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Respiratory

Respiratory complications are a common reason patients end up back in the hospital. This is especially true for patients who have cardiothoracic procedures. These complications can be prevented. The best ways to help avoid problems that lead to hospital readmission include breathing exercises, walking, coughing and deep breathing.

Gabrielle and Dan are respiratory therapists from the Department of Cardiothoracic Surgery. They have some important tips about how to keep your lungs clear and strong. They will demonstrate these techniques in this series of videos. If you have any questions about any information in the videos, please ask a member of your healthcare team.

This simple exercise can be done anywhere.

Purpose:

To help clear secretions from your lungs

How to deep breathe and cough:

  • Sit up straight on a chair.
  • Take a deep breath in. Feel your diaphragm (the muscle at the bottom of your rib cage) expand.
  • Exhale evenly and actively.
  • Repeat this type of breathing 10 to 15 times.
    Then, cough strongly 2 or 3 times. If you have an incision, place a pillow firmly against it while coughing.

Positive Expiratory Pressure (PEP)

The PEP device is used to clear mucus from your lungs.

Purpose:
  • To help clear secretions from your lungs.
  • To help keep airways open.
  • To protect the small air sacs in your lungs from collapsing. This can happen due to a lack of activity and shallow breathing.
How to use the PEP device:
  • Wash your hands with soap and warm water, and dry them completely with a clean towel.
  • Sit up straight in a chair.
  • Adjust the blue numbered dial on the PEP device so it is comfortable.
  • Place the mouthpiece in your mouth. Make sure to keep your mouth tight around the mouthpiece.
  • Take a deep breathe in. Feel your diaphragm (the muscle at the bottom of your rib cage) expand.
  • Exhale evenly and actively (not forcefully) so that the blue indicator raises and stays between the two lines on the pressure indicator. It should take you about 3 or 4 seconds to fully exhale.
  • Take 10 to 15 breaths using the PEP. You can take breaks as needed.
  • Cough strongly 2 or 3 times to get out any mucus that may have come loose while breathing. If you have an incision, place a pillow firmly against it while coughing.
How to clean the PEP device:
  • Wash mouthpiece, tubing and valves with soap and water.
  • Do not place the entire pressure indicator under water. If this happens, it won’t work correctly.

The Acapella device is used to clear mucus from your lungs. It is also called the “green pickle”.

Purpose:
  • To loosen mucus so it is easier to cough up.
  • To help keep airways open.
How to use the Acapella device:
  • Wash your hands with soap and warm water, and dry them completely with a clean towel.
  • Sit up straight in a chair.
  • Turn the dial on the back of the Acapella counter-clockwise.
  • Place the mouthpiece in your mouth. Make sure to keep your mouth tight around the mouthpiece.
  • Take a deep breath in. Feel your diaphragm (the muscle at the bottom of your rib cage) expand.
  • Blow evenly and actively (not forcefully) through the mouthpiece. Adjust the resistance dial so that it takes 3 to 4 seconds to completely exhale.
  • Take 10 to 15 breaths using the Acapella device. Take breaks as needed.
  • Cough strongly 2 or 3 times to get out any mucus that may have come loose while breathing. If you have an incision, place a pillow firmly against it while coughing.
How to clean the Acapella device:
  • Wash entire device with soap and water.
  • Rinse with warm water and let air-dry completely.
Purpose:

A nebulizer changes liquid medicine into fine droplets (in aerosol or mist form) that are inhaled through a mouthpiece or mask. These medications are used in your nebulizer to help open your airways and help clear mucus:

  • Fluticasone and Salmeterol (Advair)
  • Albuterol
  • Ipratopium (Atrovent)
  • Budesonide (Pulmicort)
  • Tiotropium (Spiriva)
Make sure you know:
  • How much nebulizer medication you need to use each time and what to do if you miss a dose.
  • How to store your nebulizer medication.
  • Side effects to report to your doctor.
How to use the nebulizer with your mucus-clearing device:
  • Wash your hands with soap and warm water, and dry them completely with a clean towel.
  • Carefully measure the medicine exactly as you have been instructed. Use a separate, clean measuring device like an eyedropper or syringe, for each medicine as shown to the right.
  • Remove the top part of the nebulizer cup.
  • Place your medicine in the bottom of the nebulizer cup.
  • Attach the top portion of the nebulizer cup and connect the mucus-clearing device (PEP or Acapella) to the cup.
  • Turn on the compressor with the on/off switch. Once you turn on the compressor, you should see a light mist coming from the back of the tube opposite the mouthpiece.
  • Sit up straight on a chair.
  • Use the PEP or Acapella device as instructed.
How to clean your nebulizer:

After each treatment:

  • Rinse the nebulizer cup and mouthpiece or mask in warm tap water.
  • Let the pieces air-dry on a clean, dry towel.

After the last treatment of the day:

  • Wash entire device with a mild soap and water.
  • Rinse with warm water and let the device air-dry completely.

Every three days:

  • Soak the nebulizer for 20 minutes in a mixture of 1 part vinegar and 3 parts water.
  • Rinse with warm water and let the device air-dry completely.
For more information on nebulizer therapy:

Reviewed 12/12

Talk to a Nurse: Mon. - Fri., 8:30 a.m. - 4 p.m. (ET)

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

© Copyright 2014 Cleveland Clinic. All rights reserved.

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