Secretion Clearance Flashcards
Why is secretion clearance so important? (educate)
aid in respiratory status
- increase ventilation
- decrease work of breathing and thus O2 consumption
Indications for secretion clearance
hyper secretory lung disease
inability to clear secretions
risk of secretion retention
disease that impairs cough
precautions/contraindications for airway clearance techniques
coughing up blood (hemoptysis) pneumothorax raised ICP headache sinusitis GERD Nausea and or vomiting pregnancy hypertension rib fracture/osteoporosis chest wall pain/discomfort chest wall surgery coagulation disorders
what are some adjunct treatments to enhance airway clearance ?
inhalation therapy physical activity noninvasive ventilation analgesia Humidification
What should be apart of every secretion clearance technique
the basic cough
Describe Huffing (forced expiratory technique FET
Huff (2 reps ) then deep breath (3 reps)
huff is 2 secs more than inspiration
arms bent and placed at side
mouth in O
tighten chest wall and abdomen
huff is forced not violent
FET changes the equal pressure point in the airway thereby stabilizing the airway and improving clearance
what is assisted cough especially good for?
quads
duchenne muscular dystrophy
ALS
neuromuscular disease
Active Cycle of Breathing Basics
Normal Breath
Thoracic Expansion
Huff (FET)
should be done in sitting or in postural drainage positions
how long should you be in a postural drainage position for?
3- 10 mins per broncho
pulmonary segment
how many postural drainage positions for RUL
3 (apical, posterior, anterior)
how many postural drainage positions for RML
1 ( lateral/medial)
how many postural drainage positions for RLL
superior, medial basal, anterior basal, lateral basal
posterior basal
how many postural drainage positions for LUL
4 (apical, posterior, anterior, lingula
how many postural drainage positions for LLL
anterior , lateral , posterior
what lobes drainage position is head of bed or sitting at 90 degrees supine
Right & left upper lobe apical segment
what lobes drainage position is just supine
RUL - anterior
what lobes drainage position is prone
RLL superior
LLL superior
prone with quarter turn with right lung up
RUL- posterior
30-45 degrees downward tilt side lying with right side up ?
if left side was up?
RML - medial & lateral segments
RLL- lateral
RLL- medial &
LUL lingula
LLL- lateral
30-45 degrees downward tilt and prone
RLL - posterior
LLL - posterior
30-45 degrees downward tilt supine
RLL & LLL-anterior segment
head of bed at 45 degrees and supine
LUL anterior
sitting/leaning over bed/chair
LUL - posterior
percussion technique
cupped hands
30-60 secs at a time
slow breaths
vibrations technique
during exhalation
in direction of ribs and soft tissue
usually done with 3 deeper breaths than normal post percussions followed by coughing
rib springing technique
chest compression followed by overpressure and quick release at end expiration
only a few reps
precautions/contraindications
fractured ribs prone to hemorrhage osteoporosis metastatic bone cancer burns/recent skin graft subcutaneous emphysema of neck/thorax pneumothorax chest wall surgery
Positive Expiratory Pressure (PEP) Mask
one way breathing valve
patient presses face against mask and slowly inhales through
inspires 5-20 times with active exhalations ratio of 1:3 or 1:4 usually followed by FET
go until patient has expelled all secretions usually about 15-20 mins
Good for children with CF
What is collateral channel;s
the ventilation of alveolar structures through passages or channels that bypass the normal airways
oscillating pep
handheld device which one breath into the device and it oscillates/vibrates the small/large airways
no difference between PEO for evidence based practice
