Adjunctive Cardiopulmonary Techniques Flashcards
Types of techniques
-Incentive spirometry
-oscillatory PEP therapy
-IPPB
Incentive spirometry
-it encourages deep breathing and mimics a sigh
-for post-op pts
-has two types
Two types of incentive sprimetry
-volume spirometers requires less effort and lead to more airflow
-flow spirometers are difficult to use for older and weaker pts as it requires more muscle work to lift the ball
How to use an incentive spirometer
-pt seated upright or in high sitting
-hold spirometer parallel to floor
-shoulder girdle exercises performed beforehand
-PT to place hands on the lateral aspect of thoracic cage
-pt inhales slowly and deeply to try to lift the ball while breathing into the PT’s hands
-pt should reach expansion in basal lungs without elevation of the shoulder girdle
-volume of spiromete adjusted to lowest and increasing with progression.
-pt required to use spirometer hourly throughout the day
Contraindications and precautions of Incentive spirometry
-there are no contraindications
-PT should stand behind or on the side for infection control
-extremely weak trauma pts may not be able to master technique, therefore use alternative method
Positive Expiratory Pressure (PEP) Therapy
-improves secretion clearance
-for pts with chronic lung conditions such as cystic fibrosis
Two types of PEP therapy
-continuous
-oscillatory
Continuous PEP Therapy
-apparatus includes a mask, one way valve and expiratory resistors
-pt seated upright or high sitting
-pt seals mask to face and performs a sequence of 10 breaths at a time
-during each sequence, the mask keeps the alveoli pressurised
-pt performs 2-3 sequences with a pause period between each sequence in one treatment
-start at lower pressure and progress with higher pressures.
Oscillatory PEP therapy
-can be administered using bubble PEP bottle or a flutter device
-for both devices PT should hold pt cheeks
Bubble PEP bottle
-fill a top open bottle with 10cm water on put in a 30cm plastic tubing 10cm below the water surface
-pt inhaled deeply with or without inspiratory hold followed by expiration into the tube
-repeat 10 times and then rest
-bubbles are created in water that mobilise secrestions
-pts may become dyspnoetic therefore monitor closely
-should be performed every waking hour during the day
-progression is to other levels of PEP techniques or increasing the water levels in the bottle
Flutter PEP device
-mainly for pts with cystic fibrosis
-it is a platic pipe with a steel ball inside the circular cone, and a mouthpiece
-pt take deep breath and exhales into the device
-flutter creates oscillations in airways the loosen secretions
-pt performs 4 exhalation breaths followed by maximal exhalation
-aim of the 4 breaths is to loosen the secretions and the last breath is to move the secretions from the airways to be cleared
-use regularly during the day
Contraindications and precautions of PEP therapy
-should not be done in the presence of pneumo-, haemothorax or pleural effusion
-not for haemoptysis unless bleeding is identified and managed
-not for cardiovascular instability
-active tuberculosis du to equipment contamination
-when using bubble PEP bottle, pt should not drink the water
Intermittent Positive Pressure Breathing (IPPB)
-it is the delivery of patient-triggered positive airway pressure throughout inspiration
-for pts who suffer from increased work of breathing due to fatigue or weakness, and those with low lung volumes due to post-op
-may enhance secretion clearance and re-expand collapsed lung areas
How to use IPPB
-pt relaxed in sitting or sidelying or PD to assist in breathing
-machine connected to oxygen source
-mask or mouthpiece is attached to pt
-machine deliver dry oxygen to pt therefore humididfication required
-nebuliser administer with 4ml of saline or mucolytic drug
-machine inflates lungs and on expiration it stops cycling to allow pt to exhale fully
-duration=time taken for nebuliser meds to finish
Contraindications and precautions of IPPB therapy
-undrained pneumo- or haemothorax
-active TB
-lung abscessed
-haemoptysis or pulmonary haemorrhage
-bronchial tumor in proximal airways
-consult surgical team for pts who had thoracic therapy
-reduced cardiac output use with precaution
-not for young children
