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Airway clearance: incentive spirometry, deep breathing, coughing and oscillating devices

  • Procedure

Slow deep breaths, effective coughing and simple devices open the small airways and move mucus, which helps prevent lung problems after surgery.

Updated

What it is

After