Respiratory Question: What to do first?

[HopeItWorksDNP]

I've recently picked up a PRN job taking care of a pt with a trach. Orders are to give HIT and CPT tx's every 4 hours as well as a saline neb. Doesn't specify what order. What's the appropriate order to give these treatments in order to get the best result?

For those of you that don't know what HIT is, like I didn't, it's giving breaths by the ambu bag to optimize lung expansion. Don't know if HIT is just a name my agency uses, or if its a common term I wasn't familiar with. Thanks for your help.

[GQRN]

Not familiar with "HIT" term, but I know CPT means chest physio therapy.

Bottom line is, you need to grab the policy and procedure manual at your facility and read it regarding Trach Care. I'm sure it should answer all your questions.

Here are my 2 cents: CPT is done to get all that excess mucus in the lungs to move around in order for oxygenation to get better. I don't think HIT will be much effective if all that mucus is sitting there and clogging the passages. Saline neb will definately loosen up the mucus and facilitate better movement. I would loosen the mucus, do some clapping on the back, suction and HIT. Keeping in mind that the patient doesn't suffer any resp. distress throughout the process. I guess these patient can't take it deep breaths to expand their lungs, theirfore we give them deep breaths with an ambu bag.

I guess its the same when we listen to their lungs, we hear some rumbling and we have them cough a few times (moving mucus, facilitating oxygenation) and listen again... usually does the trick.

Hope that helped, and make sure you read the policy at your facility and let us know the correct order.

[PageRespiratory!]

Checking the P & P is good advice, but personally I'd do

Aerosol Tx, then HIT, then CPT, then HIT, then suction.

Bear in mind that if a Pt. can't effectively mobilize their own secretions, they may or may not be hypoxemic, but also have an increased risk of PN. The manual resuscitator can generate large insp. pressures forcing air through collateral airways behind the secretions making it easier to cough up or suction out. It also helps to preoxygenate prior to suctioning.

I've never seen the 'HIT' term either, but I've done it many times.