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Pulmonary Hygiene After Spinal Cord Injury
WHAT YOU SHOULD KNOW:
Pulmonary hygiene is also called respiratory care. Pulmonary hygiene is a group of exercises and treatments to help you breathe better and to keep your lungs healthy. Although many people need pulmonary hygiene, it is very important for people with spinal cord injuries (SCI). Caregivers will work very closely with you to help your lungs work as well as possible and to prevent problems. The amount of trouble you have breathing depends on where your spinal cord is injured. Pulmonary hygiene consists of breathing exercises and treatments, postural drainage, chest physiotherapy (fiz-ee-oh-THER-ah-pee), quad assist coughing, and suctioning.
CARE AGREEMENT:You have the right to help plan your care. To help with this plan, you must learn about spinal cord injury and pulmonary hygiene. You can then discuss choices with your caregivers. Work with them to decide what choices may be best for you. You always have the right to refuse and make your own decisions.
- Many problems may happen after a spinal cord injury. Some of these problems include having your body temperature go too low or your heart beat too slowly. You may have trouble breathing, or be unable to breathe on your own. Being paralyzed can cause skin sores and muscle contractures. You may get a blood clot that travels to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
- Sometimes your body cannot respond correctly to problems like bladder or bowel problems. This is called autonomic dysreflexia and it causes your blood pressure to get very high. If not treated quickly, this can cause a stroke or even death. If you have a spinal cord injury and do not get treatment, you may not be able to feed or care for yourself. Talk to caregivers if you have questions or concerns about your medicines or care.
WHILE YOU ARE HERE:
- Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
- Blood gases: This is also called an arterial blood gas, or ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell caregivers how well your lungs are working.
- Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
- Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.
- Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
- Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
- An IV is a small tube placed in your vein that is used to give you medicine or liquids.
- Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
- Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
What special tests will I need?
These tests help caregivers learn more about your breathing problems. They also help caregivers plan the best treatment for you.
- Pulmonary Function Tests: These tests help caregivers learn how well your lungs work and are also called "PFTs". During the tests you breathe into a mouthpiece connected to a machine. The machine measures how much air you breathe in and out over a certain amount of time. This helps caregivers see how well your lungs are moving and working. You may feel short of breath after these tests.
What medicines will I need?
- Antianxiety medicine: This medicine may be given to decrease anxiety and help you feel calm and relaxed.
- Bronchodilators: You may need bronchodilators to help open the air passages in your lungs, and help you breathe more easily.
- Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
- Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
- Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
- Steroids: This medicine may be given to decrease inflammation.
What will be done if I have breathing problems?
- Breathing Exercises: Breathing exercises help to keep you from getting a lung infection (in-FEK-shun). You should do these exercises three to four times a day. Do them at about the same time each day. This will help you remember to do them.
- Deep breathing opens the tubes going to your lungs. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs forcefully. Do this 10 times in a row.
- You may be asked to use an incentive (in-SEN-tiv) spirometer (spi-ROM-e-ter). This helps you take deeper breaths. Exhale (breathe out) as much air as possible. Put the plastic piece into your mouth and inhale (breath in) deeply. Hold your breath as long as you can. Then let out your breath. Do this 10 times in a row. This helps bring up the extra mucous at the bottom of your lungs.
- Breathing treatments: You may need breathing treatments to help open your airways so you can breathe easier. A machine is used to change liquid medicine into a mist. You will breathe the mist into your lungs through tubing and a mouthpiece. Inhaled mist medicines act quickly on your airways and lungs to relieve your symptoms.
- Postural Drainage and Chest Physiotherapy: Postural drainage or "PD" and chest physiotherapy (fiz-ee-oh-THER-ah-pee) or "CPT" help loosen the mucous in your lungs. PD is done while lying or sitting for at least five minutes, in each of several positions. This allows gravity to help bring up the mucous. CPT is when a caregiver lightly claps on your back and chest with his hands. This breaks up the sputum in your lungs making it easier to cough up. Your caregiver may use a machine to lightly clap on your chest and back. Doing PD and CPT at the same time works even better. Do not do PD or CPT right before or after a meal because it may upset your stomach.
- Quad Assist Coughing: If your rib muscles and diaphragm do not work correctly, it may be hard to cough and bring up mucous. Doing quad assist coughing is a way to make a weak cough strong enough. A caregiver places one hand over the other on your abdomen between your ribs and belly button. At the same time that you try to cough, your caregiver thrusts his hands up. This should be repeated at least three times, or until you cough up the mucous.
