all modes 1-19 - solutions x 2 · 2019. 1. 24. · the metaneb® system user manual (174432 rev 1)...
TRANSCRIPT
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WELCOMEAll Modes of Airway Clearance
The Healthcare Environment Today
Current Situation• Respiratory complications are a
major concern• More focus on hospital acquired
infections• Changing Reimbursement
Strategies to Avoid Re-admission • Identifying patients at high risk• Early detection of respiratory
complications• Early intervention of airway clearance
Could result in:• Fewer pulmonary complication• Healthcare savings• Improved patient outcomes • Improved quality of life
Know which modality for which patient
• Chest Physical Therapy• Therapy Beds• Coughing Techniques• Mechanical Insufflation – Exsufflation• Breathing Techniques• Positive Expiratory Pressure / Oscillatory PEP• Intrapulmonary Percussive Devices• High Frequency Chest Wall Oscillation• Other adjuncts to Airway Clearance
Airway Clearance Techniques
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• Cognitive limitations– Age / mental status– Sedation
• Physical ability– Coordination / strength– Shortness of breath / fatigue– Mechanical Ventilation / Artificial Airways
• Promote improved compliance / adherence when: – Effective, without side effects– Comfortable– Time efficient– Adaptable with illness– Can be used in any setting– Easy to teach, learn and use
Considerations for Selecting an Airway Clearance Modality
Better understanding of airway clearance options:• Definition of each device / technique• Mechanisms of action• General technique for delivering therapy• Level of patient participation required• Advantages / limitations of each• Finding the best airway clearance option or combination of options for
each individual patient
Today’s Objectives…
Chest Physical Therapy
• Percussion / vibration
• Postural drainage
• Mechanical percussors
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Chest Physical Therapy
• 12 positions using: – Gravity– Percussion– Vibration
• Time consuming• Labor Intensive• May be harmful in some
patients1
1SELSBY DS, BMJ VOLUME 298 4 MARCH 1989
Hand-Held PercussorsManual, Electronic or Pneumatic
• Features to support ventilator-associated complication protocols‒ Digital HOB angle indicator and alarm‒ Continuous lateral rotation therapy (CLRT)
Pulmonary Surface (Powered Air)
• Pulmonary surface (powered air)‒ Percussion and Vibration
‒ Helps prevent ventilator-associated complications when used with CLRT
Continuous Lateral Rotation (CLRT)Percussion & Vibration Therapy Beds
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Advantages
• Effective proven therapy• Requires no equipment• May be used on very young
patients• Promotes time with caregiver
Limitations
• Technique dependent• Physically demanding on patient
and staff• Time consuming for patient and
staff• Infection control issues • Reflux related respiratory
complications• Age / weight restrictions on beds• Maintenance of beds
Chest Physical Therapy
Coughing Techniques and DevicesComing Up Next
• Red face• Distended neck veins• No airflow after first or second
cough• Decreased sats• Bronchospasms• Ineffective body position
Paroxysmal Cough
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Egans Fundamentals of Respiratory Care Ninth Edition. Wilkins R, Stoller J, Kacmarek R. Section V, Chapter 40, pages 921-9461
• Definition– One or two forced expirations without closure of the glottis1
– Followed by a period of diaphragmatic breathing and relaxation1
• Theory– The goal is to help clear secretions with less change in pleural
pressure and less likelihood of bronchiolar collapse1
– Periodic diaphragmatic breathing and relaxation following forced expiration restores lung volume and minimizes fatigue1
Huff Cough / Forced Expiratory Technique (FET)
Huff Forced Exhalation Technique1
1. 3–5 slow deep breaths through nose, exhaling through pursed lips,
using diaphragmatic breathing
2. Take a deep breath, hold for 1–3 seconds
3. Exhale contracting abdominal and chest wall muscles, with glottis
open during exhalation
4. Repeat several times
5. As secretions enter the larger airways, exhale from high-to-mid lung
volume
6. Repeat maneuver 2–3 times
Forced Expiratory Technique, Directed Cough, and Autogenic Drainage. James B Fink MSc RRT FAARC RESPIRATORY CARE • SEPTEMBER 2007 VOL 52 NO 9; page 12131
Egans Fundamentals of Respiratory Care Ninth Edition. Wilkins R, Stoller J, Kacmarek R. Section V, Chapter 40, pages 921-946
• External application of pressure to the thoracic cage or epigastric region, coordinated with forced exhalation
• Mimics the normal cough mechanism by generating an increase in the velocity of the expired air
Who could benefit?• Neuromuscular patients• Patients unable to generate the forceful expulsion of air
needed to move secretions toward the trachea
Manually Assisted Cough
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Homnick DN Mechanical insufflation-exsufflation for airway mucus clearance. Resp Care 2007; 52 (10): 1296-1305.
