Pulmonary air clearance techniques Flashcards
Goals Of Chest PT
Prevent accumulation of secretions ↑ mobilization/drainage of secretions ↑ relaxation/avoid muscle splinting Maximize chest wall mobility Regain efficient breathing pattern Improve ventilation and vital capacity
Goals of Caridovascular Physical therapy
or CPT
Instruct in use of respiratory muscles Develop respiratory endurance ↑ cardiopulmonary exercise tolerance Prevent atelectases Maximize cough effectiveness
Purposes of Postural Drainage
Align segmental bronchi with gravity
Collect secretions centrally
Cough/Huff/Expectorate after each PD position to remove secretions
Can supplement with P & V
Airway Clearance Techniques think like active cycle breathing
Postural Drainage
Percussion and Vibration and Shaking
Active Cycle of Breathing
Autogenic Drainage
Coughing Techniques
How to drain the Anterior of Both Upper Lungs
Apical Segements of Both Upper Lungs
Posterior segements
Lingula
LLL
RLL
Posterior segements
Lingula from supine
Ant segs of BUL – supine or HOB 30*
Apical segs of BUL – sitting, slightly reclined
Post segs – Sitting leaning forward with pillows on lap
RML – ¼ turn from supine on Left (bathing beauty pose)
Lingula – ¼ turn from supine on Right (as above)
LLL – R sidelyling
RLL – L sidelying
Lingula – ¼ turn from supine
Review the picture on PPT to see different lobes
review pictrue slide 10 or around to see and visualize the different lobes
Regular trendelberg beg head or leg first what about the reverse
regular trendelenberg is basically an inversion table and the other “reverse” tredendberg is the head up first
Postural Drainage Contraindications just think like the various postioning and how they would cause increased pressure on various things
ICP > 20 mmHg Unstabilized head/neck injury Active hemorrhage Hemoptysis Empyema (effected plerual effusion) Bronchopleural fistula Pulmonary edema assoc with CHF (no posutral drainage with CHF)
Large pleural effusions PE Confused/anxious patients Rib fracture Surgical wound Post op where joint compression contraindicated
contraindications to using the trendelenberg
Neuro dx: Cerebral aneurysm, ICF drain, coma, recent CVA, uncontrolled sz
↑ ICP contraindicated
Uncontrolled HTN
Distended abdomen
Post esophageal procedures
GERD
Cardiovascularly unstable: Acute MI, pulmonary HTN, arrhythmia
Aneurysm, esp AAA Continuous tube feedings Unstable fluid balance: CHF, during HD, ascites Recent hemoptysis related to lung CA Uncontrolled airway, aspiration risk
Contraindications for the precussion think like contact issues like fractures, recently healed incsions things of that nature
Pneumothorax Platelets < 50,000 Cardiovascularly unstable pt Over rib fx or lesion Osteoporosis, CA mets, Prolonged steroid use Over surgery incisions/sternotomy Over recent graft, burn or wound
When blood too thin (↑ INR, etc.) Hemoptysis (common one) Undrained empyema Subcutaneous emphysema (air under skin ) PE Flail chest (rib fracture) Awaiting R/O for MI Acute TB Severe pain Recent spinal fusion
Explain vibration and shaking is it only used upon exhalation
Used in conjunction with Percussion or alone Gentler than percussion Uses flat hand Always go “down and in” Coordinate with exhale
Contradincations to vibration and shaking
Pneumothorax Platelets < 50,000 Cardiovascularly unstable pt Over rib fx or lesion, CA mets Over sx incisions/sternotomy Over recent graft, burn or wound Osteoporosis, prolonged steroid use (relative) When blood too thin (↑ INR, etc.) Hemoptysis Undrained empyema Subcutaneous emphysema PE Flail chest Awaiting R/O for MI Acute TB Severe pain Recent spinal fusion
What is the position for active cycle breathing
A secretion clearance technique which helps to mobilize and clear bronchial secretions by combining cycles of breathing control (BC), thoracic expansion exercises (TEE) and the forced expiratory technique (FET).
Position:
The ACBT can be done in sitting or in postural drainage positions. Use pillow support as needed to ensure relaxation and comfort. A minimum of 10 minutes is recommended in productive positions.
The steps to Active Cycle Breathing
Think shallow breathes. deep breathes and then cough deep
Step 1: Breathing Control (BC):
Take slow, relaxed breaths in through your nose and out through pursed lips. These breaths should not be full or a maximum effort; they should be shallow, relaxed breaths. Continue BC until you feel relaxed.
