cough assist - publicdocuments.sth.nhs.ukpublicdocuments.sth.nhs.uk/pil4111.pdf · page 5 of 16 my...

PROUD TO MAKE A DIFFERENCESHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST

Cough Assist

Information for patients, families and carersTherapy Services

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Table of contents

Why do I need a Cough Assist?

What is a Cough Assist?

My E70 Cough Assist

Set up and use

Circuit

Interface

Treatment

My E70 Cough Assist prescription

Settings

Action plan

Cleaning and maintenance

Frequently asked questions (FAQs)

References

Contact numbers

4

4

5

6

6

7

8

9

10

11

12

13

13

14

** Please make sure you bring this booklet and your Cough Assist machine to all of your respiratory physiotherapy appointments and

any admission to hospital **

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What is a Cough Assist?

A Cough Assist is a machine that helps to clear phlegm from the lungs. The machine delivers a big breath in (deep breath), then quickly changes to a big breath out (cough breath) to remove phlegm from the lungs.

The type of Cough Assist machine we use is called an E70.

Why do I need a Cough Assist?

Coughing is an essential part of life. The linings of the airways naturally produce phlegm on a daily basis to trap any dirt and bacteria that may enter your airways. If this phlegm is not removed it could collect in the airways and cause chest infections and damage to the airways. The body’s natural way of getting rid of phlegm from the airways is by coughing.

There are three steps to a cough:

1. Deep breath in

2. Build up of pressure in the lungs

3. Squeezing of your muscles to create a 'cough'

The muscles in your chest and stomach are needed to produce a strong cough. If your muscles are weak your cough may not be strong enough to clear phlegm from your lungs. It is very important to have an effective way of clearing phlegm and a Cough Assist can help to do this.

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My E70 Cough Assist

1.

2.

3.

4.

5.

Power button: Turns the machine onand off

Circuit connector: Connect your Cough Assist circuit here

Main screen: Where you navigate the menus and view the settings on the Cough Assist

Navigational buttons: Allow you to start and end treatment as well as change settings

The Manual switch: Your physiotherapist will advise you if you need to use this

6.

7.

8.

9.

AC Power input: Connect the mains power here

Air inlet & pollen filter: This allows air to enter the machine; this is where you will insert the pollen filter supplied with your Cough Assist.

* Do not cover when using *

Air Outlets: This is where the air leaves the inside of the machine.

* Do not cover when using *

Battery: Detachable battery slot. Your physiotherapist will advise you if you need a battery

3

4

5

2

1

8

6

7

9

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Set up and use

Plug the machine into the mains power using the power cord supplied.

Set up and connect your circuit to the circuit connector on the side of the machine (See below for full set up guide).

1. Turn the machine ON using the power button.

2. Press the left navigational button to enter Settings.

3. Press Modify using the right navigational button.

4. Use the up and down navigational buttons to select the appropriate pre-set (as prescribed by your physiotherapist).

5. Press OK using the right navigational button.

6. Press Finish using the left navigational button.

7. Once back at the main screen press Therapy using the right navigational button. This will begin your treatment.

8. Once you have finished the treatment press Standby using the right navigational button. This will stop treatment.

Circuit

The Cough Assist circuit and interface need to be set up and used correctly to make sure the machine works effectively. Your physiotherapist will teach you (and your family or carers) how to set up and use the Cough Assist. The picture below shows you how to put the circuit together.

4

2

1

3, 5

6 7, 8

InterfaceAdaptor

TubingBacterial

filter

Device

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Interface

The interface is the attachment at the end of the circuit used to deliver the Cough Assist treatment.

Having the correct interface is important to make sure you can cough and clear any phlegm from your chest.

The interface is carefully selected by your Physiotherapist according to which one best suits your needs. Below are the three options of interface. You will usually only have one of these.

Your chosen interface is: ……………………………………………

(Physiotherapist: Please tick chosen option)

Mask

A well-fitting, soft-seal mask is important to reduce possible leak.

This will need to be held firmly in place during treatment either by you, or a

family member or carer.

Mouth Piece

When using a mouthpiece, It is important to make a tight seal with your lips. A nose clip may also be

required to prevent air leaking out of your nose.

Tracheostomy Mount

The mount attaches the circuit to the end of your tracheostomy.

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Treatment

The treatment using the E70 Cough Assist will be personal to you. The treatment session that is best for you will be prescribed by your physiotherapist.

The E70 Cough Assist machine has three different settings. These settings will give you deep breaths; cough breaths or a mixture of both.

Deep breaths

This setting gives you big breaths in.

Cough breaths

This setting gives you a big breath in followed straight away by a big breath out (cough breath).

Deep breaths and cough breaths

This setting gives you several big breaths in followed by a cough breath.

- +

Settings

- +

Settings

- +

Settings

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My E70 Cough Assist prescription

Your Cough Assist will be set up by your physiotherapist with the settings that are best for you. The settings on your cough assist will be saved as a 'preset'. You should try and follow the treatment pattern below.

During a treatment, you should try and sit as upright as possible. If you are unable to carry out your treatment on your own you may want to agree on a signal with your relative/carer to alert them that you want to stop treatment.

Repeat your prescription ............... times.

If you are unwell or have increased symptoms follow the advice below:

Preset number Deep breaths Cough breaths

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Settings

For attention of your physiotherapist:Please complete the table below.

Preset:

Mode: Manual / Auto / Advanced auto pre-therapy / Advanced auto therapy

Interface: Mouthpiece

/ Facemask / Trachy / ETT

Cough-Trak: On / Off

Inhale flow:

Low / Medium / High

Inhale pressure:

Inhale time:

Exhale pressure:

Exhale time:

Pause time:

Advanced Auto Pre-therapy: Off / Number of breaths .....

