In this section
Definition of Terms
Children 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, therefore the nurse can provide a significant contribution in advanced secretion clearance when oxygenation and ventilation are compromised. Airway suctioning will not be discussed in this guideline as this is covered in local guidelines depending on department acuity.
Criteria for advanced secretion clearance:
Advanced secretion clearance should not be considered routine and the rationale for treatment should be based on excessive secretions, atelectasis or abnormal gas exchange. Collaboration with physiotherapists regarding the patient’s cardiorespiratory physiology, chest mechanics and evidence for these techniques is essential.
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 1 outlines which conditions have been acknowledged as receiving benefit from advanced airway clearance techniques and those that have not. Other conditions which are deemed as having no benefit from advanced airway clearance should not be undertaken unless by a physiotherapist.
Suctioning and initiation of non-invasive or invasive ventilation is not covered within this guideline, see unit specific guidelines for guidance on these methods.
Artificial airway suctioning *intranet only
Continuous Positive Airway Pressure (CPAP) and Non-invasive Ventilation (NIV)
Non-invasive respiratory support in PICU guideline *intranet only
Nursing management of the patient with invasive mechanical ventilation in PICU *intranet only
Chronic disease with large amounts of sputum
Nursing 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 including RCH@home programs are separated from the PICU due to variations in scope of practice.
Figure 1: Hand position for chest percussions
Figure 2: Hand position for chest vibrations
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.
Evidence table for this guideline can be found here.
Please remember to read the
development of this nursing guideline was coordinated by Grace Larson, CNC, Rosella Ward,
and approved by the Nursing Clinical Effectiveness Committee. Updated February 2017.