Equipment

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Contents:

  • Flutter
  • The Vest™ Airway Clearance System
  • Intravenous Lines
  • Ports
  • Hickman catheters, PICCs & Ports: An Overview (5/97)
  • Administering Home IV Drugs
  • Nebulizers
  • Compressors (for use with nebulizers)
  • Supplemental Feeding – “The Button”
  • Aids to Positioning During Postural Drainage
  • Aids to CPT
  • Nebby Bear
  • Vaporizers (Hot Water) vs Humidifiers (Cold Water)
  • Flutter

    A small plastic pipe (like one you would smoke with) that has a ball bearing about the size of a marble (about 1 1/4″ to 1 «” in diameter) in it. When you blow into the pipe, this causes the ball bearing to move up and down, creating a vibration that pulses down into your airways thereby loosening up the mucus. Said to work pretty well by some on CYSTIC-L. May be purchased through the CF pharmacy on prescription for about $110.00. Scandipharm in Atlanta Georgia also carries the Flutter, and has national delivery. Some people have reported that the Flutter may come apart; reportedly, for a $25 money order, one can ship the flutter back to Scandipharm and they will replace the whole piece and ship it second-day air.

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    The Vest™ Airway Clearance System

    The Vest™ system is a medical device designed for clearing excess mucus from the lungs. Used widely in homes and hospitals, it consists of an inflatable vest connected by flexible tubes to an air-pulse generator. The generator rapidly inflates and deflates the vest, gently compressing and releasing the chest wall. This technology – called high-frequency chest wall oscillation (HFCWO) – loosens, thins and moves secretions toward central airways so they may be more easily cleared. The Vest system simplifies respiratory therapy routines, allows user independence, and is associated with better treatment adherence.

    Studies show that The Vest system therapy significantly improves secretion clearance and helps sustain pulmonary functions. It is used by more than 12,000 cystic fibrosis patients in their homes and in over 95 percent of Cystic Fibrosis Centers of Excellence. Cleared to market by the Food and Drug Administration in 1988, The Vest system is a product of Advanced Respiratory, Inc., located in St. Paul, Minnesota. For more information about The Vest system, call: 1-866-411-8378 or visit on the Web at: www.thevest.com .

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    Intravenous Lines

    There are several types of different access lines for intravenous infusion. The length of time the delivery line needs to be in place, and the type of drugs infused, usually determine the type of line used (along with hospital protocol and familiarity). Selastic and other non-irritable materials are preferred to protect the accessed vein and preserve it for future use. There is also a cream (EMLA) that can be rubbed on the site prior to sticks which numbs the area.

    Peripheral Lines

    The Butterfly is a small needle typically used with children for many things including getting blood samples and inserting a peripheral, short-term, IV line (usually in the hand or lower arm area). It is wholly above skin except for the needle entry. The peripheral Butterfly usually only lasts a few days and must be changed which is why they are seldom used for IV antibiotic courses (which may last for 10-14 days or longer).

    Mid Lines

    Landmark and Menlo are both trade names for lines about 8-12 inches long which are typically located in the forearm and can last for 2-4 weeks (with care). A Landmark Catheter typically goes in the inside of your elbow (where blood is usually drawn) because these are not small peripheral veins like the ones found on your forearm. All that’s left outside your arm is a butterfly with the tubing and valve attached for infusion. They last so long because they’re in bigger veins. Bigger veins are less easily irritated by repeated infusions, especially with strong, irritating antibiotics (e.g., Tobra). Recently questions of safety have been raised about the Landmark, and they are no longer manufactured (see newspaper articles in Appendix L, Longer Articles, item 2).

    Central Lines

    The PICC line is about 18 inches long (and can be cut to size) and is generally inserted in veins in the arm, looped through the shoulder area, and rests in the upper chest area (under the skin). The PICC is generally inserted in either a vein located in the arms, neck or upper leg area. It can function in the body for months at a time, although in the USA it isn’t generally left in beyond six weeks (though in England PICC lines are left in for up to a year). It has a small port which is stitched down outside of the venous entry site. Because a PICC line enters into a major vessel lying near the heart careful hygiene methods (sterile protocols) are recommended to avoid bloodstream infections which can be extremely serious.

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    Ports

    One clue for women getting a port. My surgeon had me wear a Victoria Secret Bra (Second skin satin) and outline it with a black marker the night before surgery. Then during surgery she was able to place it in the best possible place. Most women I have met that didn’t due this can’t wear a bra while they are accessed due to he strap rubbing the port. The Victoria Bras are better too because they are satin and are cut much wider than usual.

    Ports and TPN

    QUESTION: Has anyone had any experience with TPN with their ports?? My doctor and I are talking about doing it to help me put on the last eight pounds I need, but I’m concerned about possible side effects and complications. He said he’s only had one of his patients ever get her line contaminated and it was from yeast. I would appreciate anyone’s input. I’m calling the tx coordinator as well to ask her if it’s okay to do TPN.

    AN ANSWER: We had poor success with (our child’s) port and TPN and I believe that it was yeast infection. The port had some low grade infection, but when it was supplied with the TPN solution, the infection “bloomed” and we had several days of absolutely horrible fevers and several more days of recovery from that. This was all during the stay of his pneumothorax. It was not pleasant. There may be positive case history for using ports, but it did not work well for (our child).