Step 2: Thoracic expansion exercises (TEE):
Take 3 – 4 deep breaths, expanding into your lung bases, place your hand on your side to feel for lower rib expansion. If coughing is triggered by deep breathing, return to BC.
Repeat Step 1 and Step 2
Continue to repeat Steps 1 & 2 until you feel you have mucus to clear.
Step 3: Forced Expiratory Technique (FET):
FET combines 1 – 2 forced expirations (huffs) and BC. To perform FET, take a medium sized breath (not full), open your mouth and slowly empty your lungs, contracting your abdominal muscles to squeeze the last of the air out of your lungs. Follow the huff with a period of BC. Or perform the summed/stacked breathing: breath in a little, pause, little more, pause, little more and convert to a huff or a cough.
Three types of coughing assitance
Splinted cough
Assisted or Quad cough
Tracheal stimulation
Phases of coughing (think of the glottis closing building pressure than opening again)
- Deep inspiration
- Glottis closes, pressure builds as expiratory muscles contract
- Glottis opens, trapped air is forcefully expelled
What should you make sure you do when you use splitted coughing like think postion and iniscion
Pillow or hands limit thoracic excursion
Used post surgery over incision, chest tube sites or with chest wall soreness
What should you make sure you do when you use splitted coughing like think postion and iniscion
Pillow or hands limit thoracic excursion
Used post surgery over incision, chest tube sites or with chest wall soreness
Explain how to perform assisted coughing
Used for patients with abdominal weakness
Coordinate inward and upward force with patient’s attempt to cough
Use hand over hand with interlocked fingers or forearm; can also be done with 2 therapists assisting or you can use your hands on the lateral aspects of the rib cages and froce the cough down and out. two person assit is the two forearms over the umblicus and cross hands on ether side of the rib cage and froce the air out…
Mechanical device – “cough-a-lator”
Explain how to perform assisted coughing
Used for patients with abdominal weakness
Coordinate inward and upward force with patient’s attempt to cough
Use hand over hand with interlocked fingers or forearm; can also be done with 2 therapists assisting or you can use your hands on the lateral aspects of the rib cages and froce the cough down and out. two person assit is the two forearms over the umblicus and cross hands on ether side of the rib cage and froce the air out…
Mechanical device – “cough-a-lator”
Instructions for Huffing
Forceful expiration through open glottis
Instruct: “Act like you are trying to fog a mirror with your breath”
Less stressful/more comfortable
Instructions for Huffing
Forceful expiration through open glottis
Instruct: “Act like you are trying to fog a mirror with your breath”
Less stressful/more comfortable
Instructions for suctioning
When to use it and when to do it what types are there???/
How much oxygen does it deliever??
How much time for suction
No more than how many passes per second???
Clears secretions using a catheter and vacuum pressure Indications Fever from pulmonary cause Ineffective cough Types Endotracheal Nasotracheal Tracheal
Always deliver 100% oxygen for at least 5 breaths prior to suctioning
Always use sterile technique
Surgilube is only used for NTS
Maximium time for catheter pass is 15 seconds
Saline flush can be used for thick secretions or secretions that are not easily cleared with the catheter
Never perform more than 5 passes per sess
Instructions for suctioning
When to use it and when to do it what types are there???/
How much oxygen does it deliever??
How much time for suction
No more than how many passes per second???
Clears secretions using a catheter and vacuum pressure Indications Fever from pulmonary cause Ineffective cough Types Endotracheal Nasotracheal Tracheal
Always deliver 100% oxygen for at least 5 breaths prior to suctioning
Always use sterile technique
Surgilube is only used for NTS
Maximium time for catheter pass is 15 seconds
Saline flush can be used for thick secretions or secretions that are not easily cleared with the catheter
Never perform more than 5 passes per sess
What are the Five P’s of suctioning???
5 P’s Pulse/pressure Pre-oxygenate Position Proceed Post-oxygenate
What are the Five P’s of suctioning???
