Hey there
My cardio placement is on a medical ward (actually an infectious diseases ward!) and I am currently seeing a middle aged woman who was brought in 3 months ago with R sided pneumonia and R upper lobe abcess. I have seen her every day since being on this ward (for a week) and her main respiratory problem is impaired airway clearance. She was in ICU on and off for a couple of months and still has an open trachy wound. This is having a big impact on her ability to cough and clear her secretions and she needs constant reminders (like every couple of minutes) to cover the site in order to get an effective cough, and even to talk.
I have been concentrating on breathing techniques (ACBT) to mobilise her secretions and then huffing/coughing to bring them up. If needed a neb of normal saline is given prior to treatment The patient is very weark and deconditioned (her second prominent cardio problem) and can mobilise roughly 5m with a WZF before her legs give up. We have been doing some standing with marching on the spot to try and mobilise her secretions as well, but sometimes she is too weak for this (such as today, her legs just gave way, luckily we were at her bed!). She tires very easily and somtimes the effort of huffing/coughing is too much and the ACBT is just ineffective.
What I wanted from you guys was some advice from your clinical experience as to what other techniques you have found that are successful in helping with airway clearance in such a patient. We have done a whole lot of stuff at uni, and I am in the middle of revising it, but there does seem to be a bit of a gap in what we are taught and what is actually used clinically or what people have found that works for them. Any suggestions would be much appreciated.
Cheers
Bini
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2 comments:
Hi Bini, i think that manual techniques would be really appropriate for the patient you have mentioned. perhaps if you have not tried them before you could try gravity assisted postural drainage positions together with a combination of percs and vibes with your ACBT? also if it's too tiring to cough, you could always ask her for permission to suction as that is one of the indications isn't it? good luck :)
Hi Bini,
Have you considered using any devices such as PEP or flutter. They can help to mobilse the secretions a bit faster and that could mean your pt would tire less quickly.
Also, maybe you could do more TEE's and breathing control before you ask her to huff/cough and she might then be able to cough more up at once and decrease the amount of coughing she has to do to clear the same amount.
Good luck with her!!
Tara
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