The Flutter Valve (Scandipharm products) is a device to deliver PEP therapy in a slightly different approach. The device consists of a mouthpiece connected to a cylinder in which a stainless steel ball rests in a cone shaped valve. The patient exhales through the cylinder and causes the ball to move up and down during the exhalation. The effect is threefold: first, to vibrate the airways and thus, facilitate movement of mucus; second, to increase endobronchial pressure to avoid air trapping and third, to accelerate expiratory airflow to facilitate the upward movement of mucus. Technique:
Stage 1(Loosening and Mobilizing Mucus):
1. Ask the patient to slowly inhale beyond a normal breath (but not maximally).
Have the patient hold his/her breath for 2 to 3 seconds.
2. Have the patient place the flutter valve in the mouth, keeping cheeks stiff and adjusting the tilt of the cylinder. Exhale through the flutter at a fairly fast flow rate, exhaling past normal exhalation (but not maximally).
3. Repeat procedure for 5 to 10 breaths.
Stage 2 (Eliminating Mucus):
1. 1. Have the patient slowly inhale to a maximal inspiration.
2. Hold breath for 2 to 3 seconds.3. Place Flutter valve in mouth, adjusting tilt and keeping cheeks stiff.
4. Exhale forcefully through the flutter as completely as possible.
5. Repeat 1 to 2 times.
6. Initiate cough or huff maneuver.
7. Repeat procedure (Stage 1 and 2) until no further mucus production is obtained.
Types of Patients:
Acute Care: Patients with excessive mucus production having difficulty expectorating and do not have an artificial airway in place.
Subacute /Home Care: Again, the above statement applies to the home care/subacute setting. Another group of patients that may significantly benefit from Flutter therapy are those with cystic fibrosis. Traditional therapy of postural drainage and chest percussion can take over an hour to complete. Compliance with this therapy becomes difficult, especially with the teenage population. Flutter therapy has been proven to at least equal more traditional forms of therapy in much less time.
Limitations: The major limitation is patient cooperation and ability to follow directions.
Assessment of Positive Outcomes: Increased sputum production, patient's subjective response to therapy, improvement in chest x-ray, ABG's, and/or SaO2.
Tips: The amount of tilt of the Flutter is important. Initally, the mouthpiece should be horizontal to the floor. Then the cone is tilted up or down to achieve maxiaml "flutter" effect. The way this can be assessed is to place your hands on the patient's back and chest. When maximal fluttering is achieved, you will be able to fell the vibrations. The patient may need several sessions to establish the correct tilt.
In the home care setting, patients should be instructed and monitored on appropriate infection control. After each session, the device should be disassembled, rinsed and dried. Every 2 days, patients should disassemble and clean the device with a mild soap or detergent, rinse, and dry. At regular intervals, the device should be disassembled and soak their cleaned components in a solution of 1 part alcohol to 3 parts tap water for 15 minutes- then rinsed and dried
Vibratory Positive Expiratory Pressure System