Patient Guide
12 Pages
Preview
Page 1
A Patient Guide to the NIPPY Clearway
NIPPY ®Clearway
Why do I need to use a NIPPY Clearway? 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).
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.
Irritation
Breath in
Compression
Expulsion
The NIPPY Clearway is a mechanical insufflation-exsufflation device. These devices can help improve your cough strength. Your device will be set up by your physiotherapist/clinician. The NIPPY Clearway gives a deep breath in (insufflation) followed by a rapid suck out (exsufflation). This simulates what naturally happens when you cough and therefore can make your cough stronger so you can bring mucus up in to your mouth or high enough to be cleared.
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3
Navigation of your NIPPY Clearway
Ins
Exs Outlet Mask Pressure
On/Off – Press once to turn device on, press twice to turn device off
Start/Stop – Press to start or stop treatment
4
s
Ex
Ins
Mask Pressure Line Valve – Attach thin tube from breathing circuit here
Ins
Exs
Insufflation/Exsufflation Trigger (for use in manual mode) – Move the switch to the left for insufflation, hold to maintain pressure until switch is released, move to the right to activate the exsufflation
Air Outlet – Attach large tubing here
Outlet
Mask Pressure
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Navigation of your NIPPY Clearway
INS
EXS
External Battery – Twist clockwise to lock in place
6
Hand control – for use in manual mode Mains power connection
Air inlet filter and cover
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Setting up your NIPPY Clearway Interface options
1
Place the NIPPY Clearway on a clean, smooth, hard surface (not carpet).
A
Tubing
2
Connect to the mains or battery.
B
Pressure monitoring line
Attach the breathing circuit to the air outlet and pressure line to the mask pressure valve on the front of the NIPPY Clearway.
C
Carbon dioxide leak port. Do not cover this up during treatment, especially when using device in NIV mode
3 4
Attach breathing circuit to the interface. The bacterial filter should be at the end of the circuit closest to interface. This helps to protect the breathing circuit from any secretions.
1
2
3
D
Oxygen supply connection
E
Anti-bacterial filter
E
Catheter Mount
D
C
Mouthpiece & nose clip
4 B A s
Ex
Ins s
Ex
s
Ex
Ins
Ins
8
Facemask
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Entraining oxygen to your NIPPY Clearway
Information about treatment and settings Attach to interface here
If you need supplementary oxygen, it may be entrained via a connector as shown below:
• If you need a caregiver to assist with treatment, you may want to agree on a signal with them to alert them that you want to stop treatment. This maybe a thumbs up, looking up or shaking your head.
• Always switch on the NIPPY Clearway before the oxygen supply. When adding oxygen, attach an entrainment port at the mask or tracheotomy end of the circuit. • When treatment is complete, switch off the NIPPY Clearway and disconnect the oxygen tubing from the breathing circuit. • Store the breathing circuit in a clean bag or other suitable container.
Ins
s
Ex
s
Ex
Ins
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Oxygen port
• Treatment settings are prescribed like medicine; therefore, they should only be set by a clinician. Your device will be programmed with the appropriate settings for you. • If possible, try to avoid treatment immediately after a meal or food. • When using the NIPPY Clearway in the automatic modes, a Synchrony Beep will sound prior to the delivery of the negative pressure, signalling when to cough (if mucus is present), making the treatment more effective.
s
Ex
Ins
• Treatment is usually carried out in the position you cough best in. Your clinician will advise you on this.
• A NIPPY Clearway has different modes and therefore can provide different treatments. Treatment usually consists of insufflation time (Ti) (length of the breath in), exsufflation time (Te) (length of the suck out), and a pause. These three times are called a cycle. The number of cycles you should do in each treatment will be advised by your physiotherapist or clinician. After each treatment, you may need to have a short rest (30 seconds or longer). Any secretions can then be cleared.
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Starting treatment
Changing the mode on your NIPPY Clearway
When you switch on the NIPPY Clearway, it will remember the last settings that were used, so you will not need to set up the device each time, unless you are changing to a different prescription or mode.
The NIPPY Clearway has 5 different modes. Your clinician will set up the device with the most appropriate mode or modes for you.
1 2
Turn the NIPPY Clearway on by pressing the On/Off button. Position the interface. If using a mask, ensure it is firmly against your face to prevent air leakage. Your carer may need to support the back of your head to ensure a steady seal of the mask.
1
2
3 4
Use ‘Start/Stop’ button to commence therapy. If you use a ventilator in addition to the NIPPY Clearway, ensure that you only begin treatment with the NIPPY Clearway when you are ready and your ventilator is ready for you to use at the end of treatment.
3
s
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Use the - and + buttons to highlight the desired mode. Press the Set button to select. The individual settings for each mode will be retained in memory so you do not need to alter the settings each time you change mode.
Ins
Exs
Ti
Te
Pause
Cycle Rpt
Ins Rpt
Menu Clear
Mode
Help
Ext. Batt. Power
Start Stop
– Set +
s
Ex
Ins
If you have multiple modes programmed, change the mode, by pressing the Mode button to display those available to you.
Max on time 30 minutes in any 1 hour period.
Ex
Ins
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What does the therapy tracking screen mean?