Mechanism of action:1. Inflation of the lungs with positive pressure 2. Followed by an active negative pressure exsufflation3. Creates peak and sustained flows
– High enough to provide adequate shear and velocity to loosen and move secretions towards the mouth for clearance by expectoration or suctioning
Mechanical Insufflation-Exsufflation (MI-E)
Mechanical Insufflator – Exsufflator Devices
• Non-invasive• Lung Expansion• Cough Clearance
Optional Foot Pedal for purchase
VitalCough™ System User Manual (178729 REV 1) p.21
Mechanical Insufflator – Exsufflator
Circuits will contain the following; adapter, breathing hose, bacterial/viral filter, and the patient interface.
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Mechanical Insufflator – Exsufflator
• Multiple patient interfaces– Mouthpiece– Face mask– Adaptor to a tracheostomy
The following will need to be programmed before you initiate treatment
Automatic SettingsInhale Pressure*
Exhale Pressure*
Resting Pressure/PAP*
Flow Rate*
Manual SettingsInhale Pressure*
Exhale Pressure*
Resting Pressure/PAP*
Flow Rate*
*Indicates the settings that are set for both automatic and manual modes
VitalCough™ System User Manual (178729 REV 1) p.40-55, 57
Number of cycles to be completed foreach treatment setInhale breath time
Exhale breath time
Pause Time
Lock Device-optional optional both modes
Manual or Automatic Mode Programming
Mechanical Insufflator – Exsufflator Technique
Start at 10-15 cmH2O recommended for those new to the device
– Pressures can be increased as necessary to achieve adequate secretion clearance
– Typical inhale pressures 15 cmH20 to 40 cmH20– May vary depending on lung and chest wall compliance– Optimal exhale pressure 35 cmH20 and 45 cmH20
Automatic: Inhale, exhale, pause times– Inhale 2-3 seconds / exhale 1-2 seconds– Neutral (Pause) few seconds
4 – 5 cough cycles / remove visible secretions
Rest 20 to 30 seconds
Repeat 4 – 6 times or until clear
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Advantages
• Lung expansion• Cough augmentation• Alternative to suctioning• Non-invasive• Multiple patient interfaces• Alert or unconscious patient• May be used on very young
patients• Combine with other therapies
Limitations
• Incomplete AWC device• Mask / mouthpiece seal• Cleaning / changing circuit• Change filter when soiled or wet• Maintenance required
– Periodic operation verification– Change internal fuses if blown
• Assure air intake ports are not blocked
Mechanical Insufflation – Exsufflation
Breathing TechniquesActive Cycle Of BreathingAutogenic Drainage
Coming Up Next
Active Cycle of Breathing Technique (ACBT)
A cycle of breathing techniques; Breathing Control (BC), Thoracic Expansion Exercises (TEE) and Forced Expiratory Technique (FET)1
– BC to help prevent bronchospasm– TEE to loosen secretions, improve distribution of ventilation and provide
volume needed for a forced expiratory technique– FET to clear secretions with less change in pleural pressure and less
likelihood of bronchiolar collapse
TheoryEgans Fundamentals of Respiratory Care Ninth Edition. Wilkins R, Stoller J, KacmarekR. Section V, Chapter 40, pages 921-9461
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Breathing Control • Gentle diaphragmatic
breathing at tidal volume1
• Relaxation of the upper chest and shoulders1
Thoracic Expansion Exercises • Deep inhalation• Relaxed exhalation• 3-4 TEE’s1
Forced Expiratory Technique• 1-2 forced expirations
to middle to low lung volumes without closure of the glottis1
Egans Fundamentals of Respiratory Care Ninth Edition. Wilkins R, Stoller J, KacmarekR. Section V, Chapter 40, pages 921-9461
Pryor Jennifer A. Booklet: Physiotherapy for people with Cystic Fibrosis: from infant to adult. 4th edition 2009; page 6: available online on www.cfww.org/ipg-cf/22
Repeated until huff dry sounding and non-
productive or it is time for a rest2
Active Cycle of Breathing TechniqueComponents, Sequence & Duration Adapted to Need
Theory
Autogenic Drainage (AD)
• Three-phased breathing regime using high expiratory flow rates at varying lung volumes to facilitate mucus clearance– Attain highest possible expiratory flows without forced expirations and
