Our VOCSN Experience

Last spring we changed Max over to a VOCSN, the new multi-function ventilator from Ventec Life Systems which also includes Oxygen concentrator (**but see caveat below**), Cough assist, Suction, and Nebulizer. (That's right, VOCSN is an acronym.)

After eight years of carrying a Trilogy vent, T70 CoughAssist, and Easy Go Vac suction (all x2, since we never leave home without backups), we were ready to consolidate.

It's been pretty great so far...only one minor problem, easily resolvable. (The touchscreen stopped working; a hard reset resolved it, details below.)

A few observations from the transition which may be of interest to other patients considering the VOCSN:

• Max uses PC-SIMV ventilation mode (as on the Trilogy). His transition from Trilogy to VOCSN was seamless...so smooth, in fact, that during the initial trial at clinic in the hospital (when we tried ventilating him on a VOCSN for the first time, and then, when it worked well, tested out the cough and suction features), Max was fully expecting to go home with the VOCSN that same day. ("Awwwww maaaaan," he commented, when we explained that there were more hoops we had to hop through to get him switched over.)
• Our DME at the time (2019) was not able to support a VOCSN on the medical insurance we were under at the time; we changed DMEs to get the VOCSN. There was also a global pandemic and ventilator shortage, so suffice it to say it felt like a huge win when we finally got him changed over in April 2022.
• We were set up with two VOCSNs, one as a "home vent" and the other as a "travel vent." However, when we travel, we will always carry both with us (just like before when we always carried the backups with us -- always be prepared).
• We got a humidifier upgrade as well -- from F&P MR-410 to F&P HC-550). The HC-550 (which is recommended by Ventec for use with the VOCSN) runs a heated tube using two temperature probes. We moved from refilling manually with distilled water to bag water, which is kinda nice.
• The VOCSN has its own custom vent tubes which include a secondary tube to route O2 from the oxygen concentrator plus a special one-way valve to close off the humidifer during cough mode (to avoid blowing water into the tube). The latter is not included in the "travel vent" version of the tubings (which is designed for use with an HME instead of a ventilator).
• The suction is considerably quieter. Like, wow quiet. Like, a long time ago I made a wish list of medical technologies to invent and put "silent suction" on there (because the average portable vacuum suction unit is incredibly loud which can be awkward in certain social settings) and this feels pretty darn close, quiet.
• It is WAAAY easier to administer a cough (which actually means it's WAAAY easier to train caregivers - HUGE benefit!).  Just press one button, and in three seconds the vent tube starts administering cough therapy. Disconnect after however many cycles you like to cough for, suction trach, reconnect, and voila. Nurses being trained to care for Max used to S-T-R-U-G-G-L-E for weeks to master the rhythm of the cough assist + suction + 2x positive insufflations + vent cycle he typically uses, and, to be fair, it did require the caregiver to manager two tubes with EACH hand (vent, cough assist, suction tubing, suction catheter) while syncing up with an oscillating cycle that is happening in 1.5 second intervals...a bit like learning to jump rope The VOCSN drastically simplifies this: just press cough, and then suction at the right time. Easier coughs mean easier to train nurses (or family caregivers).
• I have not noticed any build-up of sputum from using the same tubing for coughs and vent. We have an omniflex on the end and can change it out easily enough if we notice it gets dirty. Occasionally if some mucus goes into the omniflex, we just suction it out with a catheter; no problem.
• Max has shown no issues with breathing on it and reports that he likes the VOCSN: he likes the coughs, the suction is fine, and he has no trouble using the passy muir valve with it.
• It supports multiple presets for cough mode; currently we have a 5-cycle option and a 10-cycle option. You can set it so that the suction comes on automatically when you start the cough.
• Battery life is approximately nine hours: 3 hours internal plus two 3-hour batteries. Buying additional batteries is quite expensive ($690/pair), but between the two vents we have 4 batteries, so up until now we have been using/charging strategically.
• The suction has been strong enough to do the job. We don't have it on full power.
• It runs through an automated pre-check each time you change the tubing (to test that everything is hooked up right and working fine). This is another reason that a vent-dependent patient needs to have a backup or travel vent on hand.
• It runs slightly louder than the Trilogy, mostly just from the steady pitched hum of the internal fan. Occasionally the one-way valve by the humidifer will make a low-pitched squeak or woof sound...I noticed this a couple times at the beginning but haven't heard it in a few days.
• The travel vent mounted beautifully onto the back of Max's Permobile F3. Saved us a lot of work vs figuring out how to mount a Trilogy 100, CoughAssist T70, suction, and humidifier on there, the way we had on his previous power wheelchair.
• The home vent hooks up to a typical suction canister. The travel vent is configured with a custom VOCSN receptacle for suction contents, which is connected to the side of the VOCSN. Like the filters and vent tubes, these are replaced regularly.
• The story of what it took for us to get this done is its own long saga (involving an in-person trial in early 2020, a global pandemic, a national vent shortage, a non-optional change of insurance companies, and a self-elected change of equipment companies). In the end, Anthem BCBS and PromptCare got us there. (Kudos to both.)
• In summer 2022, we took his two VOCSNs for a week at the beach. This unit is a champ. No problems.
• As of fall 2022, we now have the HC150 running inline with the humidifier circuit for the portable/travel vent setup on his power wheelchair.
• Max has never had his VOCSNs break. (He did have two Trilogy failures, so we know what it's like for a vent to break down--scary.) One of them was swapped out when it reached its regular service date.
• The only problems we have encountered with Max's VOCSN are:
  • In spring 2023, there was one time that the touch screen stopped responding. This was scary (as there's no way to access vital functions like cough and suction), but, after either switching him to either the backup VOCSN or AMBU bag momentarily, we reset the vent and the screen started working again. It hasn't happened since then.
  • In spring 2023, we noticed that the VOCSN (a) wouldn't issue a cough when it's only running on the internal battery, and, more annoyingly, (b) instead just shut down mid-function when we tried to do this. Obviously this is un-ideal (and even dangerous) -- if it doesn't have the power to do this, then it should prevent the user from enabling cough mode (and even warn ahead), rather than just shutting off. When this happens, you can turn it back on, and it will resume ventilation. Our workarounds for this is mainly to make sure we keep batteries charged; when we are out and about, instead of leaving the backup vent in the car, now we remove the extra batteries from it and take them with us, to double our time. And, as usual, we try to plug in and charge whenever possible. So...while this was a major surprise the first time it happened (and resulted in a quick AMBU bag session while we swapped vents and debugged what happened), now it's just one more small thing to workaround. But our verdict is that it's still worth it for the convenience of not having to lug as many machines.​
• Many have reported issues with the VOCSN related to the oxygen concentrator function. (The word on the street is, it wears down the life of the unit, and people who use the VOCSN with concentrator function end up having to swap the unit out ever few months.) We have literally never used the O2 concentrator (and likely never will, as we always travel with a spare O2 tank), so the only way we've been affected by this issue is the fact that some DMEs have soured on the VOCSN due to this issue.