- Pacing sessions may start off at very short time increments (5-10 minutes). Remember you are building up the strength of a muscle that has not been used in a while. Try to push yourself further each time. It helps to set goals for you for the next day.
- When you fatigue, generally your tidal volumes will begin to drop. You may not feel “short of breath” right away. Stop pacing session based on how you feel (i.e. Use the BORG scale to let you know when to stop). As the muscle gets stronger, the tidal volumes will stay more consistent (not drop significantly).
- On day of discharge the doctor will give you written instructions for your daily pacing schedule.
- Make sure to document the date, times of pacing, and BORG scale number on the conditioning logs. Bring your log sheets to your next doctor’s appointment so they can monitor your progress and assess for needed adjustments to the settings. Comments should include things like if you are pacing while sitting or while lying down, any problems you experience, fatigue issues, secretion changes, and generally how you did.
- When scoring the BORG scale during pacing, you should never go beyond a 4. If you get to a point where you are scoring a 3 on the BORG scale, stop the pacing session and return to your vent for a 1 hour break. The BORG scale is the best way to decide when to stop. If you score above a 3-4 there may be something else going on (other than fatigue from pacing); you may have a plug and need suctioning.
IMPORTANT: If BORG breathing scale rating for any session is 4 or above, conditioning should be STOPPED and you should be placed back on ventilator or bagged.
- NO ABDOMINAL COUGHING should be done for the next 30 days. Hands should ONLY be placed ON THE UPPER CHEST, and area vibrated to help loosen secretions. Hands should not be anywhere near pacing wires.
- Conditioning the diaphragm should not prevent you from eating or participating in physical activities, when in doubt ask your doctor or respiratory therapist.
- Binder needs to fit snugly to support abdomen
- Change positions of beige bandage clip for plug, to avoid skin breakdown
- Use alcohol to clean skin area around the wires, allow area to dry completely before taping on gauze pad. Do not tape on the beige bandage.
- The bandage tape clips (beige bandage) generally are meant to last 7-10 days, but if it is still holding and not soiled, it can remain longer. Just make sure to monitor the skin.
- Do not force the plug into adaptor cable. Make sure the pins are aligned properly. The Synapse writing on the plug and the adaptor should face outwards for the plug to fit. There is a “dud” block in the plug so that you cannot plug incorrectly.
- Both stimulator units are programmed the same. Switch out your units regularly to ensure the internal battery on both remains charged.
- For replacement supplies (i.e. Batteries, tape bandage clips, external cables) call Tamara Smith at 404 367-1253 /Apothecary at 404 350-7743. Call when you are down to 2 full batteries and/or 4 tape bandages, as it may take a week to re-supply/send to you.
- Each battery has about 500 hours worth of pacing time (at full time pacing generally will last 2-3 weeks).
- There is a backup internal battery in each unit that lasts about 24 hours. When you get a “low bat” alarm, change your battery as soon as possible.
- Used batteries and damaged cables can be thrown away. You do not have to return these items.
- The external cables that attach directly into the battery unit are the items that will most likely be damaged first (the wires coming from your body, rarely sustain damage). If the system is alarming and it is not a low bat alarm, try changing out the cable to see if the backup cable works.
- When plugging or unplugging the cables (external wire) into the battery unit do not twist or force. Pull or push the cuff gently to avoid damage.
Taking a Shower
- Before taking a shower, the respiratory staff should disconnect the stimulator box first.
- Place a large plastic bag or saran wrap (plastic wrap) on abdomen - several inches away from the wires and plug
- Windowpane the tape on the plastic and the skin.
- Do NOT let the tape touch the device parts (so it will not accidentally dislodge the wires when removed)
- Try to keep the water spray away from direct contact with the site