associated airway closure– Move mucus with a relaxed sighing exhalation, regulating airflow and velocity
with use of expiratory muscles, avoiding unnecessary expiratory resistance
Forced Expiratory Technique, Directed Cough, and Autogenic Drainage. James B Fink MSc RRT FAARCRESPIRATORY CARE • SEPTEMBER 2007VOL 52 NO 9
UnstickLLV
CollectMLV
EvacuateHLV
TV
ERV
RV
HUFF
COPDVOL
PREDVOL
*May be difficult with advanced disease
Breathing Phases of Autogenic Drainage
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Advantages
• Effective techniques• No equipment• Preferred over CPT• Saves treatment time• Active Cycle of Breathing Technique
– Easy to teach– Easy to learn
Limitations
• Limited by age / cognition• Dependent on patient effort /
ability• Autogenic Drainage
– Time consuming to teach
– Difficult to learn– Maintenance technique
Active Cycle Breathing Technique and Autogenic Drainage
Lung Expansion Therapy
• Prevent / reverse atelectasis
• Simulate / re-establish normal breathing
• Mimic natural sigh / yawn
• Deep breathing exercises
• Incentive spirometry
• Handheld devices
• Mechanical devices
http://www.smiths-medical.com/catalog/lung-expansion/ezpap-positive-airway-pressure/ezpap.html
Positive Airway Pressure System
Indicated for:• Treatment/prevention of
atelectasis• Need for lung expansion
therapyMay be used with:
• Mask• Mouthpiece• Nebulizer
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Positive Expiratory Pressure (PEP) DevicesComing Up Next
Theory
Positive Expiratory Pressure (PEP)
• Alters airflow and pressure behind mucus via collateral ventilation• Stabilizes peripheral airways• Increases pressure gradient across mucus plug forcing secretions
central• Increased outward pull on alveoli
Positive Expiratory Pressure Devices
TheraPEP® PEP Therapy SystemSmiths Medical ASD, Inc.
PARI PEP™ S SystemPARI Respiratory Equipment, Inc.
Threshold® PEPPhilips Respironics
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Oscillatory PEP Devices
Flutter® Mucus Clearance DeviceAxcan Pharma™ US, Inc.
Quake®
Thayer Medical Corporation
acapella ® Vibratory PEP Therapy SystemsSmiths Medical ASD, Inc.
acapella® choice acapella® duet
Oscillatory PEP Devices
Aerobika®
Monaghan™
The VibraPEP®
Curaplex®
Lung Flute®
Medical Acoustics, LLC
• Creates low frequency acoustical sound waves¹• Secretion mobilization and induction device¹• Components include: plastic mouthpiece, reed, 14.5 inch hardened plastic horn²
¹http://www.lungflute.com/medical-professionals.php²http://www.lungflute.com/PDF/lungflute-physics-physiology.pdf
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PEP/Oscillatory PEP TechniqueInstruct individual to sit comfortably and upright while holding mouthpiece firmly in mouth or mask firmly to face
Adjust resistance to prescribed setting
Have patient breathe in a larger than normal breath, but not to total capacity
and exhale gently through device
– maintain a pressure of 5-20 cm H2O or no longer than a 1:3 inspiratory to expiratory ratio
Have patient perform 10-20 breaths, then 2-3 Huffs
– With oscillatory PEP devices, patient should first perform forced maneuvers through device to facilitate secretion removal, then follow up with huffs
Repeat steps until:
– Secretions are cleared– Or the predetermined period has elapsed
Respiratory Care, October 2007 Vol 52 No 10 pages 1308-1327
Advantages
• Prefer over CPT• Easy to learn• Saves treatment time• Provides independence• May be used with a mask
Limitations
• Age / cognition levels• Patient effort dependent• Requires tight seal with
mouthpiece / mask • Most are flow dependent• Require periodic replacement• Cleaning required – follow
individual device manufacturer instructions
PEP / Oscillatory PEP
Intrapulmonary Percussive DevicesComing Up Next
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A therapeutic device that uses a systematic approach to enhance normal mucus clearance and resolve or prevent atelectasis.For use in Acute Care and Long Term Care
The MetaNeb® System User Manual (174432 REV 1) page 1-4
Offers 3 therapies:1. Continuous Positive Expiratory Pressure (CPEP)
– Lung expansion therapy 2. Continuous High Frequency Oscillation (CHFO)
– Secretion mobilization therapy3. Aerosol Mode
– Aerosol therapy
