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?