Pulmonary- Manual Secretion Removal Techniques Flashcards
What is postural drainage
placing pt. in varying positions for optimal gravity drainage of secretions and increased expansion of the involved segment
indications for postural drainage
- increased pulmonary secretions
- aspiration
- atelectasis or collapse
Basic procedure for postural drainage
- explain procedure to pt.
- place pt. in appropriate postural drainage position
- observe for signs of intolerance
- duration can be up to 20 min per position
What is percussion
- a force rhythmically applied w/ PT’s cupped hands to a specific area of the chest wall that corresponds to the involved lung segment
- used to increase the amount of secretions cleared from the tracheobronchial tree
- used in conjunction w/ postural drainage
Indications for use of percussion and shaking (vibration)
- excessive pulmonary secretions
- aspiration
- atelectasis or collapse due to mucous plugging obstructing the airways
Considerations before using percussion or shaking: general guidelines
pain made worse by using technique
Considerations before using percussion or shaking: circulatory system
- aneurysm precautions
- hemoptysis
Considerations before using percussion or shaking: MSK
- fractured rib
- flail chest
- degenerative bone disease
- bone metastases
Considerations before using percussion or shaking: coagulation disorders
- increased PTT
- increased pro-thrombin time (PT)
- decreased platelet count (<50,000)
- meds interfering w/ coagulation
Considerations prior to using postural drainage in Trendelenburg position: circulatory system
- PE
- CHF
- HTN
Considerations prior to using postural drainage in Trendelenburg position: abdominal problems
- obesity
- ascites
- pregnancy
- hiatal hernia
- nasea and vomitting
- recent food consumption
Considerations prior to using postural drainage in Trendelenburg position: neurologic
- recent neurosurgery
- increased intracranial pressure
- aneurysm precautions
Considerations prior to using postural drainage in Trendelenburg position: pulmonary
SOB
Procedure for percussion
- explain procedure to pt.
- place pt. in appropriate postural drainage position
- cover area to be percussed with light weight cloth to prevent erythema
- Percuss. duration depends on needs and pt. tolerance. 3-5 min of percussion per postural drainage position w/ clinically assessed improvement is a guideline
- force of percussion causes the pt.’s voice to quiver
What is shaking aka vibration
- following a deep inhalation, a bouncing maneuver is applied to the rib cage throughout exhalation
- used to hasten the removal of secretions from the tracheo-bronchial tree
- commonly used following percussion in appropriate postural drainage position
- modification may be required depending on pt. tolerance
Procedure for shaking
- explain procedure to pt.
- place pt. in appropriate postural position
- perform percussion first if appropriate
- as pt. inhales deeply, PT’s hands are placed w/ fingers parallel to ribs
- as pt. exhales, PT hands provide a jarring bouncing motion to the rib cage below
- duration depends on pt. needs and tolerance and clinical improvement. 5-10 deep inhalations with shaking technique is generally acceptable practice
- ***more than 10 would risk hyperventilation and less than 5 would be ineffective
List of airway clearance techniques
- cough
- huffing
- assisted cough
- tracheal stimulation
- endotrachial suctioning
Huffing
- more effective in pt. w/ collapsible airways (chronic obstructive diseases)
- prevents high intrathoracic pressure that causes premature airway closure
Procedure for assisted cough
- position pt. against solid surface (trendelnburg, reclined supine, sitting, ect..)
- PT’s hand is is placed below pt.’s subcostal angle
- pt. inhales deeply
- as pt. attempts to cough, Pt’s hands push inward and upward assisting rapid exhalation of air
- any secretions raised should be removed
type of pt. assisted cough is intended for
anyone w/ weak abdominal muscle that are unable to generate an effective cough, such as SCI pt.
What is tracheal stimulation
- used w/ pts. who are unable to cough on command such as infants, TBI, CVA
- Procedure: PT’s thumb or finger is placed just above the suprasternal notch, and a quick inward and downward pressure on the trachea elicits the cough reflex
when to use endotrachial suctioning
only when other less invasive techniques fail to adequately remove secretions.
Complications with endotrachial suctioning
- hypoxemia
- bradycardia or tachycardia
- hypotension or hypertension
- increased intracranial pressure
- atelectasis
- tracheal damage
- infections
Positions for postural drainage: Upper Lobes- Apical segments
- bed or drainage table is flat
- pt. leans back (basically in sitting position) on pillow at 30 degree angle against PT
- PT claps w/ markedly cupped hands over area between clavicle and top of scapula on each side
Positions for postural drainage: Upper Lobes- Posterior Segments
- bed or drainage table is flat
- pt. leans over (pt. in seated position) folded pillow at 30 degree angle
- PT stands behind and claps over upper back on both sides
Positions for postural drainage: Upper Lobes- Anterior Segments
- bed or drainage table is flat
- pt. supine w/ pillow under knees
- PT claps between clavicle and nipple on each side
Positions for postural drainage: R Middle lobe
- foot of table or bed elevated 12 inches
- pt. lies supine and rotates 1/4 turn backward on L side (sort of between side lying and supine)
- pillow may be placed behind shoulder to hip and knees flexed
- PT claps over R nipple area.
- In females, PT may use cupped hand w/ heel of hand under armpit and fingers extending forward under breast
Positions for postural drainage: L Upper Lobe (lingular segments)
- foot of table or bed elevated 12 inches
- pt. lies supine on R side and rotates 1/4 turn (sort of between side lying and supine)
- pillow may be placed behind shoulder to hip and knees flexed
- PT claps over L nipple area.
- In females, PT may use cupped hand w/ heel of hand under armpit and fingers extending forward under breast
Positions for postural drainage: Lower Lobe- Anterior Basal Segments
- foot of table or bed elevated 18 inches
- pt. lies on R side w/ pillow under knees
- PT claps over over L lower ribs.
- To drain R anterior basal segments, pt. is L sidelying and clap over R lower ribs
Positions for postural drainage: Lower Lobes- Lateral Basal segments
- foot of table or bed elevated 18 inches
- pt. prone, then rotates 1/4 turn upward (sort of L sidelying-ish)
- upper leg is flexed over pillow for support
- Pt claps over upper most portion of lower ribs
- if draining L side, position pt. into the R side-lying-ish position
Positions for postural drainage: Lower Lobes- Posterior Basal segments
- foot of table or bed elevated 18 inches
- pt. prone w/ pillow under hips
- PT claps over lower ribs close to spine on each side
Positions for postural drainage: Lower Lobes- Superior segments
- bed or drainage table is flat
- pt. prone w/ 2 pillows under hips
- PT claps over middle of back at tip of scapula on each side of the spine
