 0D X 7.5 mm ID to connect handset Green entrainment ring set to selector dot “1”. May adjust to “3” as tolerated. to spring loaded “tee”. Fill nebulizer unit 8. Patient ventilator mode should be switched to a pressure directed mode : PCV ( PC or PC SIMV) , PSV, PRVC , APRV
MetaNeb tm
In-line / Ventilator Protocol
9. Switch to a pressure trigger setting if sensitivity set to a flow trigger to avoid auto-cycling. Recommendations: Avea & Vela :20 lpm , Drager : max setting per pt range , LTV : set to 9 . Pressure trigger on Avea to - 10 cm.10. In PCV or PRVC : lengthen Ti to achieve a 1:1 I:E ratio11. MetaNeb therapy adds flow and potentiates circuit pressure. There
may be consideration for turning PSV down or off during treatment .12. Insert handset into spring loaded “tee”13. Flip master switch to ON. Switch impact to “HIGHER”14. If HOB > 30 degrees is maintained , a slight cuff leak may be created to enhance cephalad flow and facilitate secretion removal from the oral cavity. Care should be taken to not create to great a leak , the MetaNeb cannot compensate for.15. Adjust alarms accordingly.16. Monitor patient vital signs closely during therapy.17. When therapy complete : Resume previous ventilator parameters : MODE , Ti , Flow trigger . PSV , Alarms 18. Turn off Master switch , disconnect “tee” and circuit. Store appropriately for future use.19. Re-assess patient and document therapy20. Practice appropriate infection control standards post therapy.