5 P’s Pulse/pressure Pre-oxygenate Position Proceed Post-oxygenate
The “autogentic” draining how to perform
think like froced closed glottis
Patient sits in relaxed position Patient performs quiet inhalation Holds each breath for 2-3 seconds Exhalation occurs with an open glottis Start with low volume breathing and progress to collect and evacuate phases when appropriate Average session lasts 45 minutes Does not involve coughing
The “autogentic” draining how to perform
think like froced closed glottis
Patient sits in relaxed position Patient performs quiet inhalation Holds each breath for 2-3 seconds Exhalation occurs with an open glottis Start with low volume breathing and progress to collect and evacuate phases when appropriate Average session lasts 45 minutes Does not involve coughing
Explain the PEP masks
it is worn over mouth and nose
Mask creates positive pressure during exhalation
Helps prevent airway collapse and increase airflow to occluded airways
Procedure
Mask worn over mouth and nose
Pt takes 5-10 tidal breaths
Pt removes mask to cough
Cycles is repeated 7-10 times
Explain the PEP masks
it is worn over mouth and nose
Mask creates positive pressure during exhalation
Helps prevent airway collapse and increase airflow to occluded airways
Procedure
Mask worn over mouth and nose
Pt takes 5-10 tidal breaths
Pt removes mask to cough
Cycles is repeated 7-10 times
How to use VEST and a patient with this type of problem commonly uses this type of vest.
Commonly used in patients with CF
Used in combination with nebulizer or aerosol therapy
Pt wears vest and connects hoses to device
Vest inflates with air and provides oscillations similar to P/V
Treatment lasts 15-30 minutes or as MD prescibes
How to use VEST and a patient with this type of problem commonly uses this type of vest.
Commonly used in patients with CF
Used in combination with nebulizer or aerosol therapy
Pt wears vest and connects hoses to device
Vest inflates with air and provides oscillations similar to P/V
Treatment lasts 15-30 minutes or as MD prescibes
The Flutter is used for what. What is the angle that the flutter is to maintain???
the little thing with the ball in it
How to use? The vibrations are believed to moblize the secretions
Create oscillating resistance causing Airway vibration Increased expiratory airflow Aids in prevention of airway collapse Aids in secretion clearance Position Flutter valve must be placed horizontal to floor 45 degrees
Place device in mouth Inhale for 2-3 seconds Exhale through device with taut cheeks 7-10 times Suppress cough Inhale total lung breaths Exhale these breaths into device (repeat) Huff or cough to clear secretions Repeat cycle for 15 minutes
The Flutter is used for what. What is the angle that the flutter is to maintain???
the little thing with the ball in it
How to use? The vibrations are believed to moblize the secretions
Create oscillating resistance causing Airway vibration Increased expiratory airflow Aids in prevention of airway collapse Aids in secretion clearance Position Flutter valve must be placed horizontal to floor 45 degrees
Place device in mouth Inhale for 2-3 seconds Exhale through device with taut cheeks 7-10 times Suppress cough Inhale total lung breaths Exhale these breaths into device (repeat) Huff or cough to clear secretions Repeat cycle for 15 minutes
Describe the purpose of the acapella
Provides Positive Expiratory Pressure (PEP) and vibration to airways as patient exhales through device. Can be use in sitting or in postural drainage positions to loosen secretions.
Describe the purpose of the acapella
Provides Positive Expiratory Pressure (PEP) and vibration to airways as patient exhales through device. Can be use in sitting or in postural drainage positions to loosen secretions.
Oral High Frequency Oscillation (OHFO)
are these frequently used???
Use sine wave oscillations superimposed on normal tidal breathing to facilitate secretion clearance
Oscillations are produced by piston or loudspeaker
Very expensive and not frequently used
Oral High Frequency Oscillation (OHFO)
are these frequently used???
Use sine wave oscillations superimposed on normal tidal breathing to facilitate secretion clearance
Oscillations are produced by piston or loudspeaker
Very expensive and not frequently used
How to gaugh if your therapy was effective or not
Gauging Outcomes Patient reported improvement Visable secretion mobilization Improved vital signs Improved CXR Improved breath sounds
How to gaugh if your therapy was effective or not
Gauging Outcomes Patient reported improvement Visable secretion mobilization Improved vital signs Improved CXR Improved breath sounds
Criteria for discharge in pulmonary PT.
think like how much septum, was the chest xray normal was the cough effective.
Criteria for Discharge from CPT Afebrile Strong, dry, effective cough Clear or greatly improved breath sounds Normal CXR Ambulatory or OOB for long periods of time throughout the day
Criteria for discharge in pulmonary PT.
think like how much septum, was the chest xray normal was the cough effective.
Criteria for Discharge from CPT Afebrile Strong, dry, effective cough Clear or greatly improved breath sounds Normal CXR Ambulatory or OOB for long periods of time throughout the day
