• Reference Number: HEY-1314-2022
• Departments:
• Last Updated: 1 July 2022

Introduction

This leaflet has been produced to provide important information regarding care and treatment from the Home Ventilation Service.  Most of your questions should be answered by this booklet- please keep it in a safe place for future reference.  It is not intended to replace the discussion with the Doctor or Specialist Nurse, but may act as a starting point for discussion.   If there are any concerns or further explanation is required, please discuss this with a member of the Home Ventilation team.

This is a relatively simple treatment to use and carers will be given support and advice to manage the treatment and patient’s condition as appropriate. Regular training sessions for Carers are available at the Home Ventilation Department at Castle Hill Hospital- please contact us if this is required.

What is Cough Assist?

The equipment used is a pressure controlled, mechanical insufflator / exsufflator cough assist machine. It assists in the mobilisation and clearance of chest secretions by inflating the lungs with a positive airway pressure then providing a rapid change to negative pressure to assist the patient’s cough.

Ambient air is compressed by a turbine and delivered to the patient through a close fitting facemask, mouthpiece or a tracheostomy.

The Cough Assist Device may be used in hospital or homecare environment.

Why is Cough Assist needed?

The Cough Assist is typically used in patients who are unable to cough and effectively clear secretions as a result of neuromuscular disorders, spinal cord injuries or severe fatigue associated with lung disease.

Secretions will usually be cleared to the mouth so Yankeur suction may be required.

If the patient requires admission to hospital please ensure they take the cough assist to hospital with them- they must continue with this treatment in hospital. Some areas of the hospital and some nursing and/or medical staff may be less familiar with this equipment- please ask them to contact the Home Ventilation Team as soon as possible for support and advice- there is a 24 hour answerphone available for this. They will also need referral to the Physiotherapy team while in hospital to support with treatment.

How is Cough Assist used?

THE COUGH ASSIST SHOULD BE USED EVERY MORNING AND EVENING- THIS ENSURES THE LUNGS ARE PROPERLY INFLATED.

It can be used more often throughout the day if the patient has a chest infection or very productive secretions. 

The machine works by inflating the patient’s lungs with a positive airway pressure then providing a rapid change to a negative pressure enabling the patient to cough and mobilise secretions. The program will be set by the Home Ventilation Nurse and should not be adjusted.

If the sputum is in the patients mouth this can be removed with a tissue or suction machine.

How to use

• Make sure the tubing is correctly attached to the machine, filter and mask.
• It is important that the filter is in place at all the time as this stops potential contamination of the machine.
• Switch the machine on (Power button).
• Make sure the patient is comfortable and in a good position (sitting in a chair or in bed at least 45 degrees).
• Ensure the patients head is well supported.
• Explain to the patient when you are going to place the mask.
• Place the mask on the patients face ensuring there is a good seal -use one hand to do this and use the other hand to support patients neck and head.
• Press the Start/Stop button.
• The machine will start automatically.
• There will be a breath in (the number of breaths will depend on the individual setting usually between 1-5) then a negative breath out. Keep the mask securely on the face- If good mask seal is not achieved, the machine will not achieve its set pressure.
• When the cycle is completed the machine will automatically stop. If you need to clear secretions, you can manually press the Start/Stop
• On the end of the treatment there will be an additional option to deliver Recruitment breath therefore you need to press the START/STOP button again to deliver the breath
• If sputum falls in to the mask -stop therapy to avoid pushing sputum back in to the mouth. Wipe the mask clean and then restart to complete the number of breaths.
• The screen displays a graph that shows the breath in and out.
• When therapy is completed turn the machine OFF using the Power button.
• If the mask has been contaminated with sputum after the cycle is completed wash out with warm soapy water, rinse and let air dry. If the filter been contaminated change the filter when therapy is completed.
• Change the filter every day if the patient has a chest infection, otherwise change once a month.
• Change tubing circuit every 3 months.

NEVER remove the mask on the breath out. Only remove the mask on the positive breath in or during the Pause between breaths. The only time you need to remove the mask immediately during therapy is if the patient starts to vomit. 

If the patient has a chest infection and is having problems clearing secretions, you may need to use Cough Assist more frequently; you can repeat the number of cycles up to three times consecutively. Please remember that this will give the lungs quite a workout, so do not let their muscles become over tired. 

Cough Assist is used to help to clear secretions and ventilate the lungs as a form of chest physiotherapy. 

