Pediatrics – Respiratory: High Frequency Chest Wall Oscillation (HFCWO) Chest Vest Application Strength of Evidence Level: 1 PURPOSE: To dislodge mucus from the bronchial walls and to facilitate its movement up the airways. To clear the lungs from secretions, maintaining a patent airway. CONSIDERATIONS: 1. 2. 3. 4. 5. 6. 7. 8. The best times to perform this procedure are when the child wakes up, before bedtime, 1 hour before meals or 2 hours after meals. The child must be placed in the upright position for the postural drainage. Length of treatment and vibrating frequency is prescribed by physician. Treatment should not be longer than 45 minutes. If the child has a Gastrostomy or Jejunostomy tube it must be covered with a small piece of foam to prevent dislodgement or skin breakdown. Follow the manufacturer’s guidelines for covering the tubes. The child should have only a single layer of clothing on the chest. Avoid eating or drinking during treatment. DO NOT apply the vest too tight or it may cause: pain, respiratory distress or skin breakdown. If the vest is applied to loosely, the treatment will be ineffective. Read manufacturer’s instructions for cleaning equipment, vest and changing the filters. EQUIPMENT: HFCWO vest, machine and connecting hose T-shirt or light clothing PROCEDURE: 1. 2. Adhere to Standard Precautions. Identify and explain procedure to caregiver and patient, if age appropriate. 3. Remove any constricting clothing from child. 4. Review physician's orders for length of treatment and vibrating frequency. 5. Auscultate breath sounds to determine baseline prior to vibration treatment and observe chest area. 6. If the child has a Gastrostomy or Jejunostomy, cover with a small piece of foam per manufacturer’s instructions. 7. Apply vest properly, not too tight or loose. 8. Connect the hose to the vest. 9. Review machine settings with physician orders. 10. Push start button. 11. Watch the child carefully for signs of tiredness. The postural drainage should be stopped before the child becomes exhausted. It can be continued after the child has had an opportunity to rest 12. Auscultate breath sounds upon completion of vibration treatment. SECTION 20.29 __RN__LPN/LVN__HHA AFTERCARE: 1. Document in patient's record: a. Breath sounds before and after procedure. b. Secretions expelled. c. Patient’s response to procedure. d. Instructions given to caregiver. REFERENCES: Airway Clearance Using High Frequency Chest Wall Oscillation. (2009 January). Royal Brompton & Harefield NHS Foundation Trust. Manufacturer’s instructions (2009). Smart Vest Model SV2100. The Vest by Hill-Rom.