airway clearance Techniques Flashcards
indications for clearance
- retained secretions in the central airways
- prophylaxis against postoperative pulmonary complictaions
- obtain sputum for diagnostic analysis
- difficulty clearing secretions
- atelectasis caused by or suspected of being caused by mucus plugging
active cycle of breathing
ACB technique was developed under the name”forced expiratory technique” to assist secretion clearance in patients with asthma. the name of the techniques was changed to “active cycle of breathing” to emphasize that ACB alwayscouples breathing exercise with the huff cough. it includes three phases: breathing control, thoracic expansion exercises, and forced expiratory technique
breathing control
- gentle, relaxed breathing
- May be diaphragmatic breathing at patient’s tidal volume and resting RR for 5-10 sec, or as long as the patient needs in order to prepare for the next phase.
thoracic expansion exercise`
three to four deep, slow relaxed inhalations to inspiratory reserve with passive exhalation
- chest percussion , vibration or shaking may be combined with exhalation
forced expiratory technique
- one or two huffs at mid to low lung volumes with the glottis open into the expiratory reserve volume
- brisk adduction of the upper arms may be added to self-compress the thorax
autogenic drainage definition
AD uses controlled breathing to mobilize secretions by varying expiratory airflow without using postural drainage positions or coughing.
autogenic drainage procedure
- the pt is sitting upright in a chair with back support
- controlled breathing at three lung volumes:
- -unsticking phase:slowly breathe in through the nose at low lung volumes followed by a two to three second breath-hold to allow collateraal ventilation to get air behind the secretions,then exhale down into the expiratory reserve volume
- -collecting phase: breathe at tidal volume, interspersed by two to three second breath-holds
- -evacuating phasee: deeper inspirations from low-to mid inspiratory reserve volume, iwth breath holding followed by a huff
- exhalation through pursed-lips may be used to control expiratory flow rate
- an average tx is 30 to 45 minutes
Directed Cough
- tries to compensate for the patient’s physical limitations to elicit a max forced exhalation
- inhlae maximally close the glottis and hold breath for 2-3 seconds
- contract the expiratory muscles to produce increased intra-thoracic pressure against the closed glottis
- cough sharply two or three time through a slightly open mouth
- post-surgical pt may need to splint the chest or abdomen by applying pressure over teh incision with a pillow or blanket roll
Directed huff
- is a forced expiratory maneuver performed with the glottis open. the maneuver is similar to fogging a pair of glasses with your breath. although huff does not produce the same airflow velocity as cough, the potential for airway collapse is less. huffing may be reinforced by a quick adduction of the arms to self-compress teh chest wall
- inhale deeply through an open mouth
- contract teh abdominal muscle during a rapid exhalation with the glottis open, saying “ha, ha, ha”
precautions/contraindication for coughing/huffing
- inability to control possible transmission of infection from pt suspected or knwon to have pathogens transmittable by droplets
- elevated ICP, aneurysm
- reduced coronary artery perfusion
- acute unstable injury
- regurgitation/aspiration
- hiatal hernia, pregnancy
- flail chest
high-frequency airway oscillation types and definition
- acapella and flutter are handheld devices that combine positive expiratory pressure and high frequency airway vibrations to mobilize mucus secretions in teh airways
high-frequency airway oscillation procedure
- place the device in the mouth with the lips firmly sealed around the mouthpiece
- inhale slowly to 75% of a full breath
- hold teh breath for two to three seconds
- exhale through teh device for three to four seconds
- repeat 10 to 20 breaths
- Remove the device and perform two or three cough or huffs to raise secretions
postural drainage
-consists of positioning the pt so that gravity will help drain bronchial secretions from specific lung segments towar the central airways where they can be removed by cough or mechanical aspiration
Percussion
- or cupping and clapping, is the rhythmic clapping or striking of the thorax with a cupped hand or mechanical percussor directly over the lung segment being drained. this rhythmic sequence should last for several minutes and should not be painful
Vibration
-is the application of a fine, tremulous action on the chest wall over the lung segment breing drained in the direction the ribs move during exhalation. it may be performed manually or with a mehcanical vibrator.
vibration should be performed during exhalation
