Non-invasive ventilation with a mouthpiece

Indications

Non-invasive ventilation with a mouthpiece helps the child to breathe better by mechanically pushing air and oxygen (O2) into the lungs (inspiration) and the child releases carbon dioxide (CO2) naturally by exhaling without assistance. Ventilatory assistance supports the child’s life and improves the child’s ability to do activities and to develop.
This type of ventilation should only be used by a child who is aware of his breathing needs, is able to take the mouthpiece into his mouth and who can initiate breathing.
Below is a suggested method that can serve as a guide; discuss the specific type of medical supplies and equipment used for your child with the healthcare team.

Considerations:

Non-invasive ventilation with mouthpiece is an “as needed” type of ventilation where the child initiates use of the device to breathe in (inspiration) when desired. An expiration device is not required as the child breathes out independently.
Non-invasive ventilation with a mouthpiece is only used when the child is awake, during the day, in complement with non-invasive ventilation with a mask that is used during sleep, at night.
Non-invasive ventilation with mouthpiece also facilitates the technique of pulmonary hyperinflation which is used to enhance cough and clearance of secretions from the airways and lungs. The technique of pulmonary hyperinflation may also be combined with expiratory cough assist techniques.
If your child requires medications during the time that non-invasive ventilation with a mouthpiece is being used, refer to your healthcare team to learn the techniques for correct administration.
Non-invasive ventilation with a mouthpiece may be interrupted if your child requires aspiration of secretions; refer to your child’s healthcare team to learn how to do this correctly.
As part of this method of ventilation, the mouthpiece may be positioned on a support arm mounted on the child’s wheelchair or placed within easy reach of the child.

When this ventilatory assistance device is not being used to help breathing, it is silent. This is often perceived as a benefit to users, especially in social situations such as school.
Ensure the comfort of your child during care by using different positioning and distraction techniques.
Good handwashing is essential before and after providing care.

Frequency

Non-invasive ventilation with a mouthpiece is recommended daily, as required, to meet the needs of the child.
The need for non-invasive ventilatory assistance may increase during respiratory infections.
Verify the recommended frequency of non-invasive ventilation with your child’s healthcare team.

Required materials

Circuit for ventilatory assistance, including: mouthpiece, adapters, tubing
Ventilatory assistance device with electrical power cable, built-in battery, and spare batteries, if required.
Antibacterial filter
Support arm

If needed:

Materials to suction secretions

The method of care below is illustrated using an angled mouthpiece and a Trilogy respirator.

Refer to your child’s healthcare team if the material or the sequence of steps you have been taught is different than those described here.

Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

Create the right moment: integrate the care in a routine.
Alert your child to the needed care and communicate together.
Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: Procedure

See the full description here

Summary 3 key concepts:

Safety: Carefully follow the care practice steps as you have been taught.
Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

Step 4: Prepare the device

Connect the device to an electrical wall outlet or an external battery. The built-in battery may also be used.
Make sure that the antibacterial filter is connected to the air outlet of the respirator.

Why ?

This step ensures the proper set-up for the ventilatory assistance device, in preparation for the next steps.

Step 5: Assemble the ventilation circuit

Insert the tubing into the support arm.
Connect the remaining parts of the circuit, making sure that the parts are securely joined.
Attach the support arm to your child’s wheelchair.
Position the support arm so that the end of the tubing is within easy reach of the child.

Connect the circuit to the antibacterial filter.
Verify that the tubing of the circuit is not bent, pinched or obstructed.

Why ?

A correct assembly of the circuit parts avoids air leaks during ventilatory assistance.

Air leaks can reduce the effectiveness of ventilatory assistance.

Step 6: Prepare the mouthpiece

Check that the mouthpiece is in good condition (not broken, cracked or dirty, etc.).
Connect the mouthpiece to the tubing of the circuit, ensuring that it is securely joined.

Why ?

Verifying that the mouthpiece is in good condition optimizes the ventilatory assistance.

A correct connection of the mouthpiece to the circuit avoids air leaks during ventilatory assistance.