• Provides supplemental oxygen when used with compressed oxygen
3 in 1 Therapy with Intrapulmonary Percussive Devices
Indicated for lung expansion and secretion mobilization therapies for the treatment and prevention of atelectasis and the complications of retained secretions
3 in 1 Therapy with Intrapulmonary Percussive Devices
1 molecule of therapy
Gas entrains 5 molecules
of air
Venturi Throat Jet
Venturi and Entrainment of Ambient Air
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Venturi and Entrainment of Ambient Air with Decreased Airway Compliance
• “1 dot” position – largest opening with least resistance
• “2 dot” position – creates more resistance
• “3 dot” position – smallest opening with most resistance
Exhalation Orifice
Blue Selector Ring
3 levels of Positive Expiratory Pressure (PEP) available
Additional Positive Expiratory Pressure
The MetaNeb® System
Mouthpiece Face Mask Tracheostomy In-line with Ventilator
Multiple Patient Interfaces
15. The MetaNeb® System User Manual (174432).
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The MetaNeb® System - Easy Treatment to Deliver
Delivering a Treatment
1. Begin with CPEP Mode.
2. Adjust flow and selector ring to patient comfort / needs
3. Continue CPEP Mode ~ 2 ½ minutes.4. Move the Higher/Lower dial to Higher.
• Higher/Lower dial may be moved if needed5. Change mode to CHFO Mode.
6. Continue CHFO Mode for ~ 2 ½ minutes.
7. Alternate between CPEP and CHFO ~ every 2 1/2 minutes. 8. Deliver treatment for 10 minutes or depending on patient need
or as otherwise provided in institutional protocol.
Follow instructions stated in the User Manual
15. The MetaNeb® 4.0 System User Manual (174432).
Higher
Lower
The MetaNeb® System - Easy to Deliver In-Line with a Ventilator
Delivering a Treatment1. Connect The MetaNeb® System to 50 psi oxygen source.
2. Set the mode to CHFO and select Higher.
3. Put the master switch in the ON position.4. Put a spring-valve "tee" adapter in inspiratory limb of ventilator
circuit.
5. Monitor and continue the treatment for 10 minutes or per facility protocol.
6. Adjust the alarm parameters as necessary during in-line therapy.7. Suction secretions as necessary during treatment.
8. Remove the handset and adapter from the spring-valve tee and cap before you put The MetaNeb® System master switch in the OFF position.
9. Return the ventilator alarms and mode to their previous settings if needed.
Follow instructions stated in the User Manual15. The MetaNeb® 4.0 System User Manual (174432).
• Delivers aerosolized medication and oscillates during inhalation and exhalation to help remove endobronchial secretions¹
• Single patient, multiple use device
• Hospital or home use
• May purchase compressor for home
PercussiveNEB® User Guide, rev. 3.5.2008, pages 2-11
High Frequency Intrapulmonary Percussive Nebulizer
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• During inhalation ‒ The patient entrains high density aerosol from the nebulizer with high
frequency intrapulmonary percussion for enhanced aerosol deposition
• During exhalation‒ High frequency (11-30 Hz) pressure bursts create a gas bolus velocity
profile that travels down the center of the bronchial airways
‒ Exhaled gas to travel at high speeds along the wall of the bronchial airways
‒ Imparts a sizeable force on bronchial secretions moving them up and out of the airways¹
PercussiveNEB® User Guide, rev. 3.5.2008, pages 2-11
Theory of Operation
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TechniquePlace prescribed medication into nebulizer reservoir and add saline
-Reservoir holds 20 ml and typically uses 1 ml/min (residual)
Attach high flow source to 60 l/min (±25%)
– May be used with compressed air or oxygen
Intended to be used only on those patients who are able to breathe
spontaneously and to be used with the attached mouthpiece
Adjust flow rate until modulator piston begins to oscillate and adjust
as needed for patient comfort
Adjust oscillating amplitude as needed for patient’s comfort, starting
with soft and increase to hard setting once patient appears
comfortable with good breathing pattern
Treatment times are typically 15 – 20 minutes
Advantages
• Customize treatments• Internal vs. external application• Aerosol delivery• Ability to deliver oxygen with
therapy• Delivers PEP• Shorter treatment times• Single patient multi-use circuits• May be used on very young
patients
Limitations
• Cleaning after every use recommended
• High pressure / flow gas source required
• Patient technique with mouthpiece
• Requires proper training– Staff – Patient
Intrapulmonary Percussive Devices
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High Frequency Chest Wall Oscillation (HFCWO)Coming Up Next
HFCWO for Airway Clearance System
The Vest® Airway Clearance System, Model 105User Manual (145330 REV 7) page 10
An Air Pulse Generator, connected by hoses to an inflatable garment that is rapidly inflated and deflated, creating High Frequency Chest Wall Oscillation (HFCWO)
HFCWO generates increased airflow velocities:
• Creates repetitive cough-like shear forces & an expiratory airflow bias
– Decreases viscosity of secretions
– Dislodges and moves secretions toward central
airways
HFCWO for Acute Care/Long-Term Care
The Vest® System Generator• Rolling stand• Adjustable height• Disposable Air Hoses
The Vest® System Disposable Garments• Single patient use (SPU)• Color coded to size
Wrap SPU Vest• Extra small (19”) to XXL (75”)
Full SPU Vest• Child medium (23”) to Adult Large
(52”)
33. The Vest® Airway Clearance System, Model 105 User Manual (145330 REV 13)
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HFCWO for Home Care
• Color options• Inflatable bladder• Outer shell • Soft fabric with Dupont™ Teflon® stain protection• 3D Mesh lining for breathability• Machine washable and machine dryable
C3® Garment Line
Classic Garment Line
Chest Vest Sizes Small, Medium, Large, X Large 28” to 67”
Wrap Vest Sizes X Small to XX Large 19” to 75”
• Easy to use with multiple program options• Eases into therapy to maximize comfort• Hour meter reading from main menu• Small one bag system on wheels
33. The Vest® Airway Clearance System, Model 105 User Manual (145330 REV 13)
HFCWO for Airway Clearance System
• Normal Mode- Set frequency, pressure and time.
• Program Modes- Program A & B: Use the preset
program or customize up to 8 different frequencies, pressures and times within one session with a Cough Pause™ option.
• Ramp Mode- Gradual increase of frequency and
pressure over a period of time.
• Set default settings for above modes.• Ability to change language to Spanish.
Most Commonly used treatment settings in home care:• Twice a day treatment
• Time: 20 minute treatment
• Frequency: 10-14 HZ• Pressure per garment style
– C3 (full) garment – pressures of 4-6
– Wrap garment and Chest Vest
garment – pressure of 1-4
Programmability 33Most Commonly Used Settings 52
Eases into Therapy - Gradual increase in frequency & pressure to pre-set level.
33. The Vest® Airway Clearance System, Model 105 User Manual (145330 REV 13)52. Data report (2017). Most Commonly Used Settings on file at Hill-Rom, Inc.
• Has been shown to help remove mucus from people’s lungs• Just some of the conditions/diseases that may benefit:
– Cystic Fibrosis– Bronchiectasis– Neuromuscular / Neuromotor Disease– Cerebral Palsy– Chronic Bronchitis– Asthma– Emphysema– Quadriplegia– Obesity– Many other conditions
High Frequency Chest Wall Oscillation
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New Mobile Technology in High Frequency Chest Wall Oscillation(HFCWO)
Battery powered HFCWO combining Mobility with Targeted Kinetic Energy and Airflow to mobilize secretions.
The Monarch™ Airway Clearance System is a HFCWO therapeutic device that is used to aid mobilization of secretions from the airways and help improve airway health.1
1. Monarch™ Airway Clearance System User Manual (195292) page 91.
Intentional Design – Design Matters
1. Creates impulse force (Kinetic Energy ) to:1,2,3,4
• Help break up secretions3
• Help loosen secretions3,4
2. Creates airflow within the lungs to:2,3,4,5
• Help mobilize secretions from the small airways to the large airways where they can be coughed out or suctioned.
Powered by POD Technology1
• 8 pulmonary oscillation discs (PODs) anatomically positioned on the chest wall to treat all lobes of the lungs. The PODs oscillate and provide a targeted kinetic energy to the lungs.
1. Monarch™ Airway Clearance System User Manual (195292) page 91, 95.2. Airflow data: Independent lab testing analyzed and compared average airflows at the mouth generated by high frequency chest wall oscillation (HFCWO) therapy in 10 human subjects using home care garments. Airflows
measured at maximum intensity at multiple therapy frequencies (5, 10, 15, and 20 Hz). Impulse force data: Bench testing conducted at maximum intensity at multiple therapy frequencies (5, 14, and 20 Hz). Test data and reports on file at Hill-Rom, Inc.
3. Kendrick A. (2012) Airway Clearance Techniques in Cystic Fibrosis: Physiologu, Devices and the Future, Cystic Fibrosis – Renewed Hopes Through Research, Dr. Dinesh Srifamulu (Ed), ISBN: 978-953-51-0287-8, InTech, Available from http://www.intechopen.com/books/cystic-fibrosis-renewed-hopes-through-research/airway-clearance-tecniques-in-cystic-fibrosis-physiology-device-and-the0-future
4. www.rcjournal.com/cpgs/pdtcpg.html. AARC Clinical Practice Guidelines. (December 1991) Respir Care 1991; 36 (12):1418-1426 accessed 4-5-2017.5. King M, et al. (1984). Tracheal mucus clearance in high-frequency oscillation. II: Chest wall versus mouth oscillation. Am Rev Respir Dis, 1984. 130(5): p. 703-6 King M, et al. Tracheal mucus clearance in high-frequency
oscillation. II: Chest wall versus mouth oscillation. Am Rev Respir Dis, 1984. 130(5): p. 703-6.
4 PODs on the front 4 PODs on the back
Indications for Use• The Monarch™ product is intended to provide Airway Clearance Therapy and
promote bronchial drainage where external manipulation of the thorax is the physician’s choice of treatment. It is indicated for patients having difficulty with secretion clearance, or the presence of atelectasis caused by mucus plugging.
• The Monarch™ Airway Clearance System is intended to be used in the Home Care environment by patients, 15 years and older. 38
38. Monarch™ Airway Clearance System, Model 1000 User Manual (195292).
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Treatment Adherence Can Be Low • Low adherence can affect important health outcomes including pulmonary exacerbations. 34
• Assessment and monitoring considered an integral part of management to ensure treatment interventions are optimized. 34
VisiViewTM Health Portal - Remote Therapy Monitoring With The Vest® System or the Monarch® System
• Patient’s opt in for the connectivity.• Connects patients wirelessly to their care team via the VisiView™
Health Portal.
• The dashboards and prompt feedback helps to motivate patients.
• Clinic and patient-specific dashboards to utilize adherence information to tailor care decisions
• Encourages adherence through collaboration.
34. McCullough, A. et al. (2014) Treatment adherence and health outcomes in patients with bronchiectasis. BMC Pulmonary Medicine 2014, 14:107. http//www.biomedcenter.com/1471-2466/14/107.
Advantages
• Less physically demanding on patient and staff
• Consistent quality therapy• Disposable garments / air hoses• Doesn’t require patient
cooperation / effort• Aerosol treatments
Limitations
• Requires manipulation of thorax
• Patient must be able to wear vest garment
• Follow Manufacturer’s cleaning guidelines
HFCWO
Mobility Exercise Activities
Adjuncts To Airway Clearance
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Chair Egress Lift SystemSide Egress
Flexible frame configurations, egress positions & integrated lift systemsHelp move patients easily & safely through all stages of early mobilization
Surface & Frame - Advancing Mobility
Benefits of Exercise• Improves general fitness
• Stimulates deep breathing• Uses oxygen more efficiently
• Loosens mucus by moving large volumes of air
• Creates environment less conducive to organism growth
• Preserves the elasticity of the lung
• Provides increased stamina• Builds muscle mass and weight gain
• Provides sense of independence and well being
w w w .heathersanim ations.com
The Challenge…
Identifying patient’s acute & chronic airway clearance needsand finding the best modalities for each individual patient’s may
• Decrease incidence or severity of PPC• Decrease morbidity / mortality• Reduce ICU time• Reduce length of stay• Help address readmissions / hospitalizations for the complication of retained
secretions• Decreased healthcare costs related to the complication of retained secretions• Improve QOL for patients and their families
Work with HCT, insurers, manufacturers, patients and familiesto find best modality or combination of modalities for
each individual patient
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What to Use When?Finding the Best Modality or Combination of Modalities
THANK YOU
You Are In The Best PositionTo Make The Difference!