- Suctioning: Breathing exercises and treatments, PD, and CPT may not be enough to bring up the mucous in your lungs. You may need to use a cofflater machine, or do tracheal suctioning.
- Cofflater Machine: A machine like a vacuum is put over your mouth and nose or tracheotomy tube for a few seconds. Positive air pressure is put into your lungs to inflate them and then the positive pressure changes quickly to negative pressure. This causes the air sacs to let go of their mucous and makes a cough which brings up the mucous. Some people may not be able to use a cofflater machine. Lung conditions and diseases, heartbeat problems, or an injured chest may not allow it. Ask your caregiver whether a cofflater machine is right for you.
- Tracheal Suctioning: A sterile thin tube hooked to suction is put down into your trachea. The suction pulls up the mucous from your lungs. Tracheal suction may cause other problems, so it is best to use other methods to clear mucous first.
What is a pulmonary embolism?
- A pulmonary embolism (EM-boh-lizm) happens when a thrombus (blood clot) blocks a pulmonary (lung) artery. Pulmonary embolisms are also called PE's. PE's are common problems after an SCI, and can be life-threatening. Caregivers may give you medicine to slow your blood from clotting. You may have a bed that rotates to keep your blood moving well through your body. The bed also helps prevent pressure from being placed on any part of your body for too long.
- The symptoms of a PE include very bad and sudden chest pain and difficulty breathing. Blood in your sputum (spit) is another sign. Tell your caregivers if you feel or see any of these problems. You may have one or more of the following treatments:
- Pressure Stockings: These tight elastic stockings keep blood from staying in the legs and causing clots. The stockings are also called Ted Hose® or Jobst Stockings®. These stockings can keep you from getting blood clots.
- Pneumatic (new-MAH-tik) Boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the boot or legging. This helps push the blood back up to the heart to keep clots from forming.
- Vena Cava Filter: Caregivers may suggest that you need a special filter called a vena cava filter put into a blood vessel to collect clots. You may need this surgery if medicines and other treatments are not enough to prevent blood clots.
What if I cannot breathe well enough on my own?
You may need help breathing right after your SCI. Your neck muscles may become your main breathing muscles if your SCI is at a high point on your spinal cord. You may need assisted ventilation (ven-ti-LAY-shun) if these muscles cannot get enough air to you. Ventilation assistance may include a phrenic (FREN-ik) pacer or a mechanical ventilator.
- Electrophrenic (ee-lek-troh-FREN-ik) Nerve Pacer: This electronic device stimulates the phrenic nerve that tells the diaphragm what to do, which causes you to inhale. Not all people can use a phrenic nerve pacer especially if their phrenic nerve does not respond to stimulation. The equipment used for phrenic nerve pacing is small and portable. Many people with phrenic nerve pacers may also have their trach tubes capped, allowing for better speech. Phrenic nerve pacing is very costly and requires a surgical procedure. It often takes a long "conditioning" process to learn how to do it. Ask your caregiver if a phrenic nerve pacer would work for you.
- Ventilator: This is a special machine that can breathe for you. Caregivers may put an endotrachael or "ET" tube in your throat, or a tracheostomy "trach" tube in your neck. Caregivers hook the tube to a mechanical ventilator (ven-ti-LAY-ter). The ventilator is set to give you a certain number of breaths each minute. The machine can tell if you try to take a breath on your own, and helps by adding extra oxygen if needed. The amount of extra oxygen added depends on the results of blood tests that measure how much oxygen is in your blood. The ventilator has an alarm to tell caregivers if there is any problem with the machine, and how much oxygen you are getting.
If I need a ventilator now, will I always need one?
Whether you need a ventilator depends on how high on the spinal cord your injury occurred. It also depends on how much improvement you have during rehabilitation (ree-hah-bil-ih-TAY-shun). If your injury is low on the spinal cord, you may only need a ventilator until your breathing muscles are stronger. You also may only need it until you recover from breathing problems such as pneumonia (noo-MOH-nyah). Caregivers may then slowly take you off the ventilator.
What does it mean to be taken off a ventilator?
Usually people cannot be taken off a ventilator in one quick step. Instead, caregivers make a plan to take you off the ventilator in a series of steps. This allows your breathing muscles to get stronger and also helps you not to be afraid to be without the ventilator.
- There are different ways to take a person off a ventilator. One method is called the work-rest method. The ventilator is set so that you are allowed to breathe all or partially on your own.
- This is followed by a rest period where the ventilator does all the work of breathing so your muscles can rest. The work phase slowly is lengthened until you can do all the breathing on your own. How long it takes to be taken off the ventilator depends on how long you have been using the ventilator, and other things.
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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.