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

2. Hospice 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.

3. Hospice 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 Patients with Cardiopulmonary Diseases CHEST 2005;128;3599-3610

4. Diseases that may result in death from respiratory failure Chronic Obstructive Pulmonary Disease (COPD) Lung Cancer Pulmonary Fibrosis Cystic Fibrosis Progressive Neurological Diseases

5. Symptoms/Complications associated with end stage respiratory failure Dyspnea Hypoxemia CO2 Narcosis Infection Pneumonia Pleural Effusion Tumor Encroachment Hemorrhage Progressive Respiratory Muscle Loss Dysphagia

6. Respiratory care equipment used to manage distressing symptoms Oxygen Therapy Nebulizer Therapy Secretion Management Positive Pressure Ventilation –Invasive (IPPV) –Non-invasive (NPPV)

7. Oxygen Therapy Why do we use oxygen with hospice patients? –Hypoxemia –Dyspnea –Patient comfort

8. Oxygen 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

9. Nebulizer Therapy Delivery of aerosolized medications Bronchodilators Corticosteroids Mucolytics Antibiotics Opiates

10. Nebulizer Equipment and Supplies Small Volume Nebulizer –Compressor –Neb Kit –Mask or Mouthpiece?

11. Secretion Management Suction Postural Drainage/Percussion Cough Assist Device Intrapulmonary Percussive Ventilation (IPV) Positive Expiratory Pressure (PEP) Therapy

12. Suction Machine Suction Machine Portable or Bedside – Oral Yankauer –Can be self administered –Nasotracheal Nasopharyngeal airway Suction catheter –Tracheal Suction catheter –Patient tolerance

13. Postural Drainage/Percussion Manual Pneumatic Mechanical –Goals of therapy –Patient tolerance

14. Cough Assist Device J.H.Emerson Co. Known as the “Cough Machine” or In- Exsufflator. –Goals of therapy –Patient tolerance –Administered Mouthpiece Mask Trach

15. Intrapulmonary Percussive Ventilation (IPV) Percussionaire Corporation –Goals of Therapy –Patient Tolerance

16. Positive Expiratory Pressure Therapy Self Administration Goals of therapy Patient tolerance

17. Noninvasive Positive Pressure Ventilation Ventilator BiLevel Positive Pressure Devices –Goal of therapy –Interface –Patient tolerance

18. Invasive Positive Pressure Ventilation Ventilator patients who become hospice patients Hospice patients who become ventilator patients –Principles of Hospice Care become critical here When to withdrawal? Who?

19. Ethical considerations for use of equipment Comfort vs. Cure Patient wishes vs. family wishes Limits of care Refer to the Care Plan –What are we trying to accomplish?

20. Issues associated with equipment use in hospice care Issues associated with equipment use in hospice care Caregiver/Patient training Environment of care Equipment limitations Equipment focus versus patient focus Delivery services

21. Questions?