I was recently allowed to participate in a question/answer session , with a luminary in the field of atypical Parkinson’s syndromes.
In addition to the medical questions, it was also about dealing with secretions, in professional circles gladly also called Sekretmanagemet, which means it is more than just suction.
By the way, one is rarely satisfied : either it is too much, too little, too viscous or too liquid secretion.
Due to diseases and / or therapy elements (tracheal cannula), the physiological cleaning function (cough-cough) of the lungs is often disturbed, which can lead to infections (pneumonia). This must be avoided.
What all is involved?
1) pharmacological approach
Inhalation with physiological saline solution 0.9% (pzn 00808558 ):to moisten and care for the mucous membranes. In case of very viscous secretion, one can inhale with 3% saline solution.
If you inhale with Salbutamol (PZN 01448760) or Ipra (PZN 00652547)
These do not dissolve the secretion, but improve inhalation and, if necessary, allow a burst of cough.
2) mechanical approach
Especially we neurological patients often struggle with cough insufficiency. A cough assistant or cough assist can improve the situation.
In simple terms : it supports inhalation with positive pressure and exhalation with negative pressure .
It is recommended to “breathe” 3-6 cycles (inhalation+exhalation = 1cycle), either through a mouthpiece or mouth-nose mask.
The setting of the pressures should be adjusted by a respiratory therapist or dstationary if possible.
3) Air stacking is mentioned only as a matter of form and should be left to trained personnel,”:Air stacking” using hand-held resuscitator bags. This will cause hyperinflation and better ventilation of the lungs.
4) Suctioning secretions from the trachea.is not witchcraft, but one should still be instructed and be aware of what can happen. Atraumatic and as thin as possible (PZN 03390289 Ch10-Ch12) catheters should be used. To get the best result, the principle is “AS HIGH AS POSSIBLE, AS DEEP AS NECESSARY.” The better endotracheal suctioning can be prepared with other measures, such as respiratory gas conditioning, cough assistance, and the like, the lower the risk from “deep” suctioning. If possible, the complete secretion should be cancelled.
Now some will think : logical, why else do I do it?
Complications like mucosal bleeding, panic attacks or retching ( up to vomiting and low heart rate) can occur.
Please pay attention to hygiene.
Only use the “NO-TOUCH-PRINCIPLE” for short suction catheters. In this case, the sterile part of the suction catheter should only be touched with the sterile glove. Long suction catheters are used much more frequently. For safe disposal, wrap the catheter, e.g. in the glove. And put it in the residual waste.
Be well instructed!!!
Here is a small video to illustrate the procedure
5) Positioning and mobilization
Position changes may not only serve a decubitus prophylaxis or the well-being. By different positions also secretion can flow in accordance with the core sentence “PUT THE GOOD LUNG DOWN” from the lung parts by means of gravity in the direction of the windpipe. From here, with further measures, the secretion is to be obtained.
Just the reasonable mobilization provides a very good basis on which further measures can be built. Positioning in the paschal seat, or heart bed position, is usually only a minimum requirement here. More positive is the mobilization, on the edge of the bed or, in the chair and a gait training, change not only the ventilation in your quantity and / or quality, but also increases the quality of life.
6) ASE , Vibration ect.
Contact breathing, vibration, percussion, nebulization ( with an ultrasonic nebulizer):and simultaneous joint breathing and coughing usefully flank the above measures.
Breath stimulating embrocation (ASE) is an element of basal stimulation.
Mobile patients sitting on the edge of the bed or vice versa on a chair
-Immobile patients sideways position
-At least 1 hand is continuously on the patient’s body during the entire offer.
-The rubbing is done in skin to skin contact, so without gloves!
-A medium is used (W/O emulsion)
-The offer should be carried out in a calm environment without hectic rush.
-The fingers are not spread during the offer, but form a closed surface.
The rubbing should be carried out in a breath-synchronous way, but it is not possible to offer a 15-breath rhythm to a patient with a 40-breath rate.
-The rubbing is carried out on the right and left side of the spine, the spinous processes always remaining free
-The beginning and end of the rubbing are made clear
Descending: pressure in thumb and index finger
parallel to the spine
– Pressure in the little finger
– Uniform, low pressure of the whole hand
Also from basal stimulation, to support breathing, comes vibration.
To loosen the secretion or to find a better breathing rhythm.
find.
A facial vibrax, razor or electric toothbrush are suitable for this purpose.
The Tri-Flow (PZN04751855))
should also provide for a loosening of the secretion.
Breathe and cough together for a physiological breathing rhythm.
What to do in case of too much secretion (hypersalivation)?
Medication e.g. with scopolamine patches ( PZN: 00107146))
or Botox injections into the salivary glands. Tricyclic antidepressants also cause dry mouth.
Non-drug, there is little that can be done. For one, you can put a gauze wrap in the cheek pocket and direct it out. Depending on the size of the wrap, this is probably uncomfortable and also,if we have it in our head, we get it all.
Also one can tinker a suction like with the dentist. Please no “continuous suction for several hours
Who has questions or additions, which is helped here!
Marion@leben-mit-msa.de
I do not claim the right to completeness here, otherwise it would have degenerated even more ?