Sputum retention/ impaired airway clearance Flashcards
Are secretions a problem for physios ?
Only a problem if they are seen or heard to obstruct breathing
Problems with retained secretions
Long term persistent mucus can lead to infection and inflammation
Purpose of airway clearance
To promote clearance of excessive secretions from distal airways to proximal airways where they can be cleared by huffing or coughing
What is sputum
Excessive tracheobronchial secretions
What can impaired secretions cause
Dehydration
Lack of o2
Infection
Weakness
Coughing fits
Techniques to remove secretions
ACBT
Autogenic drainage
Positioning
Mobilisation
Manual techniques
Adjuncts
Suctioning
Humidification
What is humidification
Hydration affects function of cillia as well as quality and quantity of mucus
Prevents secretion thickening, via oral/ intravenous fluids
Manual techniques
they aim to move loose secretions from the airway walls and aid mucociliary transport
Carried out in postural drainage positions
Used with huffing and coughing
Percussions
rhythmic clapping
Loose wrist and cupped hand
Cover skin with cloth
30 seconds to a min
Energy wave is created and transmitted to airways
Vibrations and shakes
Vibrations and shakes
vibrations are fine oscillations of the hand
Shaking is a coarser movement — a slower and bigger movement
Directed inwards against chest
performed on exhalation after deep inhalation
Precautions Of manual techniques
uncontrolled thoracic pain
Rib fractures
Bruises
Over any burns or frail skin
Manual technique, how to do it
affected side up
Percussions work way up from base to apex
Then add vibration so a low amplitude high frequency performed on exhalation
Back to percussions
Then shaking a high amplitude low frequency
Can also get a vibration vest for home use
What is a huff
a huff is a forced exhalation through an open mouth instead of coughing
Helps mobilise sputum up the airways towards mouth
Uses abdominal muscles and chest wall to facilitate expiratory airflow
Should always be used after breathing control
How does huffing work
during a huff, pleural pressure becomes positive and equal to airway pressure at a point called equal pressure point
The pressure outside the airway is greater than within the airway
Creating a narrowing and squeezing action moving towards the mouth
EPP occlude nearer the mouth at a high lung volume p, further from the mouth = lower lung volume.
The use of a peal flow mouth piece can help for technique
When secretions have reached larger proximal airways a huff can be used to clear the secretion
