Introduction Show
Aim Definition of Terms Assessment Management Special Considerations Evidence Table
References IntroductionChildren who experience respiratory distress may benefit from advanced secretion clearance techniques to optimize oxygenation and ventilation. Physiotherapists also provide this service within the hospital,
but are not available during all hours. Should it be identified that physiotherapy input is required for secretion clearance, then a physiotherapy EMR referral should be completed, and physiotherapy contacted if within hours. This guideline should be utilised to guide advanced secretion clearance outside of physiotherapy hours, where a physiotherapy treatment plan does not yet exist, or if a plan has been pre-discussed with nursing staff. Airway suctioning will not be discussed in this
guideline as this is covered in local guidelines depending on department acuity. Aim
Definition of Terms
Assessment Criteria for advanced secretion clearance: Patient assessment should include:
Advanced secretion clearance techniques can contribute to haemodynamic instability, further respiratory compromise and rib fractures if performed inappropriately. Therefore careful assessment should be undertaken to assess if the intervention is likely to be of benefit and whether there are any contraindications to treatment. Table 1outlines which conditions have been acknowledged as receiving benefit from advanced airway clearance techniques strategies by a nurse. Other conditions which are deemed as having no benefit from advanced airway clearance should not be undertaken unless by a physiotherapist. Related Clinical Practice guidelines
Table 1:
Table 2
ManagementNursing scope of practice will vary in regards to the degree of advanced secretion clearance that can be provided in different departments in the hospital. Non-intensive care areas are differentiated from the PICU due to variations in scope of practice and the clinical environment. Please consider patients illness profile when selecting treatment options, and always seek guidance from medical colleagues when planning to provide advanced secretion clearance. Table 3
Non intensive care areasEffective coughing:
Postural drainage positions:
Mechanical in-exsufflation (e.g. CoughAssist®):
Rosella (PICU)Effective coughing:
Postural drainage positions:
Mechanical in-exsufflation (e.g. CoughAssist®):
Deep breathing with SMI following extubation:
Chest percussion and vibrations:
Percussion:
Figure 1: Hand position for chest percussions
Vibration:
Figure 2: Hand position for chest vibrations Manual hyperinflation:Manual hyperinflation should only be undertaken by nursing staff in the intensive care if it has been deemed an appropriate treatment by review from physiotherapy. Physiotherapists should provide nursing staff with documented plan for manual hyperinflation including maximum pressures and frequency of treatment. Special ConsiderationsShould an aerosol generating procedure be undertaken on a patient under droplet precautions then increase to airborne precautions by donning N95/P2 mask for at least the duration of the procedure. Evidence TableEvidence table for this guideline can be found here. References
Please remember to read the disclaimer. The
development of this nursing guideline was coordinated by Kate Lambert, CNC, Rosella Ward, Lisa Robson, Physiotherapist and approved by the Nursing Clinical Effectiveness Committee. Updated November 2020. Which position would the nurse utilize when repositioning a patient who has increased intracranial pressure?4 Supine position is commonly used for the following procedures: intracranial, cardiac, abdominal, endovascular, laparoscopic, lower extremity procedures, and ENT, neck and face. In Supine position, the patient may risk pressure ulcers and nerve damage.
Which position will the nurse avoid when positioning a patient with ICP?Head elevation above 30 degrees should be avoided in all cases. In most patients with intracranial hypertension, head and trunk elevation up to 30 degrees is useful in helping to decrease ICP, providing that a safe CPP of at least 70 mmHg or even 80 mmHg is maintained.
When explaining normal intracranial pressure ICP balance to the patient's family which three components would the nurse include?To understand the delicate balance involved in maintaining ICP, consider that the intracranial space contains three major components: cerebrospinal fluid (CSF), the blood supply—consisting of the network of arteries and veins that supply blood to the brain—and parenchymal tissue.
What should a patient be taught to do to prevent increased intracranial pressure after undergoing a craniotomy?Interventions to lower or stabilize ICP include elevating the head of the bed to thirty degrees, keeping the neck in a neutral position, maintaining a normal body temperature, and preventing volume overload.
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