How do you use the acapella breathing device?

ACAPELLA DEVICE

The Acapella is a handheld airway clearance device that provides positive expiratory pressure (PEP) with oral airway oscillation to aid sputum clearance. PEP stabilize airways and improves aeration of the distal lung areas. During exhalation, pressure from the airways is transmitted to the Acapella device, which helps mucose dislodge from the airway wall, thereby preventing airway collapse, accelerating expiratory flow, and moving mucus toward the trachea. This device combines resistive features of PEP and vibration to mobilize airway secretions. The Acapella device is easy to use as patient with chronic conditions such as cystic fibrosis appear to receive the greatest benefit from this type of treatment.

DELEGATION CONSIDERATION

The skill of using an Acapella device can be delegated to nursing assistive personal.  The nurse is responsible for performing respiratory assessment,  determining that the procedure is appropriate and that a patient can tolerate it, and evaluating a patient's response to the procedure.

• Be alert for the patient tolerance of procedure, such as comfort level and changes in breathing pattern, and to immediately report changes to the nurse. 
• Use the specific patient appreciation, such as positioning restrictions related to the disease treatment. 

IMPLEMENTATION

Prepare Acapella device 

• Turn Acapella frequency adjustment dial counterclockwise to lowest resistance setting. As the patient improves or is more proficient, adjust proper resistance level upward by turning dial clockwise 
• If aerosol drug therapy is ordered, attach a nebulizer to the end of the Acapella value. 

Instruct the patient to:

• Sit comfortably 
• Take breath that is larger than normal but not to fill lungs completely 
• Place mouthpiece into the mouth, maintaining tight seal
• Hold breath for 2to 3 seconds
• Try to cough and to exhale slowly for 3 to 4 second through the device while it vibrates. 
• Repeat cycle for 5 to 10 breath as tolerated. 
• Remove mouthpiece and perform one or two huff coughs. 
• Repeat steps a through as ordered. 
• Auscultate lung fields, obtain vital signs and pulse oximetry.  Inspect colour, character and amount of sputum.  

Patient cannot maintain exhalation for 3 to 4 second, then adjust the dial clockwise to allow patient to exhale at a lower flow rate.