Transcript MetaNeb Therapy

Application for HFCO therapy
in airway clearance
Theory and Indications
Metaneb TM is indicated for the mobilization of secretions ,
lung expansion therapy , and the treatment and prevention
of atelectasis.
Patients with conditions/disease states that may benefit :
Bronchiolitis
Asthma
Chronic Bronchitis
Bronchiectasis
Neuromuscular disorders/deficits
Emphysema/COPD
Post operative management and management of hypoventilation
Airway management , lung expansion therapy in an acute setting ( ED )
Absolute Contraindications
*
Untreated pneumothorax
* Unskilled operator of
the Metaneb device
Relative Contraindications
Subcutaneous emphysema
Broncho-pleural fistula
Myocardial infarction
Vomiting
Pulmonary hemorrhage
Recent pneumonectomy
Untreated pneumothrax ,
or history of pneumothorax
Plateau pressures > 30 cm H20
Cautions
Read User manual before using
Circuit is single patient use only
Do not occlude entrainment orifices **
Do not use non-invasive application on
uncooperative patients
Use only with nebulizer unit provided
CPEP mode is not to be confused with CPAP
Dispose of Metaneb circuit appropriately
Modes of operation
3 selections / 2 modes
Can be run on Aerosol only
CPEP : Continuous positive
expiratory pressure
CHFO : Continuous High
Frequency Oscillation
Circuit assembly and function check
Connect to 50 psi gas source
Connect circuit to power box
Set mode to CHFO , select
“HIGHER” impact setting
Adjust green selector
ring to 3 dots
Flip master switch on
Observe/ time CHFO rate to
13-23 pulses in 5 seconds
Set mode to CPEP , with
selector ring at 3 :
Occlude patient patient port
Observe manometer for pressure
of 20 cm and not > 32 cm H20
METATHERAPY TM
Protocol and Procedure
Frequency : common strategy advocated in
acute care setting is 2-4 times a day. Patient
response should direct frequency adjustments
Procedure for non-invasive application
1. Check MD order
2. Obtain medications and verify in MAR
3. Proper hand-washing or foam
4. Introduce yourself to patient , check 2 patient identifers.
5. Perform patient assessment
6 Connect MetaNeb tm circuit to powerbox , fill nebulizer
cup with prescribed medications.
7. Set mode selector to CPEP TM
8. Set entrainment selector ring to “2” orifice indicator dots.
9. Connect to gas source and flip Master switch “ ON”
10. Occlude pt port and adjust CPEP flow level until manometer
reads 10 cm H20 pressure.
11. Attach interface ( mouthpiece or mask )
Procedure for non-invasive application
12. Instruct patient to breath in and out through mouthpiece.
13. Encourage slow exhalation : 3-4 seconds.
14. Adjust entrainment selector ring from 1 dot to 3 dots
( least to greatest resistance) , as tolerated by patient.
15. Continue CPEP mode for approximately 2 ½ minutes .
16. Instruct patient that mode will change to a pulsatile delivery of gas.
Instruct the patient to inhale and exhale through pulsations.
Encourage the patient to keep lips and cheeks splinted
Switch to “HIGHER” impact setting. Change mode to CHFO TM .
Encourage patient to breathe through pulsations and exhale slowly.
17. Continue CHFO for approximately 2 1/2 minutes .
Alternate between CPEP and CHFO until therapy session complete
10 minutes or until nebulization complete.
18. After treatment , turn off unit , and store circuit for future use.
Re-assess patient
Decontaminate with hand-washing or foam
Complete documentation of therapy
Assessment of Outcome
1.
Decrease in secretion/mucous production to
< 5 ml per 24 hr treatment period.
2. Evidence of resolved issues with atelectasis
( radiologic exam) , or retained secretions
by chest exam, CXR or bronchoscopy.
MetaNeb
TM
In-line / Ventilator Protocol
1.
2.
3.
4.
Follow organizational infection control standards
Connect Metaneb gas hose to 50 psi gas source
Connect Metaneb circuit to powerbox
Place spring loaded “tee” one-way valve into the
inspiratory limb of circuit.
5. Maintain patient position with HOB > 30 degrees
elevated if tolerated.
6. Perform patient assessment
7. Prepare MeteNeb handset :
Use 15mmOD X 15mmOD
and 15 mm 0D X 7.5 mm ID to connect handset
Green entrainment ring set to selector
dot “1”. May adjust to “3” as tolerated.
to spring loaded “tee”. Fill nebulizer unit
8. Patient ventilator mode should be switched to
a pressure directed mode :
PCV ( PC or PC SIMV) , PSV, PRVC , APRV
MetaNeb tm
In-line / Ventilator Protocol
9.
Switch to a pressure trigger setting if sensitivity set to
a flow trigger to avoid auto-cycling.
Recommendations: Avea & Vela :20 lpm , Drager : max setting per
pt range , LTV : set to 9 . Pressure trigger on Avea to - 10 cm.
10. In PCV or PRVC : lengthen Ti to achieve a 1:1 I:E ratio
11. MetaNeb therapy adds flow and potentiates circuit pressure. There
may be consideration for turning
PSV down or off during treatment .
12. Insert handset into spring loaded “tee”
13. Flip master switch to ON. Switch impact to “HIGHER”
14. If HOB > 30 degrees is maintained , a slight
cuff leak may be created to enhance cephalad
flow and facilitate secretion removal from the
oral cavity. Care should be taken to not create
to great a leak , the MetaNeb cannot compensate for.
15. Adjust alarms accordingly.
16. Monitor patient vital signs closely during therapy.
17. When therapy complete :
Resume previous ventilator parameters :
MODE , Ti , Flow trigger . PSV , Alarms
18. Turn off Master switch , disconnect “tee” and circuit.
Store appropriately for future use.
19. Re-assess patient and document therapy
20. Practice appropriate infection control standards post therapy.