What is a diaphragm pacer system (DPS)?
A treatment for people who are ventilator dependent and cannot breathe on their own. The system (Diaphragmatic Pacing System) can provide part-time or full-time respiratory support to persons who normally need to be on a mechanical ventilator. The whole treatment plan will be explained to the patient, family, and caregivers.
Are the benefits of DPS better than being on a ventilator?
- It decreases secretions
- It decreases pulmonary infections
- It decreases lifetime costs (only need 1 ventilator instead of 2)
- It decrease morbidity
- It increases quality of life
Who is eligible for a DPS?
- Be at least 18 years or older and be committed to DPS treatment
- Have a cervical spinal cord injury and be dependent on mechanical ventilation
- Be clinically stable following an acute spinal cord injury
- Have a committed primary caregiver (caregiver will be required to devote several hours during the day operating the system)
- YOU (or designated representative) and your caregiver will be required to sign a “Patient and Caregiver agreement “ form
- Female patients (of child bearing age) must have a negative pregnancy test
You are NOT eligible for DPS if...
- You have any medical conditions that would interfere with the surgery
- You have active lung disease, heart disease, or brain disease
- You require supplemental oxygen use
- You have been hospitalized for or treated for an active infection within the last 3 months
- You have a significant chest deformity or scoliosis
- You are currently pregnant or breastfeeding
- You are significantly overweight
- There is cause to anticipate poor compliance with treatment plan by you or your caregiver
- Your physician has a reason why you would not be eligible**
What are the risks or side effects of DPS?
- Pain and spasm at the surgical site
- Mild nausea after the anesthesia
- Damage to internal organ less than 1 in 5000
- The expected risks with any general anesthesia
- Not all risks and side effects can be predicted***
What is involved in the initial assessment and screening?
- As an inpatient you would probably have had the following tests performed already, if not they are a requirement for the DPS treatment..
- Physician and surgeon evaluation for eligibility for treatment
- Chest X-ray
- Lab work, which will be blood tests
- EKG to check your heart function
Ready and Committed to Start Treatment...
- You are eligible and have passed all the tests
- On surgery day, you will be taken to the Piedmont Hospital surgery center
- You will be put to sleep
- The surgeon will create four to five dime size holes in the abdominal region
- A laparoscope (tube with a camera) will be inserted, so that the diaphragm muscle can be seen
- The electrodes are attached to the diaphragm muscle and wires (leads) are tunneled under the skin to exit at the lateral chest
- The wires (leads) will be tunneled under the skin and out of your skin, through the chest, and be attached to the connector pins that will secure the wires (leads) The connector will snap into the bandage connector port
- Connector should lie flat against the skin
- Check the wires (leads). Make sure that they are properly positioned within the connector
- Call the outpatient call center if you see a change in the appearance of the connector
Care of the Skin Exit Sites and Connector
- A skin bandage with connection port (clip) will be provided
- The bandage has a connection port that will anchor the orange exit connector
- Keep the skin at the exit sites clean and dry
- Do not scratch skin at exit sites or try to remove glue residue
- Clean the exit sites with alcohol or chlorascrub swab, allow it to dry, place a clean gauze dressing over the exit site. Be sure to cover all the wires with the gauze
- Change the dressings every 3 days or more often if the dressing becomes wet or otherwise soiled
- Beige skin bandage with connection port (clip) will be placed on chest near nipple line or bra line, observe pins.
- View of stimulator cable attached to orange exit connector, cable connection will be done by the respiratory therapist.
- Clean 4X4 gauze pad, taped down on three sides of pad, bottom section of pad untapped for accessible connection to stimulator cable.
- Cover all wires with gauze pad.
- DO NOT place tape on beige skin clip bandage.
- Caught tape should be trimmed around edge of the tape bandage instead of tearing the tape off causing disruption of clip bandage.
Any problems with the DPS system or with patient while unit is in use?
- TURN OFF STIMULATOR, REMOVE STIMULATOR CABLE, AND PLACE PATIENT BACK ON VENTILATOR.
- Call medical professional
- Do not pull or cut the wires
- Use extreme caution when shaving skin area around wire site
- Do not manipulate the metal pins in the connector
Connection to the Stimulator
- The stimulator cable will connect the exit site connector (wires) to the stimulator
- Do not cut, kink or pull the cable
- Do not manipulate the metal pins in the end pieces of the cable
- Keep extra cables in a dry secure location
- When in use, the cable should fit securely into the exit site connector and the stimulator
- The length of the cable should be long enough to provide comfort and allow range of motion without pulling on the exit site connector
- Notify a medical professional if the cable gets cut, kinked, falls in water, loose connection to exit site connector or stimulator
The Stimulator (Pacing Device)
- The cable should be securely inserted into the exit site connector and the top of the stimulator
- To turn ON stimulator: Press down both buttons on the front of the stimulator at the same time
- To turn OFF stimulator: Press down both buttons on the front of the stimulator at the same time
- Do not drop, hit, or throw stimulator
- Do not immerse in water
- Do not attempt to open the box
- Do not expose to long periods of heat or cold
- Keep in a dry and secure location
- When in use, keep close to the patient’s body to avoid pulling on the cable and wires
- Notify the outpatient call center if any of the above happens
Cleaning of Stimulator and Cable
- The stimulator may be cleaned with disinfectant such as a solution of ¼ teaspoon of household bleach (3-6 % bleach)
- Addto 1 pint of water. Rubbing alcohol may be used in place of beach.
- Household cleaners such as glass or multi-surface spray cleaners are adequate.
- DO NOT use these cleaners on parts that will contact the skin.
- Cables may be cleaned with a mild anti-bacterial hand soap solution
Stimulator Alarms and Battery
- Will alarm if it detects a problem with itself, the wires or the connections. If the cable or wires become loose or disconnected a BEEPING sound will go off until the cable or wire is reconnected.
- A 10 second long beep will alarm when the stimulator switches to the internal backup battery. The 10 second alarm repeats once every hour.
- A 20 second long beep will alarm when the internal backup battery is low. The 20 second alarm repeats once every minute.
- Will alarm when battery power begins to run low
- If the stimulator displays “LOW BATTERY” or “REPLACE BATT” then replace the battery immediately!
- Stimulator must be TURNED OFF before replacing battery
- *Stimulator can be placed in a pocket of the patients clothing, a fanny pack or a table or any other convenient location
- Use only SPECIAL size “C” Lithium batteries. Do not use a standard alkaline battery in the Stimulator
- Battery should be changed every 500 hrs (3 weeks of full time pacing)
- To change battery, remove the battery cover located on the back bottom of the stimulator. Use a flat blade screwdriver to remove the battery cover located on the back bottom of the stimulator. Remove old battery and replace with new.
- Replace the battery cover and secure with mounting screws.
- Dispose of depleted batteries according to local regulations.
Spanish-translated version about DPS available here.