Airway Clearance Lab In Class

Airway Clearance Lab Session Overview

Date: Monday 10/21/24Location: Multiple rooms according to group assignments.Study Tip: Engage in task-specific training by practicing skills actively rather than just observing or reading. This hands-on approach is essential to mastering airway clearance techniques

Airway Clearance Techniques

Assessment Criteria

Need Assessment:

  1. Medical History: Review history of pulmonary issues.

  2. Cough History: Assess any cough or secretion retention history to guide technique selection.

  3. Cough Assessment: Conduct a thorough cough assessment to evaluate effectiveness.

  4. Review: Examine abnormal X-rays and results from arterial blood gases (ABGs) to support clinical decisions.

  5. Auscultation: Auscultate lung sounds to identify decreased or adventitious sounds which may indicate secretions present.

  6. Vital Signs: Check vital signs as this is critical before selecting an airway clearance technique.

  7. Contraindications: Ensure verification of contraindications prior to proceeding with any technique.

Importance of Auscultation

  • Auscultation before and after clearing techniques is essential for evaluating the effectiveness of clearance methods, allowing for modifications as needed to improve efficiency.

Techniques in Airway Clearance

Postural Drainage (PD)

  • Technique Positions Matter: Practice all techniques in various positions to optimize the effectiveness of each airway clearance method. The position significantly influences the efficacy of secretions removal.

Percussion

  • Method:

    • Position patient in PD.

    • Use cupped hands for technique.

    • Apply loose wrist movement.

    • Perform rapidly and rhythmically for 3-5 minutes over each lung segment to mobilize secretions effectively.

Vibration

  • Method:

    • Position patient in PD.

    • Use flat hands for the technique.

    • Apply proximal force from the shoulder while executing only during exhalation.

    • Vibrations should be felt by the patient but not overtly visible, allowing for better secretions clearance.

Shaking

  • Technique:

    • Position the patient in PD.

    • Use flat hands for application.

    • Apply proximal force from the shoulder with visibly large oscillations to facilitate mucus movement.

Active Cycle of Breathing Technique (ACBT)

Components of ACBT

  1. Breathing Control: Focused on relaxation to optimize lung function.

  2. Thoracic Expansion Exercises (TEE): Aimed at maximal inspiration followed by breath-holding, enhancing airflow by opening collateral channels and preventing lung collapse. These exercises also improve lung compliance and improve oxygenation.

  3. Forced Expiratory Technique (FET): Involves a combination of forced expiratory maneuvers with an open glottis (huff). Start with low lung volume huffs to mobilize peripheral secretions, transitioning to high lung volume huffs for proximal clearance.

Breathing Control Protocol

  • Practice:

    • Engage in 20-30 seconds of controlled breathing.

    • Followed by 3-4 deep breaths.

    • Incorporate an ACBT cough as needed to help clear airways effectively.

Autogenic Drainage (AD)

Phases of AD

  1. Unsticking: Loosens peripheral secretions via low volume inhalations and exhalation until expiratory reserve volume is reached (1-3 minutes).

  2. Collection: Aids in mucus collection in large airways using medium inhalations and exhalations (1-3 minutes), ensuring secretions are ready for clearance.

  3. Evacuation: Facilitates mucus transport to the mouth through slow, deep inhalation followed by short exhalation, concluding with huffing (2-3 effective huffs). This phase is critical for clearing the airways effectively.

AD Demonstration

  • Focus on:

    • The phases of Unsticking, Collecting, and Evacuating to improve comprehension and implementation of the techniques.

Devices for Airway Clearance

  • PEP & OPEP Devices:

    • Examples: TheraPep, Acapella, Flutter.

    • Function: Creates backpressure to maintain airway patency during exhalation, reducing premature airway closure and gas trapping.

    • Promotes collateral ventilation and assists in loosening mucus through oscillations during expiration.

Wrap-Up and Critical Reflection

  • Write down key takeaways from the session to reinforce learning.

  • Identify any unclear topics or areas needing review post-session for better understanding and application of techniques.