Airway Clearance Therapy



Airway Clearance Therapy







CLINICAL GUIDELINES



  • A registered nurse (RN) or a respiratory care technician may perform airway clearance therapy.


  • Airway clearance therapies should facilitate the removal of excess secretions from the peripheral parts of the lung. Research findings vary on the effectiveness of airway clearance therapies. Airway clearance therapies using vibration and percussion techniques do not reduce length of hospital stay, oxygen requirements, or improve the severity clinical score in infants with acute bronchiolitis. Research indicates airway clearance therapies have short-term effects in terms of increasing mucous transport for children with cystic fibrosis, and thus should be employed in those patients. Airway clearance therapies on newborns who are, or have been, intubated do not clearly support a correlation between reduction in the need for reintubation and the trend for decreased postextubation atelectasis when airway clearance therapies are used.


  • Airway clearance therapies are recommended for all children with cystic fibrosis for clearance of mucus, maintenance of lung function, and improved quality of life.


  • Airway clearance may be indicated for children whose clinical condition alters mucous clearance. Research indicates that airway clearance therapies may have few clinical benefits for some pediatric patients, and thus should not be routinely ordered for children with respiratory conditions. Clinical decisions to employ airway clearance therapies should be made on a case-by-case basis.


  • The method of airway clearance selected is that which best fits the child’s needs (Figure 12-1).

    imageKidKare In older children, use of a mechanical vest that provides high frequency oscillation is one type of airway clearance therapy that encourages self-care. The older child can independently put on and operate the device, and is thus not dependent on others for this part of their care.


  • Child’s chest is covered with a T-shirt or blanket before airway clearance therapies are employed to protect bare skin.


  • Oxygen saturation levels are monitored during the procedure when indicated.


  • Airway clearance therapies should not be performed for at least 1 hour after feedings/meals to prevent vomiting.


  • Continuous drip feeds should be turned off at least 30 minutes before therapy to prevent vomiting and/or aspiration.


  • The child with gastroesophageal reflux should be carefully monitored throughout therapy to ensure aspiration is avoided. Avoid Trendelenburg position.


  • Airway clearance therapies are withheld when the child has episodes of hemoptysis, pulmonary hemorrhage, fractured ribs, vertebral compression fractures, or increased intracranial pressure (ICP).


  • Implanted venous access devices (i.e., implantable ports) should be protected when performing therapy by using a handmade, donut-shaped, padded support. Do not percuss directly over the device.


  • If the child requires oxygen, ensure that the nasal cannula remains in proper place during position changes.


  • Percussion should not be performed directly over incisional areas; consider splinting for comfort.




EQUIPMENT



  • Stethoscope


  • Blanket


  • Pillows


  • Mechanical percussor (if needed, padded electric toothbrush for neonates) or airway oscillating device


  • Container for sputum


  • Suction setup (if needed)


  • Oxygen (if needed)


  • Ambu bag with oxygen setup (if needed)


  • Diversional activities such as music therapy or videos (if needed)






Figure 12-1 Positions for airway clearance therapies. (continued)








Figure 12-1 (Continued)


CHILD AND FAMILY ASSESSMENT AND PREPARATION

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Jul 9, 2020 | Posted by in NURSING | Comments Off on Airway Clearance Therapy

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