INTRAPULMONARY
PERCUSSIVE VENTILATION
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MANUAL
SECTION
POLICY CODE
and NUMBER
Care of The Patient
Treatment
TX-126
POLICY:
To provide a combination of therapeutic aerosol, volume oriented IPPB and chest physiotherapy directed toward
mobilization of endobronchial secretions and the resolution of atelectasis.
PROCEDURE:
SPONTANEOUSLY BREATHING PATIENT
I.
Gather Equipment
A. IPV Percussionator with 50-60 psi air or oxygen source.
B. IPV breathing head assembly with four color tubing.
C. Mouthpiece or mask (round percussionaire mouthpiece is the preferred delivery interface).
D. Solution for aerosol including medication, alpha or beta pharmocological agents and diluent. Diluent
should consist of 20 ccs using ¼ normal saline and sterile water. (i.e., 15 ccs sterile water and 5 ccs
0.9% normal saline or 10 ccs sterile water and 10 ccs 0.45% normal saline.
II.
Initiation of Therapy
A. Verify physician’s order for medication and diluent in patient’s chart.
B. Review patient chart and history prior to initiating IPV therapy.
C. Identify patient by checking armband.
III.
Patient Instruction
A. Introduce yourself and explain IPV therapy.
1.
Must properly familiarize patient with IPV.
2.
Apprehension from patient may occur without explanation.
B. Assess patient including:
a.
Breath sounds
b.
Heart rate
c.
Respiratory rate
d.
Color
e.
WOB
f.
Level of cooperation
C. Place patient in a comfortable sitting or semi-fowler position.
D. Assemble breathing head:
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INTRAPULMONARY
PERCUSSIVE VENTILATION
1.
Attach phasitron to top of nebulizer. Place mouthpiece on open end of phasitron and 4-5 links
of corrugated tubing proximal to mouthpiece.
2.
Connect the yellow, green , white, and red tubing to the corresponding yellow, green, white,
and red attachments on IPV percussionator. Snap lock into place.
3.
Connect the other end of yellow tubing to nebulizer, green to start button, white to phasitron,
and red behind mouthpiece. Snap lock into place. The arrow on the blue, read, and yellow
tubing must be pointing toward breathing head.
4.
Connect 50-60 psi air or oxygen source with long blue tubing to the corresponding blue
attachment on the IPV percussionator.
5.
Rotate the operating pressure control knob fully counter clockwise to the off position and
connect the IPV. Percussionator to gas source.
6.
Patient should understand the function of the remote thumb button and that they have control
over the frequency and duration of percussion.
7.
Rotate the operating pressure regulator control knob clockwise until a starting operating
pressure is selected.
a.
Adult: 25-30 psi depending on patient size.
8.
When operating pressure is selected, IPV is activated and aerosolization begins. Familiarize
patient with device by asking patient to breathe aerosol alone without depressing the remote
thumb button.
9.
Rotate the percussion control knob fully counter clockwise into the easy position (for rapid
oscillation).
10. Ask patient to start percussion by depressing the thumb remote button. Gradually allow the
IPV to fill the lungs and percuss them for 5 to 10 seconds. Have patient release thumb button
and completely exhale through mouthpiece.
11. Observe patient during percussive intervals for percussive chest movements. If no chest
movement is observed, the patient is probably nose venting. DO NOT USE NOSE CLIPS.
a.
Ask patient to hold thumb button depressed and exhale forcefully through mouthpiece
while it is pulsating.
b.
Repeat breathing cycle while unit is continuously pulsating as need until bi-lateral thoracic
persussion is observed.
12. Ask patient to release thumb button, exhale to a comfortable end level, and rest for a minute or
so. Patient should continue to breathe aerosol while resting.
13. Once patient is adjusted, comfortable, and performing technique will, slowly increase operating
pressure to optimal therapeutic pressure and slowly rotate percussion control knob clockwise to
decrease percussion rate.
14. Patient knows better than clinician what combination of pressure and frequency decreases work
of breathing the most. Patient may prefer the hold thumb button down for longer periods of
time.
