Manual Secretion Removal Techniques, Devices and Postural Drainage

Question 1

What is Percussion?

Answer 1

Therapist applies cupped hands to the patients chest to loosen secretions

Question 2

What is Shaking? When is this performed (expiration/inspiration)

Answer 2

During expiration only after deep inhalation.

Vigorous, lower frequency bouncing maneuver.

Question 3

What are the 3 Phases of Active Cycle of Breathing Training (ACBT)?

Answer 3

1. Breathing Control
2. Thoracic Expansion
3. Forced Expiration

Question 4

What is the Breathing Control Phase of ACBT?

Answer 4

Relaxed, diaphragmatic tidal breathing.

(Patient begins and always ends at breathing control!)

Question 5

What is the Thoracic Expansion Phase of ACBT?

Answer 5

Done if secretions need to be loosened.

[Patient completes Thoracic Expansion Exercises]:
- Deep Inhalations with a hold, followed by passive expirations

Question 6

What is the Forced Expiratory Technique of ACBT?

Answer 6

One or two huffs from tidal volume. For the removal of secretions.

• After completion, this is followed up with breathing control.

Question 7

Flutter and Acapella Device usage.

Answer 7

Patient first inhales a normal sized breath

Active exhalation through the device

• Causes intermittent backward air pressure.
• Vibrations through chest to loosen secretions

Question 8

What is the benefit to pursed lip breathing?

Answer 8

Breathing in through the nose and out through pursed lips.

• Helps prevent airway collapse.

Question 9

Postural Drainage Position for the Upper Lobes - Apical Segments?

Answer 9

Seated: Leaning BACK 30 Degrees

Question 10

Postural Drainage Position for the Upper Lobes -Posterior Segments

Answer 10

Seated: Leaning FORWARD 30 Degrees

Question 11

Postural Drainage Position for the Upper Lobes - Anterior Segments?

Answer 11

Patient Lying in Supine

Question 12

Postural Drainage Position for the Linguala

Answer 12

Right Side Lying with head down 15 degrees rotated 1/4 turn towards supine

Question 13

Postural Drainage Position for the Middle Lobe

Answer 13

Left side lying with head down 15 degrees rotated 1/4 turn towards supine

Question 14

Postural Drainage Position for the Lower Lobes- Anterior Basal Segment

Answer 14

Supine Head Down 30 Degrees

Question 15

Postural Drainage Position for the Lower Lobes - Posterior Basal Segment

Answer 15

Prone Head Down 30 Degrees

Question 16

Postural Drainage Position for the Lower Lobe - Right Lateral Basal Segment

Answer 16

Side lying LEFT with head down and rotated 1/4 turn towards prone

Question 17

Postural Drainage Position for the Lower Lobe - Left Lateral Basal Segment

Answer 17

Side lying RIGHT with head down and rotated 1/4 turn towards prone

Question 18

Postural Drainage Position for the Lower Lobes - Superior Segments

Answer 18

Prone with BED FLAT

Question 19

During a Huff is the Glottis Closed or Open?

Answer 19

Remains open!

Softer motion; fogging a window. Helps keep airways open.

Question 20

What are Vibrations?

Answer 20

Gentle, High-Frequency Maneuver

Performed during expiration, after deep inhalation

Question 21

Indications for Postural Drainage?

Answer 21

• Pulmonary Complications
• Weak/elderly
• Atelectasis, Pneumonia, COPD

Question 22

How long to maintain each postural drainage position?

Answer 22

5 - 10 minutes

Question 23

Precautions for Postural Drainage

Answer 23

• Pulmonary Edema or large Pleural Effusion
• Hemoptysis
• Massive Obesity or Ascites

Question 24

Relative Contraindications for Postural Drainage

Answer 24

• Increased ICP
• Hemodynamically Unstable
• Recent Spinal Fusion or Injury
• Recent Head Trauma
• Diaphragm/Hiatal Hernia