IT IS DANGEROUS TO USE THE COUGH ASSIST WHEN A PATIENT IS CHOKING. YOU MAY CAUSE THE OBJECT TO MOVE FURTHER INTO THE AIRWAY CAUSING A SERIOUS OBSTRUCTION AND EMERGENCY SITUATION.

Care of equipment

Daily cleaning – each morning use a clean damp cloth to wipe around the mask to remove any oil or saliva build up. Do not use any cleaning solutions or wet wipes. Leave the mask to air dry, ensure it is not in direct sunlight and do not place near a source of direct heat.

Weekly cleaning or if contaminated – Hand wash the mask in a bowl of warm soapy water (use own brand washing up liquid). Rinse the soap from the mask and leave to air dry, ensure it is not in direct sunlight and do not place near a source of direct heat. Do not use a towel to dry as this will cause a buildup of static.

Filters – change once a month (unless the patient has a chest infection then change daily)

Tubing – change every 3 months 

DO NOT USE ANY GELS, WIPES OR ANY OTHER CHEMICALS ON THE MASK.  These can cause the mask to perish and cause damage affecting its use.

The Cough Assist will have a green label on the side to say when its next service is due. Please inform the Nurse when this date is approaching so that a replacement machine can be left for collection or be exchanged at the next clinic appointment with the Specialist Nurse.

Cleaning- wipe the outside of the machine with a damp cloth. Ensure the machine is unplugged from the mains electric prior to cleaning. Do not immerse the machine in liquid. Most machines have a simple dust filter covering the air inlet- these should be inspected weekly and changed when contaminated. The filter will be checked when the machine is serviced, but if it looks especially dirty please contact the Home Ventilation Team for a replacement.

The Cough Assist requires mains electricity and should be plugged in before attempting to use. The Power LED will be illuminated when connected to an electricity supply.

 Cautions

1. The functioning of the machine can be adversely affected by electromagnetic interference e.g. mobile telephone operation may adversely affect the operation of the machine.

2. If the machine is moved from cold surroundings into a well-heated room, condensation may form. Do not operate the unit for at least 2 hours to allow any condensation to evaporate.
3. Do not operate the machine in direct sunlight.
4. Avoid places where there is excessive humidity or dust, which may cause damage to internal parts.
5. Keep the machine away from extreme direct heat, such as fires, heating radiators etc., and always allow a 100mm (4.0in) air space around the unit when in use.
6. If liquids are allowed to enter the unit, serious damage could occur. If any liquid gets into the machine, contact the Home Ventilation Team as soon as possible to arrange replacement equipment.
7. Do not place any form of cover over the machine, especially near the air intake.
8. Adding extra components to the breathing circuit may cause the pressure, during expiration to increase.
9. If intending to transport the device or use in multiple locations the device should be placed in the mobility bag to provide protection.

Clinic appointments

The patient will be sent clinic appointments with the Home Ventilation Nursing Team as required. Their clinical condition and response to treatment requires monitoring while they are using Cough Assist. By consenting to start treatment the patient is agreeing to attend these appointments. Failure to monitor effectiveness of treatment may be detrimental and affect the patients health.

During the appointment the Nurse will check the Cough Assist settings and filters, if a service is due the machine will be exchanged- please ensure all equipment is brought to clinic appointments.  A Capillary Blood Gas sample may be taken to check the effectiveness of treatment and to identify if any adjustments to the settings are required. An Oximeter for overnight monitoring at home may be given- the Nurse will explain how to use this equipment; this must be returned the next morning for the team to download the results.

This appointment is a good opportunity for patients or carers to ask any questions or raise concerns about treatment with the Home Ventilation Nursing team.

If the patient is unable to attend clinic appointments please contact the Home Ventilation Team as soon as possible so that we can rearrange this to a more convenient time.

Contact Information & Hours of Service

The Home Ventilation Service operates from Monday to Friday 08.00 to 16.00. (excluding Bank Holidays).

For advice or information regarding your Home Ventilation service contact us on

Tel: (01482) 624130 (24 hour answering machine)

Email hyp-tr.HUTH.HMVS@nhs.net

If you require emergency advice out of working hours please contact the Respiratory Support Unit at Hull Royal Infirmary- 01482 875875.

This leaflet was produced by the Respiratory Department, Hull University Teaching Hospitals NHS Trust and will be reviewed every 3 years             .

COUGH ASSIST – Cleaning Record For Carers

sign after cleaning

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.