Step 7: Position and prepare your child

Place your child in a comfortable position that easily allows the child to access the mouthpiece and to insert it into the mouth.
Suction the secretions, if needed.

Why ?

The best position is one where the child easily and independently accesses the mouthpiece.

Step 8: Turn on the device

Press and release the start button of the device
The backlight of the display should light up; red and yellow lights flash on briefly and a beeping sound is heard when the device is turned on.

Why ?

This step allows your child to receive ventilatory assistance.

The device must be started BEFORE your child uses it to take an initial breath.

Step 9: Position the mouthpiece and start ventilatory assistance

Make sure that the support arm is placed so that the child has easy access to the mouthpiece.
Have your child press the lips firmly around the mouthpiece.
Have your child breathe in to fill the lungs with air.
After breathing in as much as possible, your child releases the mouthpiece and breathes out naturally.

Why ?

This step connects your child to the ventilation circuit.

Step 10: Continue and supervise ventilatory assistance

While your child is receiving ventilatory assistance with the mouthpiece,

Check that the device is working properly: when your child initiates a breath, there should be air flow and the pressure graph (green bar) on the device screen should be moving back and forth.
Make sure that there are no significant air leaks around the mouthpiece or in the circuit; adjust or replace the parts as needed.
Make sure that there is no tension or pulling on ventilation circuit, mouthpiece or support arm.
Correct any device alarm situations, if any.
Contact your child’s healthcare team for any persistent alarms.

Why ?

This step ensures safe ventilatory assistance.

Air leaks may reduce the effectiveness of ventilatory assistance.

Step 11: Discontinue ventilation, remove the mouthpiece and turn off the device

When the period of ventilatory assistance for the child is over:

Have your child release the mouthpiece from the mouth.
Press and release the stop button on the device.
Confirm your intention to turn off the device by pressing the button on the bottom right of the screen.

Why ?

This step allows the ventilatory assistance to be discontinued safely and for the device to be turned off securely.

Step 12: Clean the mouthpiece

Clean the mouthpiece and store the equipment according to the recommendations.

Why ?

This step is required to prevent infections and to maintain the equipment in working order.

Step 13: Recovery

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

Listen to what your child says about the parts of the procedure that were difficult or painful.
Comfort your child and recognize your child’s collaboration with positive feedback.
Highlight your child’s specific strengths that helped make the procedure positive.
Discuss with your child what might be done the same or differently the next time the care is needed.
Keep your promises if you have promised a reward, follow through.
Reward yourself too.

.Reviser : NRoss .Version : 1.0

https://complexcareathomeforchildren.com/respiratory-support/ventilatory-assistance/non-invasive-ventilation-with-a-mouthpiece/

Disclaimer of Liability: By using this site, you acknowledge that you have read this disclaimer and agree to all of its terms. Before making any decisions regarding your health or if you have any medical questions, you should first consult a physician or qualified health care professional who can provide recommendations tailored to your specific needs. The information published on this site does not constitute a recommendation for treatment (preventive or curative), a prescription or a diagnosis and is not a substitute for the advice of a physician or qualified health professional.

As medical and technical knowledge is constantly evolving, the content of this site is made available for information purposes only. The contributors to this site, including clinical experts in pediatrics from across Quebec, make every effort to ensure that the information made available on this site is as accurate and reliable as possible, without guaranteeing the completeness or total absence of error of its content. The opinions contained in this site are the sole responsibility of the author(s) and are not binding on the contributors to this site. These opinions do not necessarily reflect the official viewpoint of the organizations mentioned, nor that of their directors or representatives. The contributors to this site cannot and will not assume any responsibility for the use of the published content or for the information otherwise accessible through any link or reference source. Any quotation or reference to a source external to this site is for informational purposes only and does not constitute an endorsement or claim, express or implied, regarding the content or validity of the information obtained from that external source.

All rights reserved: The contents of this site may not be reproduced or disseminated, in whole or in part, in any manner or by any means, electronic, mechanical, including photocopying, recording, or otherwise, or stored in a retrieval system of any kind that is not limited to private use, without the prior written permission of the copyright holder.