Respiratory Equipment Most Often Used in Hospice Care Mark Schroedel, CRT Walgreens Home Care

Respiratory Equipment Respiratory Equipment Most Often Used in Most Often Used in

Hospice CareHospice Care

Mark Schroedel, CRTMark Schroedel, CRT

Walgreens Home CareWalgreens Home Care

Hospice EquipmentHospice Equipment

• Overview of commonly used respiratory care equipment for the hospice patient.

• Issues associated with equipment use in hospice care.

• Ethical considerations for use of equipment.

Hospice Care PrinciplesHospice Care Principles

• Support for the patient and family– Advance care planning– Maintaining and supporting dignity– Support for the family

• Care of the patient– Relief of distressing symptoms– Management of the dying process

ACCP Palliative and End of Life Care for Patientswith Cardiopulmonary Diseases CHEST 2005;128;3599-3610

Diseases that may result in death from Diseases that may result in death from respiratory failurerespiratory failure

• Chronic Obstructive Pulmonary Disease (COPD)

• Lung Cancer• Pulmonary Fibrosis• Cystic Fibrosis• Progressive Neurological Diseases

Symptoms/Complications Symptoms/Complications associated with end stage respiratory associated with end stage respiratory

failurefailure

• Dyspnea• Hypoxemia• CO2 Narcosis• Infection • Pneumonia

• Pleural Effusion• Tumor

Encroachment• Hemorrhage• Progressive

Respiratory Muscle Loss

• Dysphagia

Respiratory care equipment used Respiratory care equipment used

to manage distressing symptomsto manage distressing symptoms

• Oxygen Therapy• Nebulizer Therapy• Secretion Management

• Positive Pressure Ventilation – Invasive (IPPV)– Non-invasive (NPPV)

Oxygen TherapyOxygen Therapy

• Why do we use oxygen with hospice patients?– Hypoxemia– Dyspnea– Patient comfort

Oxygen Equipment and SuppliesOxygen Equipment and Supplies

• Oxygen Concentrator• Liquid Oxygen System• Compressed Gas System• Combination of Systems

– High flow capability– Interface: Cannula, Mask (Simple,

Rebreather, Non-rebreather, Venti)– Humidifier

– Portability

Nebulizer TherapyNebulizer Therapy

• Delivery of aerosolized medications

• Bronchodilators• Corticosteroids• Mucolytics• Antibiotics• Opiates

Nebulizer Equipment and SuppliesNebulizer Equipment and Supplies

• Small Volume Nebulizer– Compressor– Neb Kit

– Mask or Mouthpiece?

Secretion ManagementSecretion Management

• Suction • Postural Drainage/Percussion• Cough Assist Device• Intrapulmonary Percussive Ventilation

(IPV)• Positive Expiratory Pressure (PEP)

Therapy

Suction MachineSuction Machine

• Portable or Bedside– Oral

• Yankauer– Can be self administered

– Nasotracheal • Nasopharyngeal airway • Suction catheter

– Tracheal• Suction catheter

– Patient tolerance

Postural Drainage/PercussionPostural Drainage/Percussion

• Manual• Pneumatic• Mechanical

– Goals of therapy– Patient tolerance

Cough Assist DeviceCough Assist Device

• J.H.Emerson Co.• Known as the “Cough Machine” or In-

Exsufflator.– Goals of therapy– Patient tolerance– Administered

• Mouthpiece• Mask• Trach

Intrapulmonary Percussive Intrapulmonary Percussive Ventilation (IPV)Ventilation (IPV)

• Percussionaire Corporation– Goals of Therapy– Patient Tolerance

Positive Expiratory Pressure Therapy

• Self Administration• Goals of therapy• Patient tolerance

Noninvasive Positive Pressure Noninvasive Positive Pressure VentilationVentilation

• Ventilator• BiLevel Positive Pressure Devices

– Goal of therapy– Interface

– Patient tolerance

Invasive Positive Pressure Invasive Positive Pressure VentilationVentilation

• Ventilator patients who become hospice patients

• Hospice patients who become ventilator patients– Principles of Hospice Care become

critical here• When to withdrawal?• Who?

Ethical considerations for Ethical considerations for use of equipmentuse of equipment

• Comfort vs. Cure• Patient wishes vs. family wishes• Limits of care• Refer to the Care Plan

– What are we trying to accomplish?

Issues associated with Issues associated with equipment use in hospice careequipment use in hospice care

• Caregiver/Patient training• Environment of care• Equipment limitations• Equipment focus versus patient focus• Delivery services

Questions?Questions?