A50474-2 In-Line Procedure

IN-LINE PROCEDURE USING CONE ADAPTER (A50474-2)
(ARTIFICIAL AIRWAY+ MECHANICALLY VENTILATED)

1. Introduce yourself and explain procedure to patient.  
2. Connect to appropriate power source.  
3. Connect IPV® in-line interface part # A50474-2 (See Drawing) to ventilator circuit.  
4. Short end of harness assembly should be connected to IPV®/IMPULSATOR® unit using correct color-coding.
5. Long end of harness assembly should be connected to Phasitron® and nebulizer using correct color-coding.  
6. Fill nebulizer with prescribed medications and dilute to 15 to 20 ccs. assemble Phasitron® to nebulizer.  
7. The following settings should be observed. 
   A. Pressure Control, SIMV-PC, and PRVC (or similar).  
   B. Turn off pressure support and flow-by.   
   C. Maintain PEEP level. 
   D. Adjust Tidal Volume and Minute volume alarms as necessary.
   E. If using an older vent such as PB 7200, Other considerations may apply.  (consult dealer).
8. Rotate frequency control knob full counterclockwise to the easy position.  
9. Rotate source pressure control knob for an initial operating pressure of 20-25 psi.  
10. Remove Phasitron® and nebulizer unit from manifold, turn unit on and observe for aerosol mist, observe percussions, turn unit off.  
11. Reconnect Phasitron® and nebulizer assembly to manifold.
12. Turn unit on and observe chest wiggle. 
    A. Patient should be assessed as necessary for BS, HR, RR, PIP see cautions,  warnings.  
    B. Assess for signs of air trapping. 
13. Once ventilator alarms (volume) have been adjusted you may lower artificial airway  cuff pressure. (If Available)
    A. Lowering of the cuff pressure facilitates secretion removal into the oral cavity where they may be suctioned. This also helps in the prevention of tube obstruction in the event copious secretions are mobilized.  
14. During the treatment, which should be about 15-20 minutes in length, the entire percussion frequency should be scanned (easy - hard) in order to mobilize secretions in the different time constants of the lung.  
    A. Source Pressure should be adjusted for effective internal percussions by assessing "chest wiggle"/chest wall movement, auscultation and patient comfort. 
15. Treatment should continue until all medication is delivered.  
    A. Additional diluents may be added if necessary.  
    B. Suctioning should be as needed and at the end of treatment.
    C. Longer duration treatments may be performed by adding diluents to neb  NEVER run device without nebulization 
16. When treatment is complete unit should be turned off (bleed off internal pressure in IPV®) 
17. Breathing head and manifold should be dismantled and stored/cleaned for future use.   
    A. Re-inflate cuff as appropriate.   
    B. Adjust and observe ventilator settings as necessary.
    C. Reassess patient for airway obstruction. 

Patient cannot be ventilated through an obstructed airway.
See Clinical Manuals for complete instructions.