Week 8: Secretion Clearance & Suctioning Flashcards
What are the FET (forced expiratory techniques) and what do they do
coughing and huffing
mechanical insufflation-exsufflation (MI-E)
active cycle of breathing technique (ACBT)
Percussions and Vibrations
Postural drainage
Mobilisation and exercise
PEP devices
When would you use an MI-E device
in patients who have weak coughs <160L/min
When is low volume huff used
secretions in lower airways
when is high volume huff used
secretions in upper airways
Active cycle of breathing technique
Relaxed breathing prevents bronchospasm and desaturation
deep breathing loosens secretions and enhances collateral ventilation
huff and cough helps clear secretions through changes in thoracic pressure
What are percussions and what do they do
Rhythmical clapping of the chest wall with cupped hands over specific lung segments
cause oscillation of airflow within the airways
increase expiratory flow rate
stimulate cilial beat
What are expiratory vibrations and what do they do
application of a vibratory action to the chest wall with a flat hand
Applied during expiration
increase peak expiratory flow to move secretions
increase annular flow of mucus
increase mucus transport by decreasing viscosity of mucus
what does coughing and huffing do
use changes to lung volumes and generation of rapid expiratory airflow to remove secretions from the lungs
Postural drainage when is upright position indicated
upper lobe clearance
Postural drainage when is downward position indicated
lower lobe clearance
How does mobilisation help move secretions
increases oxygen demands, increase flow rates, increase ventilation and increase lung volumes
increases collateral ventilation and expiratory air flow velocity (air gets behind secretions and helps move them out of lungs)
increases strength and quality of cough
increases mucociliary transport and airway clearance
Treatments for secretion movement impairments
Cough and Huff
Active cycle of breathing
Autogenic drainage
postural drainage
percussions and vibrations
devices
medications
nebuliser
Percussion during expiration or inspiration?
Both
Vibrations during expiration or inspiration
Expiration only
Benefits of secretion clearance
decreases risk of infection
reduces deterioration of breathing mechanics (decreases workload of breathing)
Increases ventilation and gas movement
When is physio needed with secretion clearance
having difficulty clearing the secretions by themselves (e.g. post op pain, weak cough, confusion)
if patient has excessive secretions –> chronic lung disease. Physio will speed up process
When would devices generally be considered?
patients with chronic respiratory diseases
Why is suctioning required
allows for rapid clearance of secretions and prevents the airway from becoming blocked
This allows for a more patent airway, improved ventilation and work of breathing
Suctioning can cause a decrease in ___ in some patients.
What do you need to do before you start suctioning?
oxygention
pre-oxygenate patient before suctioning
How much do you pre-oxygenate above baseline before suctioning
0.2 above baseline
How long should duration of suctioning procedure be limited to
<15s
What should you be monitoring during suctioning
monitor the colour, volume and consistency of sputum as well as vitals
when would you use tracheostomy
when duration of suctioning is likely to surpass 14 days
Suction pressure for adults
Less than 200mmHg and maintained at around 150mmHg
Types of suctioning
Open and closed
Oropharyngeal
Nasopharyngeal
ETT
Benefits of secretion clearance
reduce risk of infection
improve breathing mechanics
increase ventilation and gas movement
When is physio generally required for secretion clearance
patient has difficulty clearing the secretions by themselves
patient has excessive secretions
What level of CPF (Cough Peak Flow) is required to prevent retention of secretions
160L/min
What is a percussion
Rhythmical clapping of the chest wall with cupped hands over specific lung segments
What is the effect of percussions
increased airflow movement within the airways
increased expiratory flow rate
stimulate cilial beat
What are vibrations
application of a vibratory action (compression and oscillation) to the chest wall with a flat handW
When are vibrations applied
during expiration
what is the effect of vibrations
increased expiratory flow rate
decreasing viscosity of mucus
eliciting spontaneous coughs
What is postural drainage
specific positioning to allow gravity to drain secretions centrally
What do oscillating PEP devices do
provides the combination of positive expiratory pressure with high frequency oscillations
What is the aim of PEP devices
aims to loosen secretions, so they can move into central airways and be removed from the body
