Use Normal Saline (NS) only in Nebulizer cup (15-20mls)
Minimum therapy time is 15 Minutes
Give nebulizers via aerogen or small volume nebulizer before initiating IPV
The IPV is connected to a blender to give the treatments and not just plugged into the O2 source on the wall because you want to match the level of FiO2 the patient is on prior to the treatment to have a better since of oxygenation status during the treatment. You may have to adjust settings based on the O2 Sat
Indications
Aid in mobilization and removal of retained secretions from central airways
Increase effectiveness of cough
Aid in resolution of atelectasis/pneumonia
Improve ventilation/perfusion
Improve oxygenation
Improve chest x-ray
Contraindications
Untreated pneumothorax (without chest tube)
Hemoptysis
Active tuberculosis
Key Points for Usage
Turn machine on before connecting to the patient
If nebulizer cup is not nebulizing the baffle is not in place
During IPV for Trached or Intubated Patients you should Deflate the Cuff to aid in secretion removal. Re-inflate cuff after treatment
Increase Driving Pressure to achieve effective percussions by assessing chest wiggle percussion knob progression through-out the treatment
Percussion should be delivered from EASY (faster rate-counter clockwise) to HARD (slower rate-clockwise). Go from easy to hard, allowing for patient to breathe for several breaths at each incremental change before moving to harder settings. End Therapy on Easy (faster rate-counter clockwise) to allow patient to build up FRC before ending therapy
During the treatment you be monitoring:
Chest wiggle
So you know you are using high enough pressures
Blood Pressure
Increased intrathoracic pressures can cause a decrease in blood pressure
O2 saturations
Decreased O2 could signify a need to be suctioned or a decrease in MAP that would require adjustment of your settings. To compensate. If a Map issue, increase speed of percussion to allow for more breath stacking and build-up of FRC
NIRS
Decrease in CO2 causes cerebral vasoconstriction, leading to a decrease in brain sats
Level of Consciousness
Decrease in CO2 causes cerebral vasoconstriction, leading to a decrease in level of consciousness because there isn’t as much blood flow to the head
Assess tidal volumes before and after IPV treatments
Cleaning
Rinse IPV Pieces with sterile water and place in designated drying area after treatment
IPV 2C Dials
Operation Pressure Dial
The available pressure, as measured in psi, that is available for the therapist to control
Is this pressure/flow delivered to the patient? No, it is limited by the insp flow dial
Demand cpap/peep
Flow that is added to the system at a constant rate that increases the base peep the more you increase the dial/flow. Adds a level of guaranteed pressure that is in addition to the trapped peep produced by the percussion frequency dial.
Target the peep the patient requires with the multimeter peep reading on the 2c.
The demand flow will need to be adjusted as the Frequency is manipulated during the treatment.
The demand flow is not always needed with every patient when the 2c is used.
Inspiratory Flow
Increases the flow/pressure to the patient. This controls how much pressure/flow is given and should be adjusted based on patients chest wiggle.
Nebulizer Toggle
Turns on and off the nebulizer.
Inspiratory Time
This controls the I:E ratio of the percussion breath. We leave this at 12 o'clock for treatments.
Frequency Dial
This controls the amount of percussion bursts there will be given over a measured time frame.
Slow percussion rates = bigger volume, lower CO2, increased secretion movement, less trapped peep and lower spo2.
Higher percussion rates = smaller Volume, higher co2, less secretion movement, increased trapped peep and spo2, increased lung recruitment after secretions moved.
Master Dial
Turns total pressure/flow on and off
Manual Inspiratory Button
Opens total flow to the patient as long as you depress button. Risk for high pressure/flow delivery to the patient. Use with extreme caution.