    ANOTHER ANSWER: When I had my port TPN had made my “low-grade” infection get worse. I was on some hidious combination of TPN mixed with lipids!! The combo made me feel very sick at times. I still can’t figure out why I would agree to such a mix of medications. I think I was sold a big time line!! The Dr. who was trying this was a real good salesman, I think he also sold used cars on the side!!! But, It was my choice and I went for it!! These were the same folks who said you “could hardly see my port” when in fact the damn thing was an inch above the rest of my chest!! I noticed this when they took the bandages off after surgery.. Ahhh have I learned!!!!

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    Hickman catheters, PICCs & Ports: An Overview (5/97)

    of Intravenous Access Devices By Kathleen O’Connor, C.R.N.I., B.S.N.

    Reprinted from “Network”, July 1996 (see Appendix for subscrption information)

    Intravenous (or IV) antibiotics are important for fighting infection in individuals with cystic fibrosis (CF).

    Fortunately, there are many ways in which venous access may be obtained.

    Peripheral catheters are placed by an R.N. or L.P.N. in the forearm or hand and require site changes every two to three days. Midline catheters are greater than six inches in length, but do not pass the shoulder. They are placed by an R.N. in the bend of the arm and may be left in place for up to six weeks with sterile dressing changes once or twice a week. For longer therapies, a peripherally inserted central catheter (or PICC) line is used. This is placed by an R.N. into the vessel in the bend of the arm and threaded so that the tip is in the larger vessel in the chest.

    Another catheter occasionally used for home care, but more often. used in the hospital for therapy up to one month, is the central venous catheter (or CVC). These are inserted using local anesthetic by a physician and usually placed in the chest near the clavicle. The catheter goes into the subclavian vein and towards the heart. It is always sutured in place and requires sterile dressing changes two to three times per week.

    For therapies requiring access for an indefinite period of time, a true central line placed in the chest by a physician is the first choice. These catheters are very similar in composition, placement location and care and use. They are divided into two types: tunneled and implanted.

    The tunneled catheter itself is inserted under the skin and then tunneled from the skin entry site to the vein entry site near the clavicle. This provides more security, protec- tion against infection and makes it easier to conceal under clothing. Broviac and Hickman catheters are open ended, require flushing with heparin daily or after each use and have a portion of the catheter, up to approximately 6 inches, dangling from the chest exit site. Groshong catheters are closed ended with a slit in the side of the tip of the catheter. They require flushing with normal saline after each use or weekly. These also have a portion dangling from the chest similar to Broviacs and Hickman catheters. There is usually a little more difficulty drawing blood from this type of catheter than the open ended.

    An implanted port is a catheter that does not have any portion visible outside the chest. The catheter is the same under the skin and in the vessel, but this catheter is attached to a small metal chamber (or port) that is placed under the skin and some fatty tissue. Most ports, Mediports, Infusaports and Port-A-Caths are placed at particular locations on the chest, while the port of a PAS-port is placed in the arm, usually below the elbow.

    To access this type of catheter, a special needle must be used. The needle is- left in place and covered with a sterile dressing when accessed. If access is needed once a week, once a month or occasionally, the needle is removed after each use. Individuals are often instructed on the technique to access their own port or that of a family member. With this type of catheter there is no catheter dangling from the chest. Swimming is not a problem with a port, but is not recommended with other types of central line catheters.

    Tunneled and implanted catheters are more expensive and involved with placement and removal, but offer many advantages and little maintenance over the life of the catheter. Many are kept for years.

    Kathleen O’Connor, C.R.N.I., B.S.N., who does not have CF, is employed by Quantum Health Resources in Englewood, Colorado.

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    Administering Home IV Drugs

    The ‘Sidekick 100’ is a home IV pump. It’s 10 cm (4″) in diameter and weighs 320 grams (1 lb.?). Cost is $25. The medication is supplied in small cartridges that you just switch out. The main hindrance is that you can not use the pump if you are using two medications that are not compatible with one another. For example, one PWCF reports: “Two incompatible medicines were Tobra and Piperacillin. Even with the unit dose meds (the PWCF) had to wait 30 minutes in between the two due to incompatibility” However another PWCF notes: “I have been on Tobra and Piperacillin (I think that’s how it’s spelled) many a time, and have run them back to back, with only a saline flush in between”.

    Other pumps include the “Harvard Pump” which injects the meds via cartridge and is small enough (slightly larger than a full billfold!) to put into a pocket while infusing. There are also non-mechanical means of drug delivery such as the Baxter Intermate system in which the med is injected via pressure. A small elastic-type “balloon” holds the med in a small bottle (which resembles a baby bottle). One PWCF reports: “Either system is extremely convenient, especially if like me you often IV-on-the-go”.

    Another option: CaddPlus 5400. “Two years ago I got two small home IV pumps, called CaddPlus 5400. Once every 24 hours you change the medication cartridge and hit reset. For the next 24 hours the pump delivers your med at the frequency and dosage required, then automatically flushes and puts you on KVO until the next dosage. No hooking, unhooking, flushing etc… Both pumps with cartridges fit in a butt pack, that I wear while on home IVs (often more than not!). This pump is an amazing Godsend, which allows us to sleep fully through the night, and have hassle free days while on IV. I purchased my pumps though Caremark, which is now Coram, and despite some serious time on the pot reading the manual over and over, I finally got everything figured out, and I must say, my life is soooooo much easier than with all those “baby bottle” devices, gravity, syringes etc..”

    Another CADD user says: “If you can arrange for a CADD Plus pump, they are the greatest! They are of the fanny pack type, very lightweight and portable. Depends on what drug you’re getting as to whether or not you can use it. The reason being it only goes up to something like 100 mls an hour or so. Wouldn’t work for once a day Tobra, but works well for some of the every 6-8 hour meds. And now I’ve gone and gotten this humongous Baxter pump.