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Intrapulmonary Percussive Ventilation (IPV) (3.14)

Intrapulmonary Percussive Ventilation (IPV) (3.14) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Airway Clearance

3.14


3.14 Intrapulmonary Percussive Ventilation
Category: UWHC Patient Care Policy
Effective Date: December 1, 2016
Version: Revision
Manual: Respiratory Care Services

I. PURPOSE
Intrapulmonary Percussive Ventilation (IPV) is a pneumatic device that delivers aerosolized gas in the form of mini-
bursts of air at rates greater than 100 times/minute. It combines two methods of secretion mobilization; the
inhalation of an aerosol and intra-thoracic percussion.

II. INDICATIONS
A. Excessive or retained secretion clearance.
B. Atelectasis.
C. As a routine part of bronchial hygiene in patients with cystic fibrosis, neuromuscular weakness,
bronchiectasis, chronic bronchitis, necrotizing pulmonary infection, or spinal cord injury.

III. CONTRAINDICATIONS
A. Tension pneumothorax or persistent air leak
B. Intracranial pressures greater than 15 mm Hg
C. Tracheoesophageal fistula repair
D. Active hemoptysis

IV. POLICY
A. All patients will be assessed by the Respiratory Care Practitioner (RCP) to determine if the appropriate
indications for the therapy are present.
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 use.
D. Patients with Cystic Fibrosis should receive therapy in the following order ::
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
E. AFCH patients will have IPV delivered directly to their artificial airway (not through the vent circuit).
F. IPV will not be performed on infants weighing less than 3 kg.
G. Recent cranio/facial procedures/fractures require provider authorization.
H. A complete ventilator system check will be performed following therapy.

V. EQUIPMENT
A. Percussionator.
B. IPV circuit with appropriate interface.
C. One HEPA filter with mechanical ventilation.

VI. PROCEDURE
A. Review and acknowledge the provider’s order.
B. Review the patient’s chart.
C. Obtain the appropriate equipment and medication.
D. Introduce yourself to the patient and /or family. Explain the reason for the procedure.
E. Attach color-coded tubing to the aerosol generator.

F. Add saline or prescribed medication to the cup of the aerosol generator. A total of 15-20 ml is
recommended. See related link “Administration of Aerosolized Medications – Adult/Pedicatric –
Inpatient/Ambulatory” for medications that can be nebulized with IPV
G. Therapy should be initiated on the Easy setting and advanced until adequate chest wiggle is noted.
Adjust the frequency knob rotating between the EASY and HARD settings on intervals of 5 minutes
throughout the therapy.
H. IPV through a mouthpiece:
1. Depress the thumb switch throughout the therapy.
2. Patient rest periods may be taken by releasing the thumb switch.
3. The patient should continue to breathe in the solution even if the thumb switch is released as the
solution will continue to be nebulized.
4. If the green tubing is disconnected from the nebulizer, percussion will be continuous.
I. IPV through the ventilator circuit:
1. Replace circuit wye with Percussionaire® cone adaptor.
2. Add one Hepa filter to the expiratory side of the ventilator when delivering medication.
3. Decrease the minute ventilation or tidal volume setting on the ventilator so that peak airway
pressures will remain constant when the patient is receiving IPV.
4. Remove and dispose of the Hepa filter 1-5 minutes after the treatment is complete.
5. A complete ventilator system check will be performed following therapy.
J. The IPV treatment should last approximately 15-20 minutes.
K. Allow the nebulizer to air dry between treatments.

VII. REFERENCES
A. Percussionaire Corporation: Manual of Understanding, Operations, and Clinical Restrictions.
B. UWHC Health Facts for You on IPV, #4297.
C. RCS P&P #2.27 “Aerosolized Medication Treatment via Small Volume Nebulizer.”
D. “Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update,” Saiman, Siegel et al,
Infection Control and Hospital Epidemiology, vol. 35, 2013.
E. UW Health Clinical Policy 4.1.2 Infection Control in the Cystic Fibrosis Patient Population.





Approved by Director and Medical Director of Respiratory Care