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What is it?
The NIPPY Clearway (fig. 1) is a pressure-controlled machine which mechanically controls in and out breaths to assist in producing a cough. The kit consists of:
• NIPPY clearway machine
• A hand held remote control
• Face mask, mouthpiece or tracheostomy connector (fig. 2)
• Breathing circuit with filter (fig. 2)
How does it work?
People with neuromuscular conditions, spinal injuries or lung disease may find it difficult to cough and clear secretions and maintain their lung volumes independently. The machine uses positive pressure to inflate the lungs (insufflation) which then rapidly changes to negative pressure to assist in helping you cough (exsufflation). It is predominantly used as an airway clearance device but is also useful in increasing lung volumes and preventing lung collapse.
There are many benefits including the following:
1. To keep your rib cage moving freely and to stretch the muscles used in breathing and coughing.
2. To increase lung volumes.
3. To improve the effectiveness of your cough.
4. To assist with taking deeper breaths which can help clear your chest and help to prevent chest infections.
When to use your NIPPY Clearway:
The frequency per day will be advised by the prescribing physiotherapist. This will be recommended as numbers of cycles and how many times each day. It is recommended that you use your
NIPPY Clearway every day to keep your chest clear of secretions and maintain lung volumes.
When not to use your NIPPY Clearway:
• Pneumothorax/punctured lung
• Facial trauma
• Recent or existing pressure trauma to lungs
• Bullous emphysema
• Spinal instability
• Acute pulmonary oedema
• Acute lung injury
It is best to use the NIPPY Clearway in an upright position to allow you to take the deep breaths to make it as effective as possible.
Connecting the breathing circuit:
• Push the large tube onto the outlet port. To disconnect, twist the tube to ease pulling it off.
• Push the small tube onto the mask pressure port. To disconnect, twist the tube to ease pulling it off.
• Connect the face mask, mouth piece or tracheostomy connector to the filter end of the tubing.
Operating the machine:
• Plug in the machine to mains power.
• Turn the machine on by holding the power button down.
• Manual mode: Positive and negative pressures are applied using the manual switch on the front of the machine or with a remote handheld switch.
• Auto mode: cycles between insufflation and exsufflation followed by a pause, for a maximum of 20 cycles.
• When the machine is turned on, the settings and pressures will be the same as when previously used and do not need adapting unless advised by your physiotherapist.
• The machine is started by using the hand control in manual mode, or by pressing the start/stop button in auto mode.
• Press the help button at any time for on screen help on a variety of topics.
• Check the machine and all parts for any damage before using.
• Check there are no parts missing to the breathing circuit/filter. If you have any concerns do not use the cough assist machine.
• It is best to rinse or wipe the mask/mouth piece with a damp cloth after every use in, and wash in warm soapy water weekly leaving it to air dry. Replace the mouthpiece or mask if it looks worn, damaged or becomes visibly soiled.
• Change the filter on the circuit monthly (or sooner if it becomes discoloured or soiled).
• Change the tubing of the circuit only if soiled.
• To clean, wipe the exterior of the case with a soft cloth moistened with water.
• Oxygen cannot be used with the NIPPY clearway.
• DO NOT place any form of cover over the machine, especially near the air intake.
• If liquids are allowed to enter the unit, serious damage could occur. If you spill any liquid into the NIPPY Clearway, consult qualified service personnel (contact information will have been provided for you by the Oxford Sleep and Ventilation Service).