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High Frequency Chest Compression Vest Treatment (HFCC) (3.12)

High Frequency Chest Compression Vest Treatment (HFCC) (3.12) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Airway Clearance

3.12

3.12: High Frequency Chest Compression Vest Treatment (HFCC)
Category: UWHC Clinical Policy
Policy Number: 3.12
Effective Date: May 1, 2017
Version: Revision
Section: Respiratory Care Services

I. Description:

High Frequency Chest Compression (HFCC) device helps mobilize respiratory tract secretions from lung lobes or
segments into the central airways. The device consists of an air pulse delivery system and an inflatable vest.

II. Contraindications:

A. Patients with a pneumothorax or hemothorax
B. Patients with fractured ribs.
C. Patients under the age of two due to developmental stage of the head and spine.

III. Policy:

A. All patients will be assessed by the Respiratory Care Practitioner (RCP).
B. Therapy will be provided in accordance with a provider’s order.
C. Appropriate Health Facts for You (HFFY) will be given if therapy is being planned for home usage.
D. Procedure should be held for at least 30 minutes after feeding, unless patient is able to tolerate a shorter
time.
E. Patients under the age of two due to development stage of the head an spine will not receive therapy.
1. If a patient is already using the vest at home they may continue to use while in-patient.
F. All patients will:
1. Have therapy before meals, school, & bedtime.
2. Be encouraged not to refuse therapies.
3. Cough before proceeding to the next frequency.
4. Be encouraged to expectorate mucus (especially after age 7 years).
5. Patients with Cystic Fibrosis will have therapies done four times a day.
a. All CF patients should receive thirty minutes of vest therapy with 10 minutes spent in the
low range (5-10), 10 minutes in the medium range (11-15), and 10 minutes in the high
frequency range (16-20).
b. Alternating airway clearance techniques may be performed per provider’s order.
c. RCP will notify the provider when modification is necessary.
6. Do not suction without a provider's order. Nasal or oropharyngeal suctioning can be done if
secretions cannot be mobilized by other means.
G. Patients should bring their custom vest for hospitalizations.
H. The order of therapies should be:
1. Bronchodilator
2. Hypertonic Saline (can be given with ACT)
3. Dnase (can be given with ACT)
4. Airway Clearance Technique
5. Aerosolized Antibiotic
6. Inhaled Steroid
I. Disposable wraps are only to be used for ICU/IMC patients or pregnant women. Other situations should
be discussed with the AOC prior to use.
J. Clean the unit system with a germicidal spray between patients.

IV. Equipment:

A. Product manuals are located in the Respiratory Care Workspaces on Uconnect.
B. Appropriate sized vest. See Related Resources.


V. Procedure:

A. Review and acknowledge the provider's order.
B. Review patient's chart.
C. Obtain the appropriate equipment.
D. Introduce yourself to the patient &/or family. Explain the reason for the procedure.
E. Assess the patient throughout the procedure.
F. Appropriate vest size:
1. The patient should only wear a single layer of cotton clothing such as a T-shirt.
Sweaters and sweatshirts should be removed. Fit the patient with the appropriate sized vest.
2. Put the vest on the patient and connect the front closures so that the vest fits loosely.
3. Adjust the length of the vest using the shoulder straps. The bottom of the vest should be
level with the bottom of the waist and the top of the hip bone. The arm holes should fit
comfortably, not snuggly.
4. Adjust the vest to fit the patient’s chest. The vest should fit snuggly, but loose enough that
the patient or yourself can fit one fist between their chest and the vest.
5. If there is excess fabric under the front closures, fold it behind the front closure straps to
ensure proper fit and then re-tighten the front closures.
G. HFCC:
1. Pressure setting – begin with the pressure setting of 5 or the center of the dial. If the patient
complains that the compression of the vest is too tight, decrease the pressure setting.
2. Frequency setting - recommended settings
a. 8, 12 and 16, for 10 minutes each if the patient has CF or bronchiectasis.
b. 12 and 16 for 10 minutes each for non-CF or bronchiectasis patients.
c. Patient’s home settings may be used if all three frequency ranges are utilized:
low range 5-10, medium range 11-15, high range 16-20.
d. 8-10 for 10 minutes if the patient has a neuromuscular disorder.
3. Apply the vest, and place port protection over the Infusaport or G-tube as needed.
4. Securely connect hoses to the outlet ports on the pulse generator and to the ports on the vest.
5. Turn on the main power switch, beginning at the lowest frequency chosen.
6. Have the patient sit in an upright position. Leaning against something may impede the air flow
to the vest.
7. While breathing normally (tidal volume breathing), the patient should activate the HFCC device.
Maintain therapy continuously throughout the frequency. A deep breath to total lung capacity
should be taken at least once per minute.
8. After allotted amount of time at each frequency have patient perform huff cough.
9. Adjust the frequency knob to the second chosen frequency and repeat step 8 until all selected
frequencies are completed.
H. HFCC with mechanical ventilation:
1. Adjust set tidal volume so delivered volume via vent read-out is within 10 percent of the
provider's order.
2. Adjust high airway pressure alarm allowing delivery of a full breath keeping
PAP less than 50 cm H20. Inform provider of the need to go higher.
3. Suction the patient as needed and after the treatment.

VII. References:

A. Respiratory Care Services (RCS) P&P;
1. 1:40 "Cleaning and Monitoring of Patient Care Equipment"
2. 3:42 "Suctioning"
3. 3:10 "Postural Drainage, Percussion and Vibration (P&PD)"
B. Hospital Policy #13.25 “Infection Control in the Cystic Fibrosis Patient Population”
C. “Airway Clearance Therapy Guidelines and Implementation,” Lester, M. and Flume MD, P.,
Respiratory Care June 2009, vol. 54 No 6.
D. HFFY #5464, HFCC Vest

E. 1. “Cystic Fibrosis Pulmonary Guidelines: Airway Clearance Therapies”
Patrick A Flume MD, Karen A Robinson MSc, Brian P O’Sullivan MD,
Jonathan D Finder MD, Robert L Vender MD, Donna-Beth Willey-
Courand MD, Terry B White PhD, Bruce C Marshall MD, and the
Clinical Practice Guidelines for Pulmonary Therapies Committee
RESPIRATORY CARE APRIL 2009 VOL 54 NO 4
2. “AARC Clinical Practice Guideline: Effectiveness of Nonpharmacologic
Airway Clearance Therapies in Hospitalized Patients” Strickland SL,
Rubin BK, Drescher GS, Haas CF, O'Malley CA, Volsko TA, Branson
RD, Hess DR. Respir Care. 2013 Dec;58(12):2187-93.




Approved by Director and Medical Director of Respiratory Care