Using a cough assist device with a face mask: a carer’s guide

Training is needed before using the cough assist device.

The following information is for carers who are helping a patient use a cough assist device at home. This leaflet will support your training by explaining the following.

• What to do before you start using the device.

• When not to use the device.

• Details of the patient’s cough assist prescription.

• How to use the cough assist device.

• What side effects to look out for. What to do if the patient has any side effects.

We hope this leaflet answers some of the questions you may have. If you have any further questions or concerns, please speak to your trainer.

Do not try to use cough assist if the patient is experiencing any of the following

• If you suspect or are trying to remove the following from the patient’s mouth or airways.

  • A solid object.

  • An inhaled foreign body.

  This could result in the object being forced further into the airway. It could possibly cause a complete obstruction / blockage. If this happens, please call 999.

• If the patient has any of the following symptoms, ask for medical advice from their GP or call 111 before using cough assist.

  • New respiratory / lung diagnosis or symptoms.

  • Severe wheeze / gasping (bronchospasm / stridor). Cough assist will make this worse.

  • Any face / head / chest trauma, or a new head injury.

  • High or low blood pressure / heart rate. Or symptoms linked with abnormal blood pressure / heart rate, such as dizziness.

  • Coughing-up blood (haemoptysis) or vomiting blood.

  • Recent face, mouth, neck, lung, or abdominal surgery.

  • Any new diagnosis involving the stomach.

  • Heart failure.

• If the patient is finding it increasingly hard to breathe or is showing signs of respiratory distress, please call 999. Symptoms could include one or more of the following.

  • Rapid / fast breathing rate.

  • Struggling to breathe.

  • Very noisy breathing, including wheezing, gasping, or grunting.

  • Using shoulders to help breathe.

  • Restlessness or exhaustion.

  • Struggling to talk in full sentences.

  • Blue colouring of their lips.

What should I do before I start using the cough assist device?

Make sure you have the following equipment

• A cough assist device.

• Clean tubing, bacterial filter, and face mask.

• Clean gloves. If you need these, you must provide them yourself.

Prepare to use the mask

1. Explain to the patient that you are going to begin treatment. Make sure they are happy to proceed.

2. Wash and dry your hands. If you are using them, put on protective gloves.

3. Make sure the patient is in a comfortable position.

4. Plug in the cough assist device.

5. Make sure the tubing, bacterial filter, and face mask are connected and attached to the cough assist device.

6. Turn the cough assist device on.

1. 
   If you are using them, put on protective gloves.
2. 
   Tubing attached to cough assist device
3. 
   Mask attached to tubing

1. 
   Tubing and mask attached to cough assist device
2. 
   Turning on the cough assist device

Important: please make sure you have read through this list before starting treatment  

• If the patient’s tummy is bloated and painful, the cough assist may make this worse. Please ask for medical advice from their GP or call 111 before starting treatment.

• Take extra care if the patient is very restless or worried. It will be less worrying for the patient and easier if you wait until they calm before carrying out cough assist treatment.

• Make sure the patient has waited at least 1 hour after eating / enteral feeding before using cough assist.

• Make sure the mask, tubing, or bacterial filter are clean before using. If any of this equipment is dirty when used, it can cause a chest infection.

• Make sure the face mask does not fit too tightly. A tight face mask can cause injury to the soft tissue of the nose, mouth, and face.

The cough assist prescription

The patient’s prescription is pre-set. Do not make any changes to the following prescription.

How do I use the cough assist device?

1. Apply the face mask to the patient’s face. Make sure it is a comfortable snug fit. If the face mask is fitted too tightly, it can cause injury to the soft tissue of the nose, mouth, and face.

2. Once the patient is comfortable, press start on the cough assist device.

3. After the cough assist finishes, remove the face mask from patient’s face.

4. Check for sputum (a mixture of saliva and mucus) in the patient’s mouth. Use suction if prescribed or ask the patient to clear the sputum. *If you see sputum in the mask during treatment, use the start / stop button on the cough assist device to stop the treatment. Clear the sputum before restarting the device.

5. Check sputum. Is it their normal sputum colour, consistency or amount for the patient? Increasing sputum amounts or changes in colour can mean they have a chest infection. If these changes last for more than 24 hours, ask for advice from a GP or 111.

6. Check the patient is comfortable by checking the following.

   • Have their respiratory rate and oxygen saturations (if monitored) returned to normal?

   • Does their breathing look comfortable / normal?

   • Are there any signs of distress or blue colouring to the lips?

   If the patient experiences any side effects and has not returned to their normal levels within a few minutes, please call 999 for advice.

7. If further cough assist treatment is prescribed (see The cough assist prescription above) repeat steps 1 to 6.

8. Once the procedure has been completed, turn off the cough assist device and unplug it.

9. Change the circuit (tubing, bacterial filter, face mask) every 6 weeks, or earlier if it is dirty.

10. Change the circuit after a chest infection.

11. Facemasks can be washed with warm soapy water, and left to air dry.

What are the possible side effects of cough assist treatment?

If the patient experiences any of the following side effects, please stop the cough assist treatment immediately. If symptoms continue when you restart the cough assist, please ask for medical advice by calling 111 or 999.

• Increased / decreased heart rate.

• Gagging / vomiting / swallowing air / burping.

• Airway spasm or wheeze.

• Pain, distress, or discomfort.

• Respiratory distress including:

  • increased breathing rate

  • struggling to breathe

  • gasping

  • very noisy breathing

  • blue colouring of the lips

• Drop in oxygen saturations (if monitored) below their normal levels.

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