Breas NIPPY Clearway User manual

A Clinical Guide to
the NIPPY Clearway

Contents
oBasics of Cough Mechanics
oNavigation of NIPPY Clearway
Back of Device
Front of Device
oMIE and IPPB Circuit components
oNIPPY Clearway modes:
Manual control
Basic Auto
Programmed Timed Auto
Programmed Triggered Auto & IPPB setup
NIV mode (15 mins max usage)
oHow to add Insufflation & Exsufflation flow oscillations
oHow to change the Insufflation flow profile (aka ‘flow rate’ on the bird)
oHow to change the mode menu options
oHow to lock the NIPPY Clearway

Why use Mechanical Insufflation Exsufflation?
Cough is essential to prevent a build up of mucus/phlegm from our airways. Mucus is important
as it traps dirt and bacteria. The mucociliary escalator transports the mucus to the larger airways
and is usually cleared with a cough. In order for a cough to be strong and effective the following
occurs:
•A deep breath in.
•A short pause and closure at the top of our airway allowing pressure to build up in the chest.
•A good strong expiratory muscle contraction (abdominal muscles and intercostal muscles).

Why use Mechanical Insufflation Exsufflation?
These components are essential to get enough air into the lungs, so that when the expiratory
muscles contract, the air comes out faster, clearing the mucus up towards the mouth. If we have
a weakness in the muscles that we use to take in a deep breath, or in our expiratory muscles, our
cough strength decreases and becomes less effective resulting in a build up of mucus within the
lungs.
The NIPPY Clearway is a Mechanical Insufflation-Exsufflation device. These devices can help
improve a patient’s cough strength. The device should be set up by a qualified respiratory
physiotherapist/clinician.
The NIPPY Clearway gives a deep breath in (Insufflation) followed by a rapid shift to a negative
pressure (Exsufflation), in order to augment an expiratory flow sufficient to clear chest secretions
to the upper airway.

Cooling
Vent
External
Battery
Attachment
Air Inlet/Dust Filter –change 1-2
times per year
Mains Power Attachment
Serial Port for
Hand Held
Remote
Back of Device

Manual
Switch Air Outlet
Mask Pressure Line Valve
Front of Device

Mask Pressure line –
feedback for accurate
pressure delivery from
exhalation valve
Leakage Valve
22mm Clearway circuit
(changed monthly, but weekly in ICU))
Anti Bacterial Filter
(changed weekly, but daily in ICU)
NIPPY Clearway MI-E Circuit (Single Patient Use)

Mask Pressure line –
feedback for accurate
pressure delivery from
exhalation valve
Active Exhalation
Valve
Active valve
pressure line
Anti Bacterial Filter
(changed weekly, but daily in ICU)
NIPPY Clearway IPPB Circuit (Single Patient Use)

Press the ‘Mode’ button to
enter the therapy menu
Turn the device off and on
with the power button
Setting a Prescription

In Manual mode, you set your
Insufflation and Exsufflation
Pressure and deliver the
pressures via the manual switches
–handheld or on the front of the
Clearway
In manual mode, and for 1 minute
after all programmed modes, the
green hand on the screen
indicates the manual switches can
be used to deliver pressures
Manual Mode

The Basic Auto mode
delivers a clinically preset
cycle of one breath in
followed by a cough, followed
by a pause. This cycle repeats
up to 20 times, or until you
stop the treatment
Use ‘Start/Stop’ button to
commence/stop therapy
Basic Auto Mode

The NIPPY Clearway
counts the number of
completed cycles in
the top right corner
Note: In the Basic
Auto mode, 20 cycles
will be delivered as a
default unless the
therapy is stopped
beforehand
Therapy Tracking Screen

The Timed Auto mode
delivers a clinician preset
cycle of multiple insufflations,
divided by pauses, followed
by an exsufflation.
These cycles can be set to
repeat a number of times
Use ‘Start/Stop’ button to
commence therapy
TIMED AUTO
Programmed Timed Auto Mode

The Triggered Auto mode
delivers a clinician preset cycle of
multiple patient triggered
insufflations, divided by pauses,
followed by a cough.
Lengthen the pause time to give
the patient time to trigger the
next breath
These cycles are set to repeat a
number of times
Use ‘Start/Stop’ button to
commence therapy
Programmed Triggered Auto Mode

Select the Programmed Timed or
Triggered mode for IPPB use, and
set the Exsufflation pressure to
0cmH20
Increase the pause time so there is
a sufficient gap for the patient to
feel comfortable to trigger their
next breath of their own accord.
Adjust the trigger sensitivity under
the second option in the main
Menu
The number of triggered breaths
delivered is equal to the ‘Ins
repeats’ x ‘Cycle repeats’
6.00 sec
0.0 cm
Setting up for IPPB use

Set an IPAP, EPAP, Inspiratory time and
Breathing back up rate for a Pressure
Control mode of ventilation
The maximum treatment time 15
minutes – useful for reducing patient’s
work of breathing pre/post cough
therapy if required.
Patients should be monitored while
using NIV mode due to absence of any
clinical alarms. Always ensure the
exhalation valve is fitted in the circuit
when using this mode.
Non Invasive Ventilation Mode

Press the Menu Button
Select 3: Settings and Options
Select 2: Advanced Settings
Change Oscillation Magnitude settings by using +/-/set buttons
Setting up the Flow Oscillations

Press the Menu Button
Select 3: Settings and Options
Select 3: Profile Settings
Change Profile setting using +/-/Set
Setting up the Insufflation Flow Profile

Faster Rise Time Slower Rise Time
Setting up the Insufflation Flow Profile
Note the visual difference in the shape of the Insufflation flow curve

Press Menu Button
Select 3: Settings and Options
Select 4: Mode Select Options
Turn off any modes you do not want carers to access using +/-/Set buttons
Deactivation of unused modes