Airway Clearance Techniques

Question 1

Indications for airway clearance

Answer 1

• retained secretions in the central airways
• prophylaxis against postoperative pulmonary complications
• difficulty clearing secretions
• atelectasis caused by or suspected by caused by mucus plugging

Question 2

active breathing cycle procedure

Answer 2

breathing control
- relaxed breathing for 5-10 seconds

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
• a brisk adduction of upper arms may be added to self compress the thorax

Question 3

ACB precautions/contraindications

Answer 3

• splinting postop incisions to achieve adequate expiratory force
• bronchospasm or hyperactive airways

Question 4

Autogenic drainage

Answer 4

• uses controlled breathing to mobilize secretions by varying expiratory airflow without using postural drainage positions or coughing
• may not be suitable for young patients or patients who are not motivated or easily distracted

Question 5

AD procedure

Answer 5

Unsticking phase- slowly inhale, hold for 2-3 seconds, slowly exhale all air

collecting phase- breathe at tidal volume with 2-3 second holds

evacuating phase- deeper inspirations from low-to-mid inspiratory reserve volumes with breath holding followed by a huff

procedure lasts 30-45 min

Question 6

Precautions/Contraindications of AD

Answer 6

requires motivation and concentration to learn

Question 7

directed cough and huffing

Answer 7

cough -compensates for the patient’s physical limitations to elicit a maximum forced exhalation
huff- similar to coughing but does not produce the same airflow velocity; the potential for airway collapse is less

Question 8

cough and huff procedure

Answer 8

• post-surgical patients may need to splint the chest or abdomen by applying pressure over the incision with a pillow or blanket roll
  huff- inhale and exhale saying ha ha ha

Question 9

precautions and indications for cough and huff

Answer 9

• inability to control possible transmission of infection from patients suspected or known to have pathogens transmittable by droplets
• elevated intracranial pressure or known intracranial aneurysm
• reduced coronary artery perfusion
• acute unstable head, neck, or spine injury
• potential for regurgitation
• acute abdominal pathology, abdominal aortic aneurysm, hiatal hernia or pregnancy
• untreated pneumothorax
• osteoporosis
• flail chest

Question 10

High frequency airway oscillation

Answer 10

• the acapella and flutter are handheld devices that combine positive expiratory pressure and high frequency airway vibrations to mobilize mucus secretions in the airways

Question 11

precautions and contraindications of high frequency airway oscillation

Answer 11

• patient tolerance of increased work of breathing
• intracranial pressure >20 mm Hg
• hemodynamic instability
• recent facial oral or skull surgery or trauma
• acute sinusitis
• nose bleed
• esophageal surgery
• active hemoptysis
• nausea
• known or suspected tympanic membrane rupture or other middle ear pathology
• untreated pneumothorax

Question 12

Postural Drainage

Answer 12

positioning the patient so that gravity will help drain bronchial secretions from specific lung segments toward the central airways where they can be removed by cough or mechanical aspiration
- hold each position for 2-3 min

Question 13

postural drainage contraindications

Answer 13

• intracranial pressure > 20 mmHg
• head and neck injury until stabilized
• active hemorrhage with hemodynamic instability
• recent spinal surgery or acute spinal injury
• active hemoptysis
• empyema
• bronchopleural fistula
• pulmonary edema associated with CHF
• large pleural effusion
• PE
• confused or anxious patients
• rib fracture with or without flail chest
• surgical wound or healing tissue

Question 14

postural drainage contraindications for trendelenburg

Answer 14

• uncontrolled hypertension
• distended abdomen
• esophageal surgery
• recent gross hemoptysis related to lung carcinoma treated surgically or with radiation therapy
• uncontrolled airway risk for aspiration (tube feeding)

Question 15

Apical segments right and left upper lobe position

Answer 15

• the patient is sitting, leaning back 30-40 degrees, percussion is performed above the clavicles

Question 16

Posterior segment right upper lobe postion

Answer 16

• patient is turned 1/4 from prone on the left side with the bed horizontal and the head and shoulders raised on a pillow
• percussion is performed around the medial border of the right scapula

Question 17

posterior segment left upper lobe position

Answer 17

• patient is turned 1/4 from prone on the right side with the head of the bed elevated 45 degrees and the head and shoulders raised on a pillow
• percussion performed around the medial border of the left scapula

Question 18

lingula left upper lobe position

Answer 18

• the patient is turned 1/4 from supine on the right side with the foot of the bed elevated 12 inches.
• percussion is performed over the left chest between the axilla and the left nipple

Question 19

anterior segments right and left upper lobes position

Answer 19

• the patient is in supine with the bed horizontal

- percussion is performed below the clavicles

Question 20

right middle lobe position

Answer 20

• patient is turned 1/4 from supine on the left side with the foot of the bed elevated 12 inches
• percussion is performed over the right chest between the axilla and the right nipple

Question 21

superior segments left and right lower lobes position

Answer 21

• patient is prone with the bed horizontal

- percussion is performed below the inferior border of the left and right scapulae

Question 22

anterior basal segments left and right lower lobes position

Answer 22

• the patient is in supine with the foot of the bed elevated 18 inches
• percussion is performed over the lower ribs on the right and left

Question 23

posterior basal segments left and right lower lobes position

Answer 23

• patient is prone with the foot of the bed elevated 18 inches
• percussion is performed over the lower ribs on the left and right side of the chest

Question 24

lateral basal segments lower lobes position

Answer 24

• patient is in sidelying with the foot of the bed elevated 18 inches
• percussion is performed over the lower ribs
• for lateral segment of left, patient is laying on right side

Question 25

Percussion/vibration precautions and contraindications

Answer 25

• all for postural drainage
• subcutaneous emphysema
• recent epidural spinal infusion or spinal anesthesia
• recent skin grafts, or flaps, on the thorax
• burns, open wounds, and skin infections of the thorax
• recently placed transvenous or subcutaneous pacemaker
• suspected pulmonary tuberculosis
• lung contusion
• bronchospasm
• osteomyelitis of the ribs
• osteoporosis
• complaint of chest wall pain

Question 26

Expected outcomes of airway clearance

Answer 26

• easier clearance of secretions and increased volume of secretions during and after treatments
• improved breath sounds in the lungs being treated
• increase in sputum production
• change in vital signs- moderate changed in respiratory rate and pulse rate are expected
• resolution or improvement of atelectasis and localized infiltrates observed with chest x-ray
• improvement in arterial blood gas values or oxygen saturation