Airway Clearance Techniques Flashcards
Indications for airway clearance
- retained secretions in the central airways
- prophylaxis against postoperative pulmonary complications
- difficulty clearing secretions
- atelectasis caused by or suspected by caused by mucus plugging
active breathing cycle procedure
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
ACB precautions/contraindications
- splinting postop incisions to achieve adequate expiratory force
- bronchospasm or hyperactive airways
Autogenic drainage
- 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
AD procedure
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
Precautions/Contraindications of AD
requires motivation and concentration to learn
directed cough and huffing
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
cough and huff procedure
- 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
precautions and indications for cough and huff
- 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
High frequency airway oscillation
- the acapella and flutter are handheld devices that combine positive expiratory pressure and high frequency airway vibrations to mobilize mucus secretions in the airways
precautions and contraindications of high frequency airway oscillation
- 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
Postural Drainage
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
postural drainage contraindications
- 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
postural drainage contraindications for trendelenburg
- 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)
Apical segments right and left upper lobe position
- the patient is sitting, leaning back 30-40 degrees, percussion is performed above the clavicles
Posterior segment right upper lobe postion
- 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
posterior segment left upper lobe position
- 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
lingula left upper lobe position
- 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
anterior segments right and left upper lobes position
- the patient is in supine with the bed horizontal
- percussion is performed below the clavicles
right middle lobe position
- 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
superior segments left and right lower lobes position
- patient is prone with the bed horizontal
- percussion is performed below the inferior border of the left and right scapulae
anterior basal segments left and right lower lobes position
- 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
posterior basal segments left and right lower lobes position
- 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
lateral basal segments lower lobes position
- 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
