In-Exsufflator Use

The in-exsufflator should be used for persons who have difficulty clearing the airway by coughing or suctioning. A doctor must order this treatment because it can carry risks for people with certain other medical conditions.

The treatment may help patients who are experiencing symptoms such as:

• Rattling breath sounds are heard.
• Mucous is bubbling up in the throat or trach tube.
• When a hand on the chest can feel the rattling of congestion.
• When the person tells you it is hard to breathe.

• Step 1: Set exhale pressure to 45. Do this by covering the tubing with your hand and sliding the handle to the left. Watch the pressure go up and adjust it to 45-50.
• Step 2: Set the inhale pressure to 40. Do this by covering the tubing with your hand and sliding the handle to the right. Watch the pressure go up and adjust it to 40.

The machine is ready for use once the pressures have been set. Always follow the advice of your doctor about pressure settings. Safe pressures can vary from person to person.

With a trach tube

Two people are needed to safely perform this procedure. One person (Helper 1) will provide extra breaths, bag, and assist cough, while the second person (Helper 2) will operate the in-exsufflator machine.

• Helper 1: Provide the person with extra breaths by bagging with the Ambu Bag. Give extra breaths before, during, and after each treatment.
  • You may also need to perform the assist cough procedure. See the assist cough lesson for more information.
  • If the mucous is thick, you can use normal saline to make it thinner. Squirt a small amount into the trach tube and then bag the person with the Ambu Bag. This will help loosen up the mucous and make it easier to in-exsufflate.
• Helper 1 and Helper 2: Wash your hands.
• Helper 2: Put on clean gloves (recommended). Turn on the in-exsufflator.
• Helper 1: Provide several extra breaths using the Ambu Bag. When done with the Ambu Bag, move hands down below the person’s rib cage to be ready to assist cough when it is time.
• Helper 2: Attach the in-exsufflator tubing to the trach tube.
  • Slide the black handle (or press switch) to the right side to inhale.
  • Hold for 1 second, then slide the black handle (or press switch) to the left to exhale and hold for 2 seconds.

• Helper 1: During the exhale phase, perform the assist cough, followed by providing extra breaths with the Ambu Bag. Do this after each cough cycle.

The in-exsufflator treatment can be done by giving the person 1 to 3 cough cycles in a row with rest periods and extra breaths/bagging in between each cycle. Allow the person to say which is best and most comfortable.

At the end of each cough cycle, clear the tubing of any remaining mucous. This can be done by detaching the tubing from the person, holding the tubing over a paper towel or trash container and turning the machine to the inhale cycle. This will blow the mucous out of the tubing. The other option is to use new tubing with each cough.

Turn the in-exsufflator off, remove the gloves, and wash your hands.

With a mask or mouthpiece

This procedure is basically the same as stated above, except that a mask or mouthpiece is used instead of the trach tube.

• If using a mouthpiece, place it in the person’s mouth and ask them seal their lips around it.
• If you are using a mask, securely hold it over the person’s nose and mouth during the procedure.
• The person’s mouth should still be cleared of mucous after each cough, whether using a mask or a mouthpiece. Have some tissues ready.