Nippy Clearway Clinical Guide 2017

Contents o o

o o

o o o o

Basics of Cough Mechanics Navigation of NIPPY Clearway  Back of Device  Front of Device MIE and IPPB Circuit components NIPPY Clearway modes:  Manual control  Basic Auto  Programmed Timed Auto  Programmed Triggered Auto & IPPB setup  NIV mode (15 mins max usage) How to add Insufflation & Exsufflation flow oscillations How to change the Insufflation flow profile (aka ‘flow rate’ on the bird) How to change the mode menu options How to lock the NIPPY Clearway

Why use Mechanical Insufflation Exsufflation? Cough is essential to prevent a build up of mucus/phlegm from our airways. Mucus is important as it traps dirt and bacteria. The mucociliary escalator transports the mucus to the larger airways and is usually cleared with a cough. In order for a cough to be strong and effective the following occurs: • A deep breath in. • A short pause and closure at the top of our airway allowing pressure to build up in the chest. • A good strong expiratory muscle contraction (abdominal muscles and intercostal muscles).

Why use Mechanical Insufflation Exsufflation? These components are essential to get enough air into the lungs, so that when the expiratory muscles contract, the air comes out faster, clearing the mucus up towards the mouth. If we have a weakness in the muscles that we use to take in a deep breath, or in our expiratory muscles, our cough strength decreases and becomes less effective resulting in a build up of mucus within the lungs. The NIPPY Clearway is a Mechanical Insufflation-Exsufflation device. These devices can help improve a patient’s cough strength. The device should be set up by a qualified respiratory physiotherapist/clinician. The NIPPY Clearway gives a deep breath in (Insufflation) followed by a rapid shift to a negative pressure (Exsufflation), in order to augment an expiratory flow sufficient to clear chest secretions to the upper airway.

Back of Device Serial Port for Hand Held Remote

Cooling Vent

External Battery Attachment

Mains Power Attachment

Air Inlet/Dust Filter – change 1-2 times per year

Front of Device Manual Switch

Air Outlet

Mask Pressure Line Valve

NIPPY Clearway MI-E Circuit (Single Patient Use) Mask Pressure line – feedback for accurate pressure delivery from exhalation valve

Leakage Valve

22mm Clearway circuit (changed monthly, but weekly in ICU))

Anti Bacterial Filter (changed weekly, but daily in ICU)

NIPPY Clearway IPPB Circuit (Single Patient Use) Active valve pressure line

Mask Pressure line – feedback for accurate pressure delivery from exhalation valve

Active Exhalation Valve

Anti Bacterial Filter (changed weekly, but daily in ICU)

Setting a Prescription

Press the ‘Mode’ button to enter the therapy menu

Turn the device off and on with the power button

Manual Mode In Manual mode, you set your Insufflation and Exsufflation Pressure and deliver the pressures via the manual switches – handheld or on the front of the Clearway

In manual mode, and for 1 minute after all programmed modes, the green hand on the screen indicates the manual switches can be used to deliver pressures

Basic Auto Mode The Basic Auto mode delivers a clinically preset cycle of one breath in followed by a cough, followed by a pause. This cycle repeats up to 20 times, or until you stop the treatment

Use ‘Start/Stop’ button to commence/stop therapy

Therapy Tracking Screen

The NIPPY Clearway counts the number of completed cycles in the top right corner

Note: In the Basic Auto mode, 20 cycles will be delivered as a default unless the therapy is stopped beforehand

Programmed Timed Auto Mode The Timed Auto mode delivers a clinician preset cycle of multiple insufflations, divided by pauses, followed by an exsufflation. These cycles can be set to repeat a number of times TIMED AUTO

Use ‘Start/Stop’ button to commence therapy

Programmed Triggered Auto Mode The Triggered Auto mode delivers a clinician preset cycle of multiple patient triggered insufflations, divided by pauses, followed by a cough.

Lengthen the pause time to give the patient time to trigger the next breath

These cycles are set to repeat a number of times

Use ‘Start/Stop’ button to commence therapy

Setting up for IPPB use Select the Programmed Timed or Triggered mode for IPPB use, and set the Exsufflation pressure to 0cmH20 Increase the pause time so there is a sufficient gap for the patient to feel comfortable to trigger their next breath of their own accord. Adjust the trigger sensitivity under the second option in the main Menu

The number of triggered breaths delivered is equal to the ‘Ins repeats’ x ‘Cycle repeats’

0.0 cm

6.00 sec

Non Invasive Ventilation Mode Set an IPAP, EPAP, Inspiratory time and Breathing back up rate for a Pressure Control mode of ventilation

The maximum treatment time 15 minutes – useful for reducing patient’s work of breathing pre/post cough therapy if required.

Patients should be monitored while using NIV mode due to absence of any clinical alarms. Always ensure the exhalation valve is fitted in the circuit when using this mode.

Setting up the Flow Oscillations

Press the Menu Button Select 3: Settings and Options Select 2: Advanced Settings Change Oscillation Magnitude settings by using +/-/set buttons

Setting up the Insufflation Flow Profile

Press the Menu Button

Select 3: Settings and Options Select 3: Profile Settings Change Profile setting using +/-/Set

Setting up the Insufflation Flow Profile Faster Rise Time

Slower Rise Time

Note the visual difference in the shape of the Insufflation flow curve

Deactivation of unused modes

Press Menu Button

Select 3: Settings and Options Select 4: Mode Select Options Turn off any modes you do not want carers to access using +/-/Set buttons