Back-tapping sputum-evacuation is a common nursing technique that is often used especially on patients in home care. For patients with serious respiratory diseases, or the elderly who have been bedridden for a long time, for their weak physical condition and sticky phlegm, coupled with weak coughing, it is very easily to cause respiratory infections and even lead to pneumonia. Therefore, in respiratory diseases, the main manifestation of the patient is sputum and coughing. If phlegm accumulates excessively and cannot be cleared in a timely manner, it can lead to infection and airway obstruction, triggering asthma and shortness of breath. In severe cases, it may even lead to suffocation, posing a threat to the patients life. Therefore, it is very important to master the technique of back-tapping sputum-evacuation in home care.
1. Who is suitable for back-tapping sputum-evacuation?
Back-tapping sputum-evacuation is suitable for patients who have undergone chest surgery, as well as those with chronic obstructive pulmonary disease (COPD), pneumonia, bronchitis, and other respiratory diseases. It is also beneficial for individuals who are bedridden for long periods, generate thick sputum, are chronically ill and weak, have difficulty clearing sputum, or keep an artificial airway. These conditions can cause the accumulation of phlegm in the lungs, affecting respiratory function. Back-tapping sputum-evacuation can help them effectively remove phlegm and improve their breathing condition.
However, not everyone is suitable for this method. For the following individuals, it is recommended not to accept the method or accept it under the guidance of healthcare professionals: those with pneumothorax, rib fractures, chest injuries, coughing up blood, pulmonary edema, high risk of blood clots, patients with low blood pressure, and individuals who have recently experienced myocardial infarction or pulmonary embolism. For individuals with poor blood clotting, those at risk of bleeding, or those currently using anticoagulant medication, as well as pregnant women, it is recommended to consult a healthcare professional before being treated with this method.
2. What are the essentials and skills to be mastered for back-tapping sputum-evacuation?
(i) Selection of appropriate body position. It can be done in a seated or side-lying position. For the sitting position, the patient can sit on a chair with their back close to the backrest and both feet on the ground. This facilitates back massage and sputum clearance. For the side-lying position, the patient can lie on their side on a bed, either left or right, depending on the situation on site.
(ii) Back-tapping technique. The operator should bring their five fingers together and curl them into a small cupped shape, forming an empty palm. During the percussion, the palm should be parallel to the area being tapped. Use the power of the wrist joint to perform gentle, quick, and orderly tapping using the padded part of the thumb and the base of the little finger (referred to as the "thenar eminence" and "hypothenar eminence" respectively). The ideal distance between the base of the palm and the area being tapped is 3 to 5 centimeters.
(iii) Mastering the strength and technique. The rhythm and strength of the percussion should be adjusted to ensure the patients comfort. The more air there is between the palm and the patients chest wall during percussion, the better the percussion effect.
(iv) Remember the sequence. The sequence of back-tapping starts from the tenth intercostal space (along the line below the scapular angle, kindly consult a doctor or search online) and proceeds from bottom to top, and from the outer to the inner side.
(v) Control the frequency. 120 to 180 times per minute, 1 to 3 minutes for each area, and 10 to 15 minutes of percussion time per session.
3. What are the precautions for back-tapping sputum-evacuation?
(i) During the percussion process, it is important to continuously observe the patients vital signs. The timing and frequency of percussion should be adjusted according to the specific condition of the patient. If the patient experiences symptoms such as wheezing or oxygen deprivation, the operation should be immediately stopped.
(ii) After the percussion, instruct the patient to cough effectively. During the coughing process, the patients body should be slightly inclined forward. They should take a deep breath, hold their breath for 3-5 seconds, and then cough again. This should be repeated to forcefully expectorate the sputum. It is also recommended that they drink plenty of water to help thin the mucus.
(iii) When performing percussion, it is important to avoid randomly striking with excessive force. The percussion force should be moderate to avoid causing pain to the patient. It is important to avoid tapping areas such as the spine, bony prominences, breasts, and the precordial area during percussion.
(iv) If the patients cough reflex is sluggish, we can stimulate, compress, and vertically move their upper sternum airway after they exhale, thus promoting coughing.
(v) Choose the right timing, preferably 30 minutes before or 2 hours after a meal, or 5-10 minutes after nebulization inhalation.
It should be emphasized that the technique of back-tapping sputum-evacuation is only an auxiliary home care method and should not replace the treatment and advice of a doctor. Before back-tapping sputum-evacuation, it is essential to communicate and consult with a doctor to understand the specific condition of the patient, ensuring safety and effectiveness. Meanwhile, family members should keep patient and caring when performing back-tapping sputum-evacuation, providing the patient with full support and encouragement, and working together to promote their recovery and health.
Text from Wen Fengfeng, Chief Nursing Officer of the Integrated Ward