Acapella Oscillatory PEP Device
The Acapella Oscillatory PEP Device is a handheld tool designed for positive expiratory pressure (PEP) therapy, combining PEP with airway vibrations to help mobilise and clear pulmonary secretions. It is used for patients with conditions like cystic fibrosis, COPD, asthma, or lung diseases involving excessive secretions and atelectasis, and is suitable for adults and children over 5 years old who can follow instructions or are supervised.
The device allows adjustments to frequency and resistance via a dial, and it can be used with a mouthpiece, mask, or inline nebuliser for aerosol drug delivery.
Indications and Benefits in Nursing Care
Nurses often incorporate the Acapella into bronchial hygiene routines for patients with impaired airway clearance, such as those post-extubation or with respiratory infections. Key benefits include improved secretion clearance, prevention or reversal of atelectasis, and optimised bronchodilator delivery, typically requiring 15-20 minutes per session compared to longer traditional chest physiotherapy. In clinical cases, it has helped avoid invasive procedures like mini-tracheostomy by enabling effective self-managed clearance.
Nursing Guidelines for Using the Acapella Device
Nurses play a key role in educating patients, demonstrating proper use, and monitoring outcomes. Ensure the patient is in a comfortable position, such as sitting or semi-reclining, as the device is not position-dependent.
Preparation and Patient Instruction
Assess the patient’s ability to follow instructions; it’s contraindicated for those unable to tolerate increased breathing effort or with conditions like hemodynamic instability.
Adjust the device’s resistance dial to match the patient’s expiratory flow (e.g., Acapella blue for flows under 15 L/min).
Instruct on assembly if needed (e.g., for models like Acapella Choice, which disassemble for cleaning).
Demonstrate the technique: Emphasise slow, deep inhalations followed by controlled exhalations against resistance to generate oscillations that loosen secretions.
Recommended Regimen
A typical session follows this cycle, repeated 3-4 times daily or as tolerated:
Take 6-10 slow, deep breaths through the device, exhaling actively to functional residual capacity to create vibrations.
Perform 1-3 huff cough maneuvers (forced expirations) to expel secretions, either through or outside the device.
Repeat the cycle 6-10 times, depending on sputum volume, fatigue, and dyspnea.
Sessions last about 15-20 minutes; combine with nebulised medications if prescribed for enhanced delivery.
Monitoring and Evaluation
Track effectiveness to guide care and prevent complications:
Monitor vital signs (oxygen saturation, pulse rate, respiratory rate, blood pressure) during and after sessions to ensure stability.
Assess sputum characteristics (amount, colour, odour) daily.
Perform chest auscultation before and after use to note improvements in aeration.
Review chest X-rays for signs of secretion clearance or atelectasis resolution.
Encourage patient feedback on comfort and ease; adjust resistance if oscillations feel insufficient.
Contraindications and Precautions
Avoid use in patients with inability to handle increased breathing work, intracranial pressure over 20 mm Hg, recent facial/oral surgery, active hemoptysis, untreated pneumothorax, acute sinusitis, epistaxis, esophageal surgery, nausea, or middle ear issues like tympanic membrane rupture. Always evaluate these risks before starting therapy, and discontinue if adverse effects like exhaustion occur.
This approach empowers patients for independent use while ensuring safe, effective nursing oversight. If designing a similar device, consider incorporating user-friendly features like adjustable settings and easy cleaning for better compliance.
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