This afternoon, I knocked on a patient’s door frame simultaneously saying, “knock, knock” and the patient had a surprised look on their face. I had caught them in the act! I caught them using their incentive spirometer…CORRECTLY! Magic.
The incentive spirometer; the hospital version of a Happy Meal toy. There are only two ways to use it, and most patients use it incorrectly at first.
Incentive spirometry (IS) is an important part of post operative care to keep lungs healthy and elastic during the recovery period that sees the patient in bed more than we would like. Inactivity and lack of deep breathing weakens the lungs and puts patients at risk for atelectasis (partially collapsed lungs), pleural effusions (fluid around the lungs), or pneumonia (fluid in the lungs).
Educating the use of an incentive spirometers is usually an on going process. Since the patient is usually still working off the effects of anesthesia when they arrive on the unit, introducing IS is all their attention span can process at that point.
Anatomy of the IS:
- A hose to inhale, NOT EXHALE/BLOW
- A diaphragm in the lung volume chamber that rises with inhalation
- A sliding measuring device to note peak air flow
- A bobber chamber that reads “good, better, best” from top to bottom. The lower the bobber floats during inhalation, the better.
- One or two, kung fu grips on the side(s) of the device.
Once the patient is attentive and ready to talk about IS the teaching is this basic:
- Inhale deeply
- Inhale slowly
- Repeat 10 times an hour, preferably spaced out over a hour
- Monitor the progress with the measuring device on the IS
I recommend two deep inhalations every commercial break while the patient is awake, if they are watching TV. Inhaling deeply helps expand the bottom of the lungs; that’s the area we are after. Inhaling slowly increases the effectiveness of the inhalation. Spreading out the inhalations is a better work out for the lungs than doing 10 in a row. The measuring slider on the IS will give us a baseline of the patient’s inhalation effort.
To determine the effectiveness of education, ask them to demonstrate use of the device. Re-educate as necessary.
Common barriers to learning and trouble shooting:
- A patient that confuses INHALATION/EXHALATION and BLOWS into the device
- Pain (it will hurt to breathe deeply for a patient after an abdominal surgery, for instance). Medicate them as needed, it is important they breathe deep in spite of the pain
- Inhaling too quickly, it will shoot the diaphragm all the way to the top of the volume chamber and do nothing for the lungs
- Cognitive impairment, it may be more appropriate to do frequent ambulation, have the patient out of bed to chair, or head of bed elevated
- Decreased inhalation effort as evidenced by them being unable to reach their previously measured efforts. Assess patient’s lung sounds, breathing, pulse oximetry, pain level, and ability to correctly use the device to determine the cause and applicable solutions.
- A decrease in inhalation effort (and other associated clinical findings) can often indicate a decline in the patient’s condition, requiring intervention from Respiratory Therapy and/or physicians.
IS is simple and effective, but can require multiple teaching sessions to make sure the patient understands its importance and complies with using it properly. Again, when all those things fall into place…magic!