Advanced Auto Therapy breaths: Number of breaths .....

Advanced Auto Post-therapy: On / Off

Advanced Auto Cycles: .....

Preset:





Inhale flow:

Low / Medium / High

Inhale pressure:

Inhale time:

Exhale pressure:

Exhale time:

Pause time:

Advanced Auto Pre-therapy: Off / Number of breaths ......




Preset:





Inhale flow:

Low / Medium / High

Inhale pressure:

Inhale time:

Exhale pressure:

Exhale time:

Pause time:





Preset:





Inhale flow:

Low / Medium / High

Inhale pressure:

Inhale time:

Exhale pressure:

Exhale time:

Pause time:





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Action plan

Adapted from 'Physiotherapy management of the adult, medical, spontaneously breathing patient. Web Appendix 10 – Action Plan for a Person with Neuromuscular disease' BTS Guidelines (2009)

If the following describes you Action required

GreenIf you have an effective cough and no signs of a chest infection

- You are able to work, play or function as usual

- You do not have any of the symptoms in the next section

• Continue your prescriped cough assist routine

Amber:If your symptoms are troublesome and getting worse

- You start to feel unwell with cold or cough or notice a change in your cough

- You are producing phlegm which is diffi cult to clear

- You notice any of the following:

• You are having diffi culty swallowing

• You are more breathless on activity or lying fl at

• You are waking with headaches in the morning

• You feel tired during the day• You are lacking concentration• You suffer from general

malaise or poor appetite• You are getting regular chest

infections• You are needing to use your

ventilator more than normal

• Contact GP/ventilation service for a review or advice

• Consider starting your home supply of antibiotics (if you have them) if sputum green or yellow

• Increase use of cough assist as advised by your Physiotherapist

Red:Your symptoms have not improved or continue to worsen

- You are unwell with cold or cough and this has not improved with antibiotics /or treatment prescribed above

- You are producing phlegm and you are unable to clear it

- You are very breathless

• Contact your GP or local ventilatory service for an emergency assessment and advice.

• If you are on ventilation you can use your ventilator to support you while you wait for advice and or assessment

• If you have an oxygen alert card make sure you give this the health professional looking after you

• Do not delay – get help now

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Cleaning

Machine

Unplug the machine and clean the outside using a damp cloth using warm water and washing up liquid.

Allow the machine to dry completely before plugging in the power cord.

The machine requires servicing every two years. You will be contacted when this is due.

Circuit

The circuit and patient interface should be washed thoroughly with warm water and washing up liquid. We recommend this is done weekly but it may be required more often if you are coughing up a lot of phlegm. These parts must completely air dry before reuse.

The mask will need to be replaced if it becomes torn or if you can no longer maintain a good seal.

Pollen Filter

This should be taken out of the back of the machine once a week and washed in warm water and washing up liquid. This should be completely dried before replacing.

If you need a replacement please contact the Pulmonary Function Unit - see page 14 for contact information.

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Frequently asked questions (FAQs)

Question: Will I be taught how to use the machine before being given it at home to use?

Answer: Yes. Your physiotherapist will show you your E70 Cough Assist and explain how to use it. They will check that you are able to use it correctly. They will also make sure that your family or carers are able to use the machine. If you have any questions about using the machine you should contact the Respiratory Physiotherapy Department on (0114) 271 5060 (Monday - Friday, 8.30am - 4.30pm).

Question: Who do I contact if I have questions about the use of the machine?

Answer: If you have a question about how to use the E70 Cough Assist or are having problems using your Cough Assist you should contact the Respiratory Physiotherapy Department on (0114) 271 5060 (Monday - Friday, 8.30am - 4.30pm).

Question: Who do I contact if there is a fault with the machine?

Answer: If you have a problem with the E70 Cough Assist machine, or you think that you need a new circuit you should contact the Pulmonary Function Unit on (0114) 271 4784 (Monday - Friday, 8.30am - 4.30pm). Alternatively you can bring your E70 Cough Assist to a drop in session Monday to Friday 2.00pm - 3.00pm in the Pulmonary Function Unit, Chest Clinic, Brearley Outpatient Department, Northern General Hospital.

Question: Who will be responsible for machine maintenance?

Answer: Your E70 Cough Assist machine remains the property of Sheffield Teaching Hospitals NHS Foundation Trust. This means we take responsibility for all repair and on-going servicing. Your machine will require servicing every two years. You will be contacted when it is due.

Question: What do I do if my E70 Cough Assist is not working outside of normal working hours?

Answer: If your E70 Cough Assist needs replacing urgently and you cannot wait until the next working day please contact Brearley 4 ward on 0114 271 5092 and ask to speak to the nurse in charge. In order to get a replacement E70 Cough Assist you, or someone else on your behalf, will need to attend the ward with your E70 Cough Assist and this booklet.

References:

• BTS/ACPRC (2009) Guidelines for physiotherapy management of the adult, medical spontaneously breathing patient. Thorax, 64(1), i1-51. Web Appendix 10.

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Contact numbers:

Respiratory Physiotherapy Department:

• 0114 271 5060Monday - Friday, 8.30am - 4.30pm

Pulmonary Function Unit:

• 0114 271 4784Monday - Friday, 8.30am - 4.30pm

• Drop in clinics: Monday - Friday, 2.00 - 3.00pm

PD9659-PIL4111 v1 Issue Date: December 2018. Review Date: December 2021

Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better

To donate visitwww.sheffieldhospitalscharity.org.uk Registered Charity No 1169762

Alternative formats can be available on request. Email: [email protected]© Sheffield Teaching Hospitals NHS Foundation Trust 2018Re-use of all or any part of this document is governed by copyright and the “Re-use of Public Sector Information Regulations 2005” SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email [email protected]

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