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The PEP-set consists of a breathing mask, one-way valve and eight different resistors.
Fit a resistor in the expiration side of the valve in the white nozzle. The capacity of the resistor should be determined by the use of a Pep/Rmt manometer. The smaller the diameter, the higher expiration resistance.
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1. The smallest diameter resistor which the patient can use effortlessly for 2 minutes, while simultaneously raising an expiration pressure of 10-15 cm water column, will prove to be the correct one. If the patient experiences discomfort, the diameter is too small or the technique is wrong.
As a guideline use 1.5 mm for infants and increase gradually to 2.5-3 mm for older children and adults not suffering form pulmonary diseases. 3.5 mm may be used for adults suffering from bronchial emphysema.
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2. The mask must fit airtight around the nose and mouth of the patient.
Inspiration
Ask the patient to breathe slowly and deeply through the mask.
Expiration
The expiration must be slightly activated, but not forced. It is important that the patient yields to the resistance and breathes at a higher lung volume.
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3. Remove the mask from the face after 10-15 respirations through it, ask the patient to breathe out forcefully, i.e. make long and forced expirations with the glottis open in order to move the loosened secretion towards the trachea. Then ask the patient to cough. Alternate between a series of respirations through the mask and forced breathing out and coughing until the patient feels free of secretion.
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4. At the beginning some assistance may be necessary to make the mask fit airtight against the face which is a a must to obtain the desired effect. Apart from that, the patient can in most cases administer the PEP-set himself after careful instruction by the physiotherapist.
Information on the disease and what the patient can do to improve the situation is an integral part of the treatment.
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5. A good treatment posture is to sit with the elbows resting on a table.
For acute diseases the PEP-set may be used several times daily.
For chronic cases the PEP-set should be used for 15 minutes 3 times daily. In a postoperative situation an hourly use of a PEP-set can have an atelectasis prophylactic effect. For prophylaxis and atelectasis treatment a pressure of 15-20 cm watercolumn is recommended, and for release of secretion obstruction in pulmonary patient 10-15 cm watercolumn is recommended.
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