ACTIVE CYCLE OF BREATHING TECHNIQUE

Transcription

1 ACTIVE CYCLE OF BREATHING TECHNIQUE Aim To safely and effectively teach and supervise the active cycle of breathing technique (ACBT) with sevice users as prescribed by registered practitioner. Background The ACBT is an evidence based 1, effective method of sputum clearence which avoids bronchconstriction (often caused by excessive coughing). There are three parts to the technique: breathing control (relaxed breathing), deep breath with hold, and huff (forced expiration). control aims to get the service user to breath in a relaxed way, using the diaphragm. Deep breathing ensures a good air flow into the lungs, and the hold means a greater amount of gas exchange can take place and air is encouraged to flow deep into the lungs, behind secretions. The Huff (or forced expiration technique) is a forced, rapid expiration with an open glottis. This is an effective means of clearing sputunm in the major airways and avoids bronchoconstriction. Coughing is only used where secretions are high in the upper airway. The typical ACBT cycle is shown in the diagram below: HUFF x 3-4 Control Deep x 3-4 Deep x 3-4 Control Active Cycle of Technique

2 Procedure 1. Check plan for length of treatment and any variations (e.g. position). Identify whether any observations need to be taken and do this prior to commencing the technique (as per the relevant competencies) 2. Explain the reason for the technique: e.g. this is to help you clear secretions from your chest, which will make your breathing easier. It consists of relaxed controlled breathing, followed by deep breathing to move the secretions upward then forced expiration (huff) to expectorate the secretions, then controlled breathing again to allow you to recover. 3. Position of Service User: check plan. The service user position is important as ACBT may be carried out with postural drainage to aid secretion removal. The service user may have preferred or more effective relaxed breathing positions. 4. Position of Rehabilitation Assistant: in front and to side of service user, so you can clearly observe their face and respiratory action throughout. 5. Explain how to perform the exercise: the ACBT has four parts which are repeated. I will teach you each one in the order they are performed to complete the technique. Demonstrate each phase if necessary. a) Control (relaxed breathing): you need to relax your head and shoulders and breath from your lower chest - try to inhale through your nose. If you are very short of breath you can breathe in and out of your mouth initially then gradually start to breathe in through the nose and out through the mouth. out through slightly pursed lips sometimes helps. b) Deep breathing- inhale deeply, using your lower chest and hold (for 2-3 seconds). Breathe out through your mouth. This is repeated 3 4 times, and helps move your secretions up into the bigger airways. c) Huff (forced expiration) from a medium breath in you need to quickly and forcibly breathe out, keeping your mouth open (as if blowing down a tube). d) control again to repeat the cycle. 6. Ready Ask the service user to undertake a) breathing control b) deep breathing exercise c) huff d) breathing control (as per competencies) Correct each step as necessary. If the service user not able to clear secretions or becomes wheezy or excessively breathless STOP and seek advice from senior/team leader. If the service user is unable to perform exercise due to poor technique allow them to rest & repeat each stage. If they are still unable STOP and seek advice from team leader/senior. 7. On completion seek feedback from service user re how they found the technique. Ensure the service user is comfortable and not in distress.

3 8. Document in the Service User s notes. 9. Feedback clearly to the Registered Practitioner who delegated the task. 1.Lewis LK, Williams MT, Olds TS The active cycle of breathing technique: A systematic review and meta-analysis Respiratory Medicine Volume 106, Issue 2, Pages

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5 SUPERVISED TASKS/EXERCISES CARRIED OUT BY REHABILITATION ASSISTANT COMPETENCIES NAME: TAUGHT MODELLED COMPETENT PT66 Active Cycle of Technique DATE DATE DATE 1 Read plan, identify exercises and any variations 2 Decide where to undertake ACBT (e.g. in sitting, walking, with PD or with relaxed breathing positions) 3 Appropriate explanation of the reason for ACBT to Service User 4 Start position of Service User 5 Position of Rehab Assistant relative to Service User 6 Verbal explanation and demonstration of how to perform ACBT, including when to use and any warnings 7 Supervision of exercise/technique i Verbal prompts and encouragement ii Appropriate correction iii Correct timing of repetitions and rest periods iv Appropriate use of touch v)appropriate recognition of when to stop and seek advice/help

6 PT66 Active Cycle of breathing Technique DATE DATE DATE 8 Completion of ACBT seek feedback from & give appropriate feedback to service user 9 Documentation 10 Feedback to Registered Practitioner Signature of Learner Sign and date when achieved Signature of Assessor Date of Review

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