Week 8: Secretion Clearance & Suctioning

Question 1

What are the FET (forced expiratory techniques) and what do they do

Answer 1

coughing and huffing
mechanical insufflation-exsufflation (MI-E)
active cycle of breathing technique (ACBT)
Percussions and Vibrations
Postural drainage
Mobilisation and exercise
PEP devices

Question 2

When would you use an MI-E device

Answer 2

in patients who have weak coughs <160L/min

Question 3

When is low volume huff used

Answer 3

secretions in lower airways

Question 4

when is high volume huff used

Answer 4

secretions in upper airways

Question 5

Active cycle of breathing technique

Answer 5

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

Question 6

What are percussions and what do they do

Answer 6

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

Question 7

What are expiratory vibrations and what do they do

Answer 7

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

Question 8

what does coughing and huffing do

Answer 8

use changes to lung volumes and generation of rapid expiratory airflow to remove secretions from the lungs

Question 9

Postural drainage when is upright position indicated

Answer 9

upper lobe clearance

Question 10

Postural drainage when is downward position indicated

Answer 10

lower lobe clearance

Question 11

How does mobilisation help move secretions

Answer 11

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

Question 12

Treatments for secretion movement impairments

Answer 12

Cough and Huff
Active cycle of breathing
Autogenic drainage
postural drainage
percussions and vibrations
devices
medications
nebuliser

Question 13

Percussion during expiration or inspiration?

Answer 13

Both

Question 14

Vibrations during expiration or inspiration

Answer 14

Expiration only

Question 15

Benefits of secretion clearance

Answer 15

decreases risk of infection
reduces deterioration of breathing mechanics (decreases workload of breathing)
Increases ventilation and gas movement

Question 16

When is physio needed with secretion clearance

Answer 16

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

Question 17

When would devices generally be considered?

Answer 17

patients with chronic respiratory diseases

Question 18

Why is suctioning required

Answer 18

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

Question 19

Suctioning can cause a decrease in ___ in some patients.

What do you need to do before you start suctioning?

Answer 19

oxygention

pre-oxygenate patient before suctioning

Question 20

How much do you pre-oxygenate above baseline before suctioning

Answer 20

0.2 above baseline

Question 21

How long should duration of suctioning procedure be limited to

Answer 21

<15s

Question 22

What should you be monitoring during suctioning

Answer 22

monitor the colour, volume and consistency of sputum as well as vitals

Question 23

when would you use tracheostomy

Answer 23

when duration of suctioning is likely to surpass 14 days

Question 24

Suction pressure for adults

Answer 24

Less than 200mmHg and maintained at around 150mmHg

Question 25

Types of suctioning

Answer 25

Open and closed
Oropharyngeal
Nasopharyngeal
ETT

Question 26

Benefits of secretion clearance

Answer 26

reduce risk of infection
improve breathing mechanics
increase ventilation and gas movement

Question 27

When is physio generally required for secretion clearance

Answer 27

patient has difficulty clearing the secretions by themselves
patient has excessive secretions

Question 28

What level of CPF (Cough Peak Flow) is required to prevent retention of secretions

Answer 28

160L/min

Question 29

What is a percussion

Answer 29

Rhythmical clapping of the chest wall with cupped hands over specific lung segments

Question 30

What is the effect of percussions

Answer 30

increased airflow movement within the airways
increased expiratory flow rate
stimulate cilial beat

Question 31

What are vibrations

Answer 31

application of a vibratory action (compression and oscillation) to the chest wall with a flat handW

Question 32

When are vibrations applied

Answer 32

during expiration

Question 33

what is the effect of vibrations

Answer 33

increased expiratory flow rate
decreasing viscosity of mucus
eliciting spontaneous coughs

Question 34

What is postural drainage

Answer 34

specific positioning to allow gravity to drain secretions centrally

Question 35

What do oscillating PEP devices do

Answer 35

provides the combination of positive expiratory pressure with high frequency oscillations

Question 36

What is the aim of PEP devices

Answer 36

aims to loosen secretions, so they can move into central airways and be removed from the body