Secretion management- treatment Flashcards
mannual techniques
aim to move loose secretions from the airway walls and aid mucociliary transport, commonly carried out in modified PD position (gravity assisted position)
percussion
rhythmic clapping on the chest, loose wrist and cupped hand, energy wave created is transmitted to the airways, skin is covered with a thin layer cloth, single/double handed, duration- 30 secs to 1 min, use double hand fast to aid people who can’t cough, deep breath along percussion- need to monitor sats to ensure they dont drop
use ausc to decide where to percuss
vibrations and shakes
vibrations are fine oscillations of the hands, shaking is a coarser movement, directed inwards against the chest, performed on exhalation after a deep inhalation, moves sputum so it is easier to clear, place hands on front of rib cage and one hand on back
precautions of mannual techniques
current large frank hypothesis, severe clotting disorder, uncontrolled thoracic pain, rib fractures/flail segment/osteoporosis/Ca, active TB, pneumothorax/surgical emphysema, over incisions/burns/ frail skin, implanted venous access devices
Techniques to remove excess sputum
ACBT, autogenic drainage, hydration, positioning, mobilisation, mannual techniques, adjuncts, suctioning,
Techniques to remove excess secretions- general principles
airway clearance techniques aim to enhance mucociliary clearance and mucus transport. Mobilizing secretions toward the mouth to aid expectoration. Practice is influenced by culture, skills of the therapist, finances of healthcare provision, and where possible patient preference
Techniques to remove excess secretions- other considerations
prevent excess energy expenditure, ensure adequate oxygen, ensure adequate energy supply, long term airway clearance regimes need to be negotiated and reassessed on a regular basis
huffing
a forced exhalation through an open mouth and glottis instead of coughing. Referred to as FET. helps mobilize sputum in airway towards mouth, uses the ab muscles and chest wall to facilitate expiratory airflow.
what should huffing be followed by
breathing control and should not be so forced that it causes wheezing or tightness in the chest.
precautions when huffing
take care with asthma and COPD, if someone is struggling to do huff- stop huff with throat- airways to narrow- trying to create back pressure, can hold tissue and try to get patients to move tissue (distract patient)
Huffing technique
many patients mistake blowing for huffing- use peak flow mouthpiece to help technique/. Huffing into low lung volume may be easier if patients take a normal sized breath in, then partially breathe out and finally huff near the end of exhalation.
ACBT
active cycle of breathing- BC/ TEE (2-3 breaths max- can lead to dizziness due to lack of CO2)/ BC/ HUFF, may continue to repeat cycle unti secretions are cleared (can take 10+ mins). May just use BC and huff if patient is unstable. Deep breathing technique acts as a scrape- moves sputum to prox airways
how does TEE work
use of collateral ventilation- channels have a high resistance- as we breathe out- some air goes through channels and other air mobalsies sputum
right side lying- ACBT
pillow between legs and hug pillow- still feel for expansion- may add shake during expiration
respiratory adjuncts
a device which will aid our other hands on treatment. When used it forms part of a holistic treatment approach to aid achieving outcomes and goals in order to improve patients will being and QOL. Cheap way to mimic- blow into water bottle of (10-15cm of water), always use in lean position
