Paediatric physiotherapy cough assist (Nippy)

This document aims to provide information to patients, parents and carers on the use of the cough assist device. This information sheet is aimed to provide guidance for users that have been identified by a trained professional for the use of this device. Practical training sessions will also be mandatory.

What is a cough assist?

The cough assist is a device to support a child with a weak ineffective cough. In children with weak respiratory muscles they are often unable to take an effective deep breath in, which is needed for an effective cough. Also due to muscle weakness they are unable to produce the forceful exhalation needed to produce an effective cough and clear their secretions. The cough assist machine works by blowing air out to help the child take a deep breath in and then suck air back out to stimulate and help produce an effective cough.

Guidance on the use of a cough assist device

When to use the cough assist device

• As part of daily physio sessions that will be set and guided by your physiotherapist.
• If you identify your child is having difficulty clearing their secretion load and this is causing them discomfort or distress.
• Increase in your child’s work of breathing/effortful breathing that is secondary to needing to cough.

When not to use the cough assist device

• If your child has recently or is actively vomiting.
• If there is fresh blood in secretions or can be seen around the upper airway.
• The patient is distressed or crying as the device will be ineffective if your child is unable to synchronize and make a good seal with the device.
• Where possible wait at least 30 minutes to one hour after feeding.

What to check before and after each round of cough assist

• Your child's respiratory rate and effort of breathing.
• Colour of your child is normal for them and there have been no changes.
• Their heart rate/oxygen levels – if this has been recommended by your physiotherapist.
• The amount/colour of secretion cleared.
• The cough assist tubing must be changed monthly along with the filter (the filter should be changed sooner if becomes wet/contaminated with secretion).
• The mask should be wiped clean after every treatment session.

For how long should the cough assist be used during treatment?

Using the cough assist will be a form of exercise for your child’s lungs. As with any types of exercise, if you do this for too long you run the risk of fatigue. The tolerance of this will differ from patient to patient; your physiotherapist will guide you on the maximum number of cycles to be carried out per treatment session. You should be guided by your child during these sessions. Signs to stop treatment are:

• Visible fatigue from the patient.
• No longer clearing secretions or your child sounds clear of secretions.
• You have reached a high number of cycles that will have been specified by your physiotherapist and are still getting a secretion load. It may be the case that when a child is unwell they will have an ongoing secretion load but it is important they rest between treatment sessions.
• Discomfort/distress from the patient.

When to seek medical advice

If the machine or a component of the machine breaks you should contact the respiratory physiotherapy team at Addenbrooke’s Hospital before continuing to use the machine.

If you are concerned about your child’s respiratory health, you should seek further guidance from your GP.

Machine set-up

Procedure to use the cough assist

Preparation of your child

1. Explain the procedure to the child and, if they are able, ask if they are happy to continue.
2. Reassure them.
3. Ensure they are in a comfortable position and their airway is easily accessible.

Preparation of equipment

1. Wash your hands.
2. Ensure the machine is turned on and all the tubing is correctly attached.
3. Before each use please check that there is no damage to the tubing/mask as this will make treatment ineffective.
4. Ensure the child has a way of communicating that they would like to stop the treatment whilst the mask is in place.

Procedure

1. Let the child know that you are going to start the treatment and have a communication method in place for if they want to stop treatment (if appropriate), for example by giving a ‘thumbs down’.
2. Place the mask to cover your child’s nose and mouth ensuring enough pressure is placed to make an effective seal.
3. Start the treatment cycle. Communicate with the child throughout to ensure effective syncing with the machine where appropriate.
4. Once the treatment cycle has finished remove the mask and ensure the child is able to effectively clear their secretion load. If your child needs a suction machine to clear their secretions, they may need it at this point.
5. Continue the treatment until either the secretion load reduces or is cleared, you have reached the maximum cycles in one session or if the child is showing signs of fatigue. Aim to complete cycles on both sides and back where appropriate.
6. Once treatment has finished turn the device off and wipe clean the mask. Re-check the tubing and filter to see if they need changing.