Manual Secretion Removal Techniques

Question 1

What are the 4 manual secretion removal techniques?

Answer 1

1) percussion
2) shaking (vibration)
3) postural drainage
4) airway clearance techniques (cough, huff cough, etc)

Question 2

For which respiratory issues would it be indicated for you to use postural drainage? (3)

Answer 2

1) increased pulmonary secretions
2) aspiration
3) atelectasis or collapse

NOTE that these are the same for percussion and shaking also, since percussion/shaking and postural drainage are typically done together

Question 3

How long would you execute postural drainage? What do you do to do so?

Answer 3

explain procedure to pt, then put them in the position - observe for signs of intolerance

• put them in the position for up to 20 minutes
• duration typically equals the duration of other manual techniques also used in conjuction

Question 4

With what position would you place the patient to drain the upper lobes? (apical segments)

Answer 4

patient leans back on pillow at 30deg angle while short sitting on bed
- therapist claps on top of shoulder between clavicle and top of scapula

Question 5

With what position would you place the patient to drain the upper lobes’ posterior segments?

Answer 5

bed flat

- pt leans over pillow at 30deg angle; therapist claps over upper back on both sides

Question 6

With what position would you place the patient to drain the anterior segments of the upper lobes?

Answer 6

bed flat

- pt supine with pillow under knees; clap between clavicle and nipple on each side

Question 7

With what position would you place the patient to drain the lateral basal segments of the L lower lobe?

Answer 7

foot of the bed elevated 20in

• pt on abdomen, head down, then rotates 1/4 turn upward to the L (upper L leg supported on pillow)
• clap over uppermost portion of lower ribs

Question 8

With what position would you place the patient to drain the posterior basal segments of the lower lobes?

Answer 8

foot of table elevated 20 in

- pt prone with pillow under hips; clap over lower ribs close to spine on each side

Question 9

With what position would you place the patient to drain the superior segments of the lower lobes?

Answer 9

bed flat

- pt prone with two pillows under hips; clap over middle of back at tip of scapula on either side of spine

Question 10

With what position would you place the patient to drain the anterior basal segments of the L lower lobe?

Answer 10

foot of table elevated 20in

- pt lies on R side, head down, pillow between knees; clap over lower ribs

Question 11

With what position would you place the patient to drain the right middle lobe?

Answer 11

foot of tale elevated 16in

• pt lies head down on L side, rotates 1/4 turn backward
• pillow behind pt from shoulder to hip
• clap with heel of hand under armpit and fingers extending forward beneath the breast

Question 12

With what position would you place the patient to drain the left upper lob lingular segments?

Answer 12

foot of table elevated 16 in

• pt les head down on R side and rotates 1/4 turn backward, pillow behind body
• cup with the same technique as R middle lobe, either right over nipple area or from armpit to below breast

Question 13

How long do you percuss an area?

Answer 13

3-5 minutes per postural drainage position should do it

- the force you’re using should cause the pt’s voice to quiver

Question 14

What is the shaking/vibration technique for manual secretion removal?

Answer 14

following a deep inhalation, a bouncing maneuver is applied to the rib cage throughout exhalation

Question 15

What is used first, percussion or vibration?

Answer 15

percussion, usually then followed by vibration

Question 16

What is the position of the therapist’s hands when doing shaking/vibration?

Answer 16

fingers parallel to rib cage

Question 17

Before you tip a patient’s head of the bed down to perform postural drainage and other manual clearance techniques, what 4 things contraindicate this?

Answer 17

1) pain made worse by technique
2) aneurism precautions, hemoptysis (blood in cough)
3) increased PTT, PT, or decreased platelet count (<50,000) or medications that interfere with coagulation
4) degenerative bone disease, bone metastases

Question 18

How many vibrations should you do?

Answer 18

5-10 exhales is typical

Question 19

After each time you use a manual secretion removal technique, what should you have the patient do?

Answer 19

cough to try to clear the airway

- in upright sitting position

Question 20

For patients with COPD, instead of coughing (which causes high intrathoracic pressure that can cause premature airway closure in their already collapsing airway), what airway clearance technique should you use?

Answer 20

huffing

Question 21

What airway clearance technique can you use for patients that are unable to cough on command, like infants or patients with TBI/CVA?

Answer 21

tracheal stimulation: downward/inward pressure onto trachea at sternal notch

Question 22

How long is typical time for suctioning so as to not damage the inner lining of the trachea?

Answer 22

10-15s

Question 23

How does one perform autogenic drainage?

Answer 23

independent program to sense peripheral secretions and clear them without traheobronchial irritation from coughing

• unstick: quiet breathing at low lung volumes to get peripheral secretions
• collect: breath at mid lung volumes to affect secretions in middle airways
• evacuation: breathing from med to high lung volumes to clear secretions from central airways

Question 24

What is a FLUTTER device?

Answer 24

external device that vibrates the airways on exhalation to improve airway clearance with intermittent, positive expiratory pressure

Question 25

What is the semi-fowler position?

Answer 25

HOB inclined to 30deg - 45deg

Question 26

Would you use airway clearnace on a patient that has shortness of breath, pulmonary edema, or CHF?

Answer 26

you can, it’s just a precaution that you might not want to put the head of the bed in trendelenburg (15-18 deg descent)

Question 27

What is segmental breathing technique?

Answer 27

1) position patient in proper positional drainage position
2) apply gentle pressure to thorax over area of hypoventilation
3) increase to firm pressure just prior to inspiration
4) ask pt to breathe in against resistance
5) allow full inhalation

Question 28

What is segmental breathing for?

Answer 28

used to improve ventilation to hypoventilated lung segments, alter regional distribution of gas, maintain/restore FRC

Question 29

What is sustained maximal inspiration used for? Used for what types of patients?

Answer 29

increase inhaled volume, sustain or improve alveolar inflation, and maintain/restore FRC
- used for pts with post-trauma pain, postop pain, acute lobar collapse

Question 30

T/F: Pursed lip breathing is used to increase RR.

Answer 30

false, decrease RR

Question 31

What type of patients can benefit from pursed lip breathing?

Answer 31

those with COPD who have trouble getting air out; facilitates relaxation, reduces dyspnea, increases TV

Question 32

What additional methods can be used to increase exhale in pursed lip breathing?

Answer 32

hand to abdomen to press in
abdominal contraction (but not too much, which can increase intrathoracic pressure and cause airway collapse)

Question 33

Those who can’t cough well need what type of strengthening?

Answer 33

abdominal strengthening