Secretion Management

Question 1

What can we do for secretion management?

Answer 1

• Positioning
• Postural drainage
• Manual techniques - percussions, shakes/vibs
• Adjuncts
• ABCT
• Autogenic drainage
• Hydration
• Mobilisation
• Suctioning

Question 2

Problems with retained secretions?

Answer 2

• Infection and inflammation
• Damage to cilia/epithelium
• Diffusion problems with gas exchange
• Dyspnoea
• Atelectasis

Question 3

Normal cough mechanism

Answer 3

1. Inspiration - near to IRV
2. Compression - snapping shut of the glottis, short pause, increase in intrathoracic pressure
3. Expiration - sudden opening of glottis, explosive acceleration, sheer force overcomes viscous secretions

Question 4

Factors that will impair a cough?

Answer 4

• Pain/fear
• Embarrassment
• Thickness of sputum
• Weak respiratory muscles
• Reduced vital capacity
• Reduced cough reflex

Question 5

Percussion

Answer 5

• Rhythmic clapping on the chest with one or two hands
• Hands are cupped and the wrists are loose
• Skin covered with a towel
• Duration 30 seconds to 1 minute

Question 6

Vibrations and Shakes

Answer 6

• Fine oscillations of the hands - vibrating effect
• Directed inwards against the chest
• Performed on exhalation after a deep inhalation
• Shaking is a coarser movement

Question 7

Precautions of manual techniques

Answer 7

• Frank haemoptysis (coughing up blood from lower than the glottis)
• Uncontrolled thoracic pain
• Rib fractures
• Pneumothorax
• Over incisions, burns of frail skin

Question 8

Breathing control: technique

Answer 8

• Diaphragmatic/relaxed breathing
• Breathe in and out gently through the nose (tidal volume) - helps with humidification
• Hand on the diaphragm/stomach - feel where the breath is
• Also helps with SOB/WOB

Question 9

Thoracic Expansion Exercises technique

Answer 9

• Deep breathing
• Take long slow deep breath through the nose, keeping the shoulder and chest relaxed
• Inspiratory hold, sniff at the top
• Breathe out gently through the mouth
• Repeat 3 to 4 times (dependent on patient, they might get dizzy)
• Aids secretion by creating collateral ventilation behind the sputum

Question 10

Huffing technique

Answer 10

• Forced exhalation through open mouth and glottis
• Forced expiratory technique
• Helps mobilise the sputum to the airways proximal to the mouth
• Should be followed by breathing control
• Usually starts from low lung volume (nearer the alveoli - short breath in, long huff out) to the high lung volume (nearer the proximal airways - long breath in, short huff out)
• Works by reaching EQUAL PRESSURE POINT - dynamic compression (squeezing action)

Question 11

Autogenic drainage

Answer 11

• Airway clearance technique using controlled breathing in three stages. - low volume, medium (tidal) volume and large volume
• Used at different lung volumes to unstick, collect and evacuate to the central airways
• From ERV to TV to IRV, moving through the lung - from small peripheral airways to the medium airways to the large central airways.
• Used for chronic patients. Difficult to teach yet extremely effective

Question 12

Adjuncts - PEP Mask, Bubble PEP, Acapella/Flutter

Answer 12

• Works by creating positive pressure in the lungs and keeping the airways from closing. Therefore forcing air behind the secretions and moving them to larger airways
• Can be less tiring than ACBT
• Flutter helps move secretions due the vibratory effect