What Works for Me
To me a measure of quality of life for a ventilator-dependent person is how often that person gets into a shower with water running over the body. Since facial interfaces and trach positive pressure connections are air tight, there is little danger of water getting into the airways. Care should be taken to not pour a hard stream of water on the trach or face.
I have crafted for myself and friends an extra long vent circuit. It is two Allegiance Catalog No. 001795 disposable non-heated circuits coupled together at a length of about 12 feet. The LP10 or PLV-100 ventilator is outside the bathroom, allowing more staging room in the shower area. The hose lays on the floor and is routed for convenience to the attendant and patient.
A 22 mm coupler is used for the two hoses and the 1/8" exhalation valve tube runs inside 22 mm hose. The small tube is brought out at each end through a 3/16" hole in the connector. The 1/8" tube can either be spliced inside the hose or 15 ft. of it can be purchased at a home center. If this is too difficult a task, the tube can run alongside the hose using the clips supplied with the kit. With my technique for eliminating the Patient Pressure/PAP line, the shower hose can be just one 22 mm, 12 ft. long hose. The circuit should be thoroughly tested before showering. There should be no noticeable loss of circuit efficiency due to the extra length. This cannot be done with LTV circuits or heated hose circuits.
Jerry, Vancouver, WA (firstname.lastname@example.org, 360-883-4857)
If you use the LP10 or PLV-100 or PLV-102 volume ventilators, how many small tubes are running along the larger 22mm hose?
They can be a nuisance getting caught on things. This is what I have done to resolve this problem. One tube is for the exhalation valve. It is always necessary, but the small tube can be run inside the larger tube if you know how to craft it. The Proximal Sensing tube can often be eliminated from going to the exhalation valve. Coming off the ventilator output, a 22mm connector with the oxygen input has the small tube that returns to the Patient Pressure port of the vent. By doing this, the Proximal Sensing tube is eliminated. The vent will still sense the same patient pressure. If you use The Assist Mode wherein you trigger breaths often, there might be just a little less sensitivity to patient effort. Or it might not be noticeable. I only have the exhalation valve tube on my setup. On the one where there is no heated hose wire there are no tubes running along the 22mm hose.
Jerry D., Vancouver, WA (email@example.com)
After 50 years of post-polio ventilator use via a tracheostomy, my bronchial tree isn't in the best of condition. Some long-term vent users struggle daily with mucus problems, while others may only occasionally need to suction or use mechanically assisted coughing.
In the last 10 years, I have had to deal aggressively with chronic bronchitis. I had frequent hospitalizations and somewhat desperate treatments of prednisone and strong antibiotics. Now, with the leadership of a good pulmonologist and state-of-the-art ventilatory equipment through Apria, my home health care company, I am making it in the often cold and damp Northwest. I haven't been hospitalized in more than five years and use less and less prednisone and antibiotics, but daily vigilance is the key.
My home ventilator cart looks like something out of the ICU. There is the LP10 vent with the HC500 humidifier inline. (A water trap in the circuit is emptied daily.) A Pari aerosol pump sits on the bottom of the cart. The DeVilbiss 7305P suction machine is used at various locations around the home. There are backup units for all respiratory equipment.
Handheld nebulizers are not useful for many of us vent users because we do not have the muscle strength to hold the unit up to the mouth. But there are some "closed" nebulizers, such as those from Pari, Airlife and Hudson RCI, that adapt well to inline use with the ventilator.
I use three treatments to keep my chronic bronchitis under control.
Inline heated hose humidity. The circuit setup is a little complicated, but quickly becomes routine. For some vent users, passive humidity is adequate. (See humidification articles in Ventilator-Assisted Living). For a vent user in a wheelchair, humidifiers take up too much space. An artificial nose may help, but it will only work for people who use inflated, cuffed tracheostomy tubes.
Frequent suctioning. (How many times per day?)
Albuterol aerosol treatments. The LP10, PLV®-102, and LTV® series vents can deliver aerosol treatments with the correct setup by a respiratory therapist (RT). Then a family caregiver – in my case, my wife – or attendant can administer the treatments at the prescribed time. I design my own circuits and have them inspected by an RT.
|With my well-planned setup, Albuterol treatments can start in about a minute. The aerosol treatments are a comfort to a constricted and congested bronchial tree.|
In the flex hose going from my exhalation valve to the trach swivel adapter, I have a T-connector inline. When not in use, it is capped. Treatments are delivered by a 3-ft. section of 22mm hose running from the nebulizer to the T-connector. Before beginning the treatment, I make sure there is a strong fog coming out of the 22mm tube. Because I can't hold the nebulizer, I designed a holder for it, mounted on the left rail of my LP10.
|My crafted bracket clamps to the LP10 left rail. This Hudson nebulizer adapts well to inhale aerosol treatments. The Pari LC Plus and Airlife nebulizers take a slightly larger bracket hole, and they work well, too.|
Jerry D., Vancouver, WA (firstname.lastname@example.org)