Best Practice for Sizing & Fitting ComfortLite™ Direct Seal™ Cushion

1) Use either Sizing Gauge to determine the appropriate mask size.
	Bag Sizing Gauge: Place the sizing gauge beside the patient’s nose. Choose the size that corresponds to the patient’s nostril opening.
	Plastic Sizing Gauge: Place sizing gauge into the patient’s nostril so that the indicator line matches the edge of the nostril. Note: Use the LARGER of two sizes if the patient is between sizes. Direct Seal is designed to provide a seal on the outside rim of the nostrils, so generally a larger size is recommended.
2) Properly fit the headgear on the patient.
	The headgear fits on the head similar to a baseball cap. The front of the headgear sits just above the eyebrows and ears.
	Unfasten the crown strap, if necessary, to make sure the front of the headgear rests above the eyebrows and ears and the crown strap rests comfortably on the top of the head.

	Use the back strap to fit the headgear snugly around the circumference of the head.
3) Prepare the mask before placing on the patient.
	Remove the headgear from the patient and turn the twist adjuster to extend the vertical adjustment tube.
	Pivot the angular adjustment to its backmost position, extending the end of the tube outward.
	Attach the appropriate size of the Direct Seal cushion to the vertical adjustment tube.
4) Place the mask on the patient and make pre-adjustments while the patient is lying down.
	Pivot the angular adjustment so that the Direct Seal cushion sits gently against the face.
	Turn the twist adjuster so that the Direct Seal cushion rests comfortably against the outside edge of the nostrils.
	If necessary adjust the metal support located on the Direct Seal cushion so that there are no visible gaps between the nostrils and the cushion.
5) Administer pressure and adjust for leakage. In the event of leakage, there are four recommended methods for obtaining a better seal.
	First: Re-seat the mask to allow airflow to re-inflate the cushion after multiple adjustments.
	Second: Adjust the metal support band. For leaks along the outside of the nostrils: Squeeze the metal band to bring the bulbs of the Direct Seal cushion closer together and accommodate the seal.
	For leaks at the base of the nostrils or near the upper lip: Curl the metal band to direct the airflow more vertically into the nostrils.
	Third: Tighten the vertical adjustment to apply a tighter fit of the cushion to the base of the nostrils. Note: Excessive tightening may cause unnecessary discomfort.
	Fourth: Try the next size cushion. Direct Seal is designed to provide a seal on the outside rim of the nostrils, so generally a larger size is recommended. However, some patients may prefer and/or achieve a better seal by using a smaller size cushion that extends into the nose.
6) Remove the mask
	To remove the mask, simply grasp the angle adjustment mechanism, pull the mask directly away from the face and lift off the head. Note: It may be necessary to pivot the angular adjustment away from the nose to remove the mask with the Direct Seal cushion.

	Note: It is recommended that the patient pay close attention to the location of the tubing connection before going to sleep. The mask will be more stable if the tubing connection has minimal interaction with the patient’s pillow.