High Frequency Chest Wall Oscillation (HFCWO) Device

Commonly known as “Vest”

Important information: 

High frequency chest wall oscillation devices help to clear mucus from the lungs. If your child has a weak cough, thick secretions, or cannot move mucus well, this device will help to remove the mucus.   

When used as part of an airway clearance program HFCWO can decrease the number of lung infections, emergency department visits, and hospitalizations.

The goal of these devices: 

• Provide an adequate airway clearance program

• Help decrease the number of pulmonary (lung) infections

• Minimize the need for emergency room (ED) visits and hospitalizations

Types of HFCWO devices recommended at Children’s Hospital of Philadelphia (CHOP): Links to the manufacturer's instructions are linked below.

• The Vest system

• The Vest APX system

• InCourage system

• SmartVest® clearway® system

• SmartVest® system

Will my medical insurance cover these devices?

It depends on your child’s diagnosis and the type of insurance. 

• Some insurance programs will provide full coverage. 

• Other insurance programs will cover part of the cost and expect the family to cover the rest. Ask if the vest company offers a payment plan option. 

• If your insurance company denies coverage, call them to find out the reason. 

How can I partner with my medical team to obtain insurance coverage? 

The medical team will write a “Letter of Medical Necessity.” They will send this letter, along with your child’s medical history, to the device company. 

• The device company will contact your insurance to determine coverage of the device. 

• If medical coverage is denied, contact your medical team to assist in this process. 

How will I receive my device?

• When a device is approved for your child, a representative from the device company will come to your house and teach you how to use it. 

• Call customer service for broken/malfunctioning items, new vest garment, and questions or concerns with the operating the vest device.

Patient instructions:

Airway clearance treatment program

• Continue chest physiotherapy (CPT) as prescribed until the device is received. 

• Complete vest treatments as instructed by your medical team. Usually, 2 times a day when well for 20-30 minutes; 3-4 times a day when sick.

• It is important to help your child cough to clear the loosened mucous from the child’s lungs every 10 minutes and at the end of the vest treatment.

  • The huff cough  is one of many techniques that can help effectively move mucous out of the lungs.

  • If your child does not have an effective cough, your medical team may prescribe a Cough Assist Device treatment.

• Your medical team will assist you in managing the vest settings and will recommend adjustments as needed.

During vest therapy, monitor your child for:

• Prolonged coughing or irritation

  • Pause the therapy then restart once cough or irritation has subsided

• Vest position 

  • The vest should cover the ribs and extend down towards the pelvis when sitting.

  • Try to avoid placing the vest over a gastrostomy (GT) tube or a central line. This could damage the device.

  • You may consider using foam for padding over the site. Ask your medical team before doing so. 

• Mealtime

  • Avoid doing the therapy right after a meal as it could cause discomfort or vomiting.

• Avoid doing the therapy if your child has:

  • High blood pressure

  • Headache

  • Recent surgery on or near areas that the vest covers

  • Reach out to your medical provider if you are unsure if it is safe to use your vest.

Reviewed October 2024 by Jacqueline Vicencio, PT, DPT and William Glenn BHS, RRT-NPS