IPV (Intrapulmonary Percussive Ventilation)

According to the sales rep that came to our department, Percussionaire has only used word of mouth to get the word out regarding Intrapulmonary Percussive Ventilation device. This explains why we have hardly used it, despite the great reputation IPV has for airway clearance techniques.

First of all, this is one of the first hospitals I've worked at that really does CPT the way it ought to be done. We are actually allotted the 40-50 minutes it should take to position, percuss, vibrate, and coach our patients in huff coughing and other airway clearance maneuvers. Most of this therapy is oriented around our CF population, but obviously overflows to other pulmonary diseases.

So this weekend I had a patient, CF, increased oxygen requirement, retaining CO2, who is NOT getting the crap out of her lungs. I tell her I think there's more, and she complains that she feels like there's a plug she just can't get behind it.

We have an IPV 1-C, and have only ever implemented IPV on a different patient, with a "whatever the previous model" was version.

So it was a Saturday--not a good day to get residents to implement a new therapy. Also, not a good day to float to NICU at 3 pm, if I wanted to see this started. Fortunately the workload was a little slow, so I had time to hunt down a circuit, scrounge up the literature, and be somewhat prepared when I called the resident. Who had no idea what I was talking about--"I'll talk to Dr. McXXXX about it."

I've only worked day shift for part of this year, and I confess I don't know many of the attendings well. However, I've had a few opportunities to talk to Dr. McXXXX, and I had a good feeling she'd jump on this.

Which she did, because the order came through about 30 minutes after I requested it.

Well, I did have to float to NICU, so I got the circuit together, tried to assemble it, then left it in the hands of another therapist.

I found out the next day that they weren't able to maintain pressure, so she had gotten more CPT. Luckily for my NICU float, I had taken my turn for the weekend, so I was able to get my patient again. Once more, slow enoughworkload to research. I went to YouTube, and found this:

on assembling the Phasitron for hospital use, and this --on the inline cone assembly.

It turns out I had goofed, and set it up for inline use, using our diagrams. Once I set it up right, we were in business, and I was able to perform two IPV treatments that day. My patient brought up about 3 times the sputum that I was getting out of her the day before. Although she was still tachypneic, she was clearly working less and reported feeling like we had cleared her better.

I haven't worked clinically since then--I will have to follow through.