To provide the respiratory therapist a set of guidelines and therapies specific for volume expansion and prevention/mobilization of secretions. This Slideshow focuses on the MetaNeb Device, it's benefits and procedures; it also highlights its indications and contraindications. Enjoy.

1. METANEB
IN-SERVICE
BY: ANREY BARTOSZYNSKI-BSRT,
RRT-ACCS

2. WHAT IS
MetaNeb?
MetNeb is a therapeutic
device that utilizes a
systemic approach to
enhance normal mucous
clearance and resolve or
prevent patchy
atelectasis.

3. Purpose
Volume expansion and prevention/mobilization of
secretions.

4. Indications:
1. Evidence of difficulty with secretion clearance
2. Presence of atelectasis caused by or suspected of being caused by
mucus plugging
3. Diagnosis of disease
a. Asthma
b. Chronic Bronchitis
c. Emphysema
d. Bronchiectasis
e. Neuromuscular Disorders
f. COPD
g. Patients who need Postoperative Airway Management
h. Patients who need Emergency Room Airway Management

5. Contraindications
Absolute:
● Untreated tension
pneumothorax
● Head or neck injury that has
not been stabilized
● Anyone actively
hemorrhaging with
hemodynamic instability.
Relative:
● History of pneumothorax
● Pulmonary air leak
● Recent pneumonectomy
● Pulmonary hemorrhage
● Myocardial infarction
● Vomiting

6. Potential Adverse Reaction
A. Hyperventilation
B. Gastric distension
C. Decreased cardiac output
D. Increase intracranial pressure
E. Increased air trapping
F. Hyper-oxygenation
G. Pneumothorax
H. Pulmonary air leak
I. Pulmonary hemorrhage

7. Equipment (MetaNeb circuit system set-up)
Required:
· Controller
· Circuit
· Gas Hose
Additional:
(Dependent on therapy delivery option)
· Mask or mouthpiece
· Flex tube connector

8. Pre-Check Procedure
1. Connect the gas hose to 50 psi source
2. Connect the circuit to the controller
3. Set mode to CHFO, and select Higher.
4. Set the selector ring on the handset to the Three-dots position.
5. Put the master switch in the on position.
6. Occlude the patient opening of the handset
7. Watch the pressure gauge. The average of pressure fluctuations should not be less than 15 and not
more than 30 cm H20.
8. Set the mode to CPEP.
9. Turn the CPEP flow dial counterclockwise to full flow.
10.With the selector ring on the three-dots, occlude the patient opening of the handset and monitor the
manometer. Make sure there is a peal pressure occurrence of no less than 20 and not more than 30
cm H2O.
11. If the device is not within the parameters specified above, do not use the unit, tag the unit and place a
biomed work order.
*Keep all sources of ignition away from this device.

9. Therapy Procedure
(For Non-ventilated Patients)
1. Turn the master switch ON.
2. Set the mode to CPEP
3. Instruct the patient to inhale and exhale slowly.
4. Based on patient response, adjust the selector ring on the handset for higher resistance (3 Dots), to lower
(1 Dot) resistance and adjust the CPEP flow as applicable.
5. Encourage the patient to exhale slowly (3-4 seconds).
6. Continue CPEP for 2 ½ minutes.
7. Tell the patient the mode will change to CHFO.
8. Encourage the patient to continue breathing when you transition to CHFO.
9. Move the selector switch to Higher and the mode to CHFO.
10.Encourage the patient to inhale normally and exhale slowly (3-4 seconds) against pulsations.
11.Continue CHFO for 2 ½ minutes.
12.Alternate between CPEP and CHFO until the treatment is complete (about 10 minutes or until the
nebulizer is empty).

10. Therapy Procedure
(For Patients on Mechanical Ventilation)
1. Follow your institutional guidelines for infection control
2. The patient should be in a position to maintain the head of the bed angle at >30
degrees if possible.
3. Assess the patient per institutional guidelines.
4. Assemble the circuit, and connect it to the controller.
5. Prepare the handset for in-line use-remove the blue selector ring from the handset, and
replaced it with the black occlusion ring to make sure the exhalation orifice is blocked.
6. Put a spring-valve “tee” adapter into the inspiratory limb of the ventilator circuit.
7. Fill the nebulizer with the prescribed medications as applicable.
8. Set the mode to CHFO and select Higher.
9. Put the master switch in the ON position.
10.Use the 15 mm x 22 mm adapter to connect the handset to the spring valve “tee”
adapter that is on the circuit.

11. Therapy Procedure
(For Patients on Mechanical Ventilation) Continuation..
1. Monitor the patient response to the therapy, and continue the treatment for 10
minutes or per facility protocol.
2. Adjust the alarm parameters as necessary during the in-line therapy.
3. Suction secretions as necessary. Do Not leave the patient during the therapy,
and be prepared to suction.
4. When the treatment is complete, remove the handset and adapter from the
spring-valve “tee”, and cap the “tee” before you put the master switch in the OFF
position.
5. Return the ventilator alarms and mode to their previous settings.
6. Monitor and document the patient’s tolerance during and after the treatment.
7. Store the circuit per your institution’s infection control protocol.

12. Indications to Modify Therapy
Discontinue MetaNeb or PRN status may be indicated when:
1. Vital capacity >10 ml/kg.
2. Chest exam demonstrates absence of retained secretions/atelectasis.
3. Breath sounds have become clear and improved aeration.
4. CXR demonstrates absence of atelectasis and/or consolidation.
5. Physical assessment warrants the change.
*Instruct patient on incentive spirometry.

13. Reference:
RCJournal.com (1993, May). “AARC Clinical Practice Guideline: Use of PAP Adjuncts to
Bronchial Hygiene Therapy. Respiratory Care 1993: 38:516-520”, Retrieved (2018, August 6),
from http://www.rcjournal.com/cpgs/papcpg.html

14. Web-Sources
MetaNeb Brochure:
● https://www.hill-rom.com/globalassets/website-
documentation/english-websites-us--int/respiratory-care-us--
int/metaneb-system---us/metaneb-brochure-165667r5.pdf
MetaNeb System:
● https://www.hill-rom.com/usa/Products/Category/Respiratory-
Care/MetaNeb-System/