Cleaning and maintenance
Ti - Breath in
The device:
Filters, breathing circuit and interface:
•
The device and power cord should be checked for signs of external damage weekly. If any damage is evident, contact your clinician.
•
•
To clean the device, make sure it is switched off and disconnected from the mains or external battery.
•
Using a clean, damp cloth, wipe down the exterior of the device. You may use a mild neutral detergent or soapy water or an antibacterial wipe. Do not immerse the machine in or spray with water or use any solvent cleaning solutions.
The air inlet filter, located on the back of the machine, should be checked weekly and replaced when grey or visibly soiled. To remove the filter, grip the black plastic filter housing across the top corners and pull away. Remove the filter and replace it only with a spare provided by Breas Medical Ltd or reputable distributor. Push the filter cover back in place when the filter has been replaced.
•
The breathing circuit, bacterial filter and interface will also need replacing. If visibly soiled, these should be replaced before continued use, otherwise your clinician will advise how often you should replace each item.
P - Pause You will hear a ‘beep’ just before it delivers the negative pressure, at this point you should cough if mucus is present. The number in the top right corner shows the current cycle being performed by the Clearway. In this example, the device is on cycle number three out of a total of 20. The vertical white line tracks where you are in the treatment cycle on the screen. The NIPPY Clearway works through the programme of therapy, and when it beeps and ‘auto sequence complete’ appears on the screen, the treatment is finished. You may need to repeat the sequence if you feel it is necessary.
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Ins
30
Active Treatment Display
3/20
Exs
25 20 15
Ti Pause
10
cmH2O
Te - Cough phase.
Max on time 30 minutes in any 1 hour period.
Te
Ti
5 0 -10
Ins Rpt Mode Ext. Batt. Power
Cycle Rpt
P
-5
Te
-15
Menu Clear
-20 -25 -30
0.0
1.0
2.1
Pressure
Start Stop
3.1
4.2
Help
– Set +
•
Wash the interface. You may use a mild neutral detergent or soapy water or an antibacterial wipe after use and dry it with a clean cloth.
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Troubleshooting
Your prescription settings 1
Your NIPPY Clearway device will alarm or display a message when it requires attention. Below is a list of common alarms or information messages and what to do if these occur while you are using the device. Alarm/Information Message
User Action Required
Mode
Power Disconnect
If electrical power is interrupted, an audible alarm will sound and a message will appear on screen.
Insufflation Pressure
Action: check the power cable is plugged into the mains, secured in the back of the device and isn’t damaged. If you are using the external battery, check it is connected correctly.
Pressure Line Disconnect
Breathing Circuit Disconnection
Spanner symbol
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Insufflation Trigger
Exsufflation Pressure
cmH2O
Te
Sec
Ti
Sec
Cycle Repeat
Action: reconnect tube and inspect for any damage.
Pause
Sec
Device locked
Patient breathing circuit has become disconnected.
Insufflation Repeat
Proximal pressure line has become disconnected. Device still functions with possible reduced effectiveness.
Action: reconnect circuit and inspect for any damage.
Low External Battery
cmH2O
When the device is running on the external battery, an alarm will sound when the battery power is low.
Yes/No
Interface
Advance Settings:
Action: either recharge or replace battery, or switch to mains power.
Insufflation Oscillations
Flow Profile
If your device is due a service, it will display a black flashing spanner symbol. The device will continue to function as normal.
Exsufflation Oscillations
Oxygen
Action: contact your clinician or Breas Medical directly to organise a service.
Post Exsufflation Breaths
L/min
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Your prescription settings 2
Your prescription settings 3
Mode Insufflation Pressure
Mode cmH2O
Insufflation Trigger
Exsufflation Pressure
cmH2O
Insufflation Pressure
Te
Sec
Insufflation Trigger
Ti
Sec
Cycle Repeat
Pause
Sec
Device locked
Insufflation Repeat
Yes/No
Advance Settings:
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cmH2O
Te
Sec
Sec
Cycle Repeat
Pause
Sec
Device locked
Yes/No
Interface
Advance Settings:
Insufflation Oscillations
Flow Profile
Exsufflation Oscillations
Oxygen
Post Exsufflation Breaths
Exsufflation Pressure
Ti
Insufflation Repeat
Interface
cmH2O
L/min
Insufflation Oscillations
Flow Profile
Exsufflation Oscillations
Oxygen
L/min
Post Exsufflation Breaths
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Notes
Notes
*NIPPY Clearway is a trademark of Breas Medical AB
Breas Medical Ltd is registered in England and Wales: Reg No 07190611.
Breas Medical Limited, Unit A2, The Bridge Business Centre, Timothy’s Bridge Road, Stratford-upon-Avon, Warwickshire CV37 9HW United Kingdom ∙ Phone +44 (0)1789 293460 ∙ www.nippyventilator.com
Breas Medical AB/2017/DOC2610
© 2017 Breas Medical – All rights reserved. Breas Medical reserves the right to make changes in specifications and features shown herein, or discontinue the product described at any time without notice or obligation. Contact your Breas representative for the most current information. Breas and the Breas logo are trademarks of Breas Medical AB.