Physiotherapy Interventions

Question 1

Oxygen therapy prescribed flow devices:
Nasal cannulae

Answer 1

Nasal Cannulae- 1-6L/min- FiO2 24-40%

Question 2

Oxygen therapy prescribed flow devices: Simple mask

Answer 2

Simple face mask- 5-10 L/min FiO2 40-60%
Requires 5L/ min to flush out Co2

Question 3

Oxygen therapy prescribed flow devices: Venturi mask

Answer 3

Venturi mask- fixed 24%, 28%, 31%, 35%, 40% and 60%.
Ideal for COPD patients

Question 4

Oxygen therapy prescribed flow device: Non-rebreather mask

Answer 4

Non-rebreather mask- 10-15L/min FiO2 85-100%
Emergency high demand O2

Question 5

Oxygen therapy prescribed flow devices: high flow nasal cannulae

Answer 5

High flow nasal cannulae- 30-60 L/Min- up to 100%
Heated/ humidified: used in ARDS/ COVID patients

Question 6

Oxygen therapy prescribed flow devices: CPAP NIV

Answer 6

Continuous positive airway pressure
FiO2 up to 100%
5-10cmH20
Used in COPD and type 1 Resp failure
Keeps alveoli open, improves oxygenation

Question 7

Oxygen therapy prescribed flow devices: BIPAP NIV

Answer 7

Bi-Level positive Airway Pressure
IPAP: 10-20cmH2O
EPAP: 4-10cmH2O
FiO2: Up to 100%
COPD with type 2 respiratory failure ( CO2 retention)
Improves co2 clearance

Question 8

Whqt does Non invasive ventilation (NIV) do?

Answer 8

Delivers positive pressure to assist breathing without intubation

Question 9

BIPAP: IPAP

Answer 9

IPAP helps with inspiration

Question 10

BiPAP: EPAP

Answer 10

Prevents airway collapse

Question 11

Non invasive ventilation may need to be paused when

Answer 11

Secretions clearance or mobilisation with monitoring

Question 12

Benefits of Suctioning

Answer 12

Helps clear secretions
Maintain airway patent
Improve oxygenation and ventilation in patients

Question 13

What is Open suctioning

Answer 13

Involves disconnecting the patient from the ventilator or oxygen source and using a sterile suction catheter to remove secretions.

Question 14

What is Closed suctioning?

Answer 14

Definition: A suction catheter is built into the ventilator circuit, allowing suction without disconnecting the patient from the ventilator.
Used in ICU patients on mechanical ventilation
- COVID-19 or infectious patients.

Question 15

How to do a closed suctioning?

Answer 15

Steps
1. Pre-oxygenate
2. Advance catheter via closed system
3. Suction while withdrawing
4. Flush catheter

Question 16

Advantages of closed suctioning?

Answer 16

Advantages:
- Maintains ventilation and oxygenation
- Reduces infection risk
- Safer for unstable patients
- Faster and easier to repeat

Question 17

Disadvantages of closed suctioning?

Answer 17

Disadvantages
- Can be less effective than open suctioning for thick or copious secretions
- May need more frequent cleaning
Physio Role: Often done in conjunction with physio for ventilated patients; can combine with manual techniques (e.g., vibrations).

Question 18

What are the steps for open suctioning?

Answer 18

Steps
1. Pre-oxygenate
2. Disconnect from the ventilator
3. Insert a sterile catheter
4. Suction during withdrawal
5. Reconnect the oxygen/ventilator

Question 19

Advantages of suctioning?

Answer 19

Advantages: More thorough suctioning
- Better visibility and control
- Useful in emergencies or when thick secretions are present

Question 20

Disadvantages of suctioning?

Answer 20

Disadvantages: Breaks the ventilator circuit → risk of desaturation, infection, and loss of PEEP: Requires sterile technique each time
Physio Role: May assist or perform during chest physio with MDT approval. Ensure pre-oxygenation and monitoring.

Question 21

Physiotherapy Interventions for secretion removal

Answer 21

Humidification
ACBT
Mobilization
PEEP
Postural drainage

Question 22

Physiotherapy Intervention for reduced lung volume

Answer 22

1. Positioning
2. Mobilisation
3. V/Q matching (good lung down)
4. TEE
5. Incentive spirometry
6. Positive pressure (CPAP, BIPAP, IPPB)

Question 23

Increased work of breathing

Answer 23

1. Patient handling (emotional+physical)
2. Positioning
3. Breathing control
4. Pacing
5. NIV (O2, PP)
6. Other (fan, sleep, relaxation, education)

Question 24

Patient has reduced mobility

Answer 24

Bed exercises/transfers/mobilise

Question 25

How to perform a closed suction

Answer 25

1. Stabilize the airway – Hold the endotracheal/tracheostomy tube securely. 2. Advance the catheter through the closed suction port: • Gently insert the catheter until resistance is met or the patient coughs. • Do not force the catheter. 3. Apply suction while withdrawing: • Press the suction valve/button only while withdrawing the catheter. • Suction duration should be <10 seconds to avoid hypoxia. 4. Withdraw the catheter fully into the sheath. 5. Flush the system (if applicable) using saline flush mechanism to clear catheter. 6. Assess the patient: • Monitor oxygen saturation, respiratory rate, and ventilator parameters. • Reassess for any signs of distress or desaturation.

Question 26

Preparation before a closed suction catheter

Answer 26

1. Hand hygiene – Wash your hands and apply gloves (non-sterile is sufficient for closed suctioning). 2. Check equipment – Ensure the closed suction catheter is properly attached and functioning. Suction pressure should be set (usually around 80–120 mmHg for adults). 3. Pre-oxygenation (if necessary) – Increase FiO₂ temporarily (e.g., to 100%) if patient is desaturating or clinically unstable. 4. Explain the procedure to the patient (if conscious).

Question 27

Indications for suctioning

Answer 27

o Only perform suctioning if there are clear clinical indications, such as:  Visible secretions in the airway  Patient distress (e.g., coughing, noisy breathing, desaturation)  Reduced oxygen saturation or ventilation problems due to secretions  Inability to clear secretions by coughing

Question 28

Assessment before suctioning

Answer 28

o Assess patient’s need for suctioning carefully. o Consider less invasive techniques first (e.g., encouraging coughing, physiotherapy). o Use suctioning only when necessary to avoid trauma or infection.

Question 29

Infection Control

Answer 29

o Follow strict hand hygiene before and after the procedure. o Use sterile or clean (single-use) suction catheters as per local policy. o Avoid cross-contamination.

Question 30

suctioning procedure

Answer 30

o Explain the procedure to the patient to reduce anxiety. o Use appropriate suction pressure (typically 80-120 mmHg for adults; lower for children). o Limit suction time to no more than 10-15 seconds per attempt to minimize hypoxia. o Allow rest periods between suction passes. o Monitor patient’s oxygen saturation and heart rate during suctioning.

Question 31

Post suction care

Answer 31

o Reassess airway patency and patient comfort. o Provide oxygen if needed. o Document the procedure and patient response.

Question 32

Suction pressure and Kpa for Adults

Answer 32

100- 150 mmHg and 13-20 suction pressure range Kpa

Question 33

Suction pressure and KPA children

Answer 33

80-100mmHg and 10-13Kpa

Question 34

Suction pressure and KPa in infants

Answer 34

60-80MMhg and 8-10Kpa