Diaphragm Pacing Sessions Fact Sheet

Tips for diaphragm pacing sessions

As you begin your diaphragm pacing sessions, it’s important to start gradually and allow your diaphragm to regain strength.

In the initial stages, sessions may be as short as 5 to 10 minutes, but the goal is to progressively increase both the duration and intensity as the muscle strengthens. Throughout this process, it’s essential to monitor your progress, track your efforts using the BORG scale, and follow specific guidelines to ensure your safety and comfort.

Here we outline key instructions for pacing, as well as tips for documenting your sessions, caring for your device, and managing daily activities, including showering and using your pacing system. Regular communication with your doctor or therapist is crucial to ensure you’re on the right track.

  • Pacing sessions may start off at very short time increments of 5 to 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 a pacing session based on how you feel, using the Borg scale to let you know when to stop. As the muscle gets stronger, the tidal volumes will stay more consistent and not drop significantly.
  • On the 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 the 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.

  • Before taking a shower, the respiratory staff should disconnect the stimulator box first.
  • Place a large plastic bag or 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.

  • 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 for a beige bandage generally are meant to last 7 to 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 such as batteries, tape bandage clips, and external cables, call Shepherd Center’s Apothecary at 404 350-7743. Call when you are down to 2 full batteries and/or 4 tape bandages to allow time to resupply.
  • Each battery has about 500 hours worth of pacing time. At full-time pacing, it generally will last 2 to 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 external wire cables into the battery unit, do not twist or force. Pull or push the cuff gently to avoid damage.
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