Common Respiratory Interventions

Oxygen therapy

Tracheobronchial suctioning
✔ Client should be in semi or high fowler’s position
✔ Use sterile gloves, sterile suction catheter
✔ Hyperventilate client with 100% oxygen before and after suctioning
✔ Insert catheter with gloved hand (3-5 inches length of catheter insertion)
✔ Apply suction during withdrawal of catheter
✔ When withdrawing catheter rotate while applying intermittent suction
✔ Suctioning should take only 10 seconds (maximum of 15 seconds)
✔ Evaluate: clear breath sounds on auscultation of the chest
 Bronchial hygiene measures
✔ Suctioning: oropharyngeal, nasopharyngeal
✔ Steam inhalation
✔ Aerosol inhalation
✔ Medimist inhalation
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Chest physiotherapy
✔ Postural drainage
✔ Percussion
✔ Vibration
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Nursing interventions in CPT
✔ Verify doctor’s order
✔ Assess area of accumulation of mucus secretions
✔ Position to allow expectoration of mucus secretions by gravity
✔ Percussion and vibration to prevent postural hypotension
✔ Procedure is best done 60 to 90 minutes before meals or in the morning upon awakening
and at bedtime
✔ Provide good oral care after the procedure

Incentive spirometry
✔ To enhance deep inhalation
 Closed chest drainage ( Thoracostomy Tube)
✔ Purposes
• To remove air and /or fluids from the pleural space
• To reestablish negative pressure and reexpand the lungs
✔ One bottle system
• The bottle serves as drainage bottle and water -seal bottle
• Immerse tip of the tube in 2-3 cm of sterile NSS to create water seal
• Keep bottle at least 2 to 3 feet below the level of the chest to allow drainage from the
pleura by gravity
• Never raise the bottle above the level of the chest to prevent reflux of air or fluid
• Assess for patency of the device
• Observe for fluctuation of fluid along the tube
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• Observe for intermittent bubbling of fluid, continuous bubbling means presence of air leak
• In the absence of fluctuation
• Suspect obstruction of the device - check for kinks along tubing, milk tubing towards the
bottle
• If there is no obstruction, consider lung reexpansion, validated by chest x-ray
• Air vent should be open to air
Two bottle system
✔ Not connected to the suction apparatus
• The first bottle is drainage bottle, the second bottle is water seal bottle
• Observe for fluctuation of fluid along the tube (water seal bottle) and intermittent
bubbling with each respiration
✔ Connected to suction apparatus
• The first bottle is drainage and water seal bottle, the second bottle is suction control
bottle
• Expect continuous bubbling in the suction control bottle, intermittent bubbling and
fluctuation in the water seal
• Immerse tip of the tube in the first bottle in 2 to 3 cm of sterile NSS, immerse the tube
of the suction control bottle in 10 to 20 cm of sterile NSS to stabilize the normal
negative pressure in the lungs. This protects the pleura from trauma if the suction
pressure is inadvertently increased.
Three bottle system
✔ The first bottle is drainage bottle, the second bottle is water seal bottle, the third bottle is
suction control bottle
✔ Observe for intermittent bubbling and fluctuation with respiration in water seal bottle,
continuous bubbling in the suction control bottle
Notes:
Encourage to do the following to promote drainage
✔ Deep breathing and coughing exercises
✔ Turn to sides at regular basis
✔ Ambulate
ROM exercise of arm
Mark the amount of drainage at regular intervals
Avoid frequent milking and clamping of tube to prevent tension pneumothorax
Removal of the chest tube - done by physician
✔ Prepare:
• Petrolatum gauze
• Suture removal kit
• Sterile gauze
• Adhesive tape
✔ Place client in semi fowler’s position
✔ Instruct client to exhale deeply and do valsalva maneuver as the chest tube is removed
✔ Chest x-ray may be done after the tube is removed
✔ Assess for complications, subcutaneous emphysema, respiratory distress