15. Patient should continue to breathe aerosol when percussion is interrupted. The 20 cc of
solution will last about 20 minutes.
IV.
IPV via mask or artificial airway (tracheostomy tube)
A. Attach appropriate size of mask to open end of phasitron.
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INTRAPULMONARY
PERCUSSIVE VENTILATION
B. Attach one link of corrugated tubing with Hudson Elbow adapter to open end of phasitron if delivery of
IPV is required via tracheostomy tube. If patient has a cuffed tracheostomy tube, cuff MUST BE
DEFLATED.
C. Hold remote thumb button 5-10 seconds, then release for exhalation. Effort should be made to initiate
percussive pulsations with patient’s initiation of inspiration.
D. In some patients, it may be beneficial to maintain percussive pulsations for periods of 30 to 90 seconds
followed by brief rest periods breathing aerosol alone. Inflate cuff again upon completion of therapy.
IPV IN LINE WITH VENTILATOR
V.
Gather Equipment
A. IPV percussionator with 50-60 psi air or oxygen source. Red tubing will connect to IPV red T-piece.
Take cap off red attachment behind mouthpiece.
B. IPV breathing head assembly with four color tubing.
NEBULIZER TOP WITH RELIEF VALVE SHOULD BE USED.
C. Medication and 20 cc solution
D. 4-5 rubber connectors
E. Hudson green “T” adapter
F.
IPV pressure relief valve
G. Hudson Green one way valve
H. 15 mm connector
VI.
I.
IPV red T-piece
J.
Airlife white one way valve
Assembly of IPV in line with ventilator
A. Assemble breathing head as stated above for spontaneously breathing patient.
B. Place IPV into the ventilator circuit between the inspiratory limb and patient “Y”.
1.
Attach rubber connector to open end of phasitron.
2.
Place Hudson Green “T” adapter at rubber connector. Attach 2 rubber connectors on open ends of
“T” adapter.
3.
Attach IPV pressure relief valve (set 10-15 cm H20 above ventilator peak pressure) at one rubber
connector and Hudson Green one way valve to other.
4.
Attach 15 mm connector to one way valve and connect to IPV red “T” tube piece.
5.
Place rubber connector to end of red T-piece and place white one way valve.
6.
Place assembly into inspiratory limb at patient ”Y”. Other adapters may be required depending on
which ventilator circuit is being used. (Refer to diagram.)
7.
Activate IPV and set adequate operating pressure and percussion control frequency. As the
clinician you will have to find the combination of pressure and frequency best suited for the patient.
8.
Activate percussion before and during inspiratory phase of ventilator. Observe patient for adequate
chest excursion. When inspiration ends, release remote thumb button and allow patient to exhale.
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INTRAPULMONARY
PERCUSSIVE VENTILATION
9.
VII.
Percussion can also be activated through inspiratory and expiratory phases and then releasing the
remote thumb button. Continue therapy on alternate ventilator cycles.
Additional Information
A. Large volumes of pulmonary secretions can be mobilized during IPV therapy, so monitor patient
carefully.
B. Documentation should include:
1.
Maximum operational pressure achieved.
2.
Heart rate before, during, and after therapy.
3.
Effectiveness of cough, sputum production, signs of stress, fatigue and discomfort.
C. Patient may complain about “sore ribs” after initiating treatment. Discomfort should disappear within a
short time.
D. Patient may experience fatigue during first treatments. Rest periods of several minutes are acceptable as
long as aerosol is breathed while not percussing.
E. When administering IPV via ventilator observe peak pressure carefully.
VIII.
Sterilization
A.
B.
Following IPV treatment:
1.
Rinse nebulizer and phasitron with sterile water.
2.
Place on clean towel and allow to air dry.
Once a week and/or between patients.
1.
Wash nebulizer, phasitron, and colored tubing in warm soapy water.
2.
Rinse completely.
3.
Sterilize in cidex.
References: Brief from Protocols For The Administration Of Intrapulmonary Percussive Ventilation (IPV) by
Percussionaire Corporation.
References:
JC-HAS:
OTHER: