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Thread: Methods for removing sputum from lungs in quads

  1. #1
    Senior Member landrover's Avatar
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    Methods for removing sputum from lungs in quads

    For those quadriplegic that have been hospitalized with pneumonia, what techniques did they use to help remove sputum from your lungs?
    Last edited by SCI-Nurse; 02-20-2018 at 12:13 PM. Reason: spelling correction

  2. #2
    Member Peders's Avatar
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    quad coughing has been by far the most effective for me. It's the only thing that really clears me when I need it. It's a lot like the Heimlich maneuver but from the front.. Somebody should know how to do it from the respiratory staff.

  3. #3
    With a lot of secretions, there are really two separate techniques.

    One is a procedure for breaking up secretions so they can be coughed out more easily.

    This can be done by chest percussion (CPT) which most respiratory therapists are proficient at. A vibration vest can also be used.

    A "flutter valve" can also be attempted for this, although it is difficult to use for many people with high SCI.

    In addition, IPPB or high frequency oscillation (CHFO) therapy such as the Hill-Rom Meta-Neb, both of which can also be used to deliver medications (mucolytics) which help to break up mucous. Many of these techniques are also used for people with cystic fibrosis.

    The second thing is to get the loosened secretions out. Due to abdominal muscle paralysis, most people with SCI above about T10 have problems producing an effective cough, so should learn how to use assisted cough techniques and be able to direct them to be done by others.

    Sadly, few health care professionals know about how to do effective assisted ("quad") cough, even many respiratory therapists. There are several technique; abdominal thrust being the most common. If there is a reason that this technique cannot be used, then a technique called ptussive squeeze or "chest wringing" can be attempted, best combined with some abdominal pressure.

    Other techniques include the use of a inexsuffalator such as the Cough-Assist or Vital Cough. Many respiratory therapists are also sadly not knowledgeable about these, and many hospitals to not own such equipment, although it can be rented.

    Suctioning should be the last resort, and really only helps for secretions fairly high in the respiratory tree. It can cause more infection and also is documented as damaging the delicate cilia cells that line your respiratory tree.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  4. #4

    Hill-Rom Airway Clearance machine and Cough Assist.

    I have both Hill-Rom Air Way Clearance machine with full air vest and VitaCough (assist). I have put on the Vest machine 1185 hours. Thirty minutes twice a day the same as VitaCough. Like medicine my pulmonologist says.

    I also use a nubulizer with albuterol then sodium chloride. First cough assist, vest with nubulizer then cough assist again.


    What they look like? See attached images. First one is
    Hill-Rom Air Way Clearance System with air vest. Second Hill-Rom VitaCough.

    Talk to your doctor or
    pulmonologist to qualify for it plus Hill-Rom offers a substantial discount based upon income. Hill-Rom Air Way Clearance machine sells for $16,800.00 USD and Hill-Rom VitaCough about $3,000.00 USD.

    Ti
    Attached Images Attached Images   
    "We must overcome difficulties rather than being overcome by difficulties."

  5. #5
    One thing which would be advisable is to not get the pneumonia in the first place and to get vaccinated for it, which I recently did. I was told for complete protection you need both the Prevnar 13, as well as the Pneumovax. Vaccinations are typically spaced one year apart, which I was told is for insurance reimbursement reasons. I had them done locally at my retail pharmacy.

  6. #6

    Mechanical (aspiration) pneumonia

    There is viral pneumonia, bacterial pneumonia and mechanical (aspiration) pneumonia which is a lung infection caused by thin fluids, food or vomit going into the lungs which cannot be vaccinated for. Prevnar 13 or Pneumovax will not help aspiration pneumonia. Aspiration pneumonia can develop over time, post 25 years from the weakening of throat muscles in the neck because of the spinal cord injury in the cervical region. Quadriplegics and seniors are very susceptible to develop aspiration pneumonia.

    If you are experiencing "fluids going down the wrong pipe" syndrome you could be at the onset of developing aspiration pneumonia. A barium swallow test can determine if you are aspirating. If you are, find yourself a good pulmonologist at a larger hospital and get a thorough examination. Sometimes you my have to see a speech pathologist to help you with swallowing and strengthening weak neck muscles.

    Sometimes adding a food thickener to thin fluids will help the fluid go down the esophagus and not the trachea into bronchial tubes.

    Ti
    Last edited by titanium4motion; 02-19-2018 at 06:22 PM.
    "We must overcome difficulties rather than being overcome by difficulties."

  7. #7
    Pneumonia vaccinations (which should be the Pneumovax 23 for people with SCI, not the Prevnar 13) only protect from bacterial pneumonia caused by 23 (therefore the name) types of bacteria which commonly can cause pneumonia. They don't protect you from viral pneumonia (such as can occur with the flu) and, as above, aspiration pneumonia.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  8. #8
    Cough assist machine plus chest percussion to clear my secretions. Always on my side and chest percussion on side of my chest to help unstick thick secretions. I also get suctioned but that is to clear liquid that builds up through the day, usually in my chair. I have a trache and vent, can't imagine what suctioning would be like without the trache.

  9. #9
    Quote Originally Posted by mrb View Post
    I also get suctioned but that is to clear liquid that builds up through the day, usually in my chair. I have a trache and vent, can't imagine what suctioning would be like without the trache.
    Nasal-tracheal suctioning is not a pleasant experience, and difficult to do well also. Do you use humidification for your vent? This helps to keep the secretions thinner and easier to get out with assisted cough (which can be done in your chair).

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  10. #10
    Quote Originally Posted by SCI-Nurse View Post
    Nasal-tracheal suctioning is not a pleasant experience, and difficult to do well also. Do you use humidification for your vent? This helps to keep the secretions thinner and easier to get out with assisted cough (which can be done in your chair).

    (KLD)
    Yes, humidification but that brings its own problems. I get a lot of condensation/rain out which can result in me aspirating warm water if my support workers don't clear it before rolling me. Had a long discussion with my ventilation team about reducing it now got another machine. Warm water is the perfect breeding ground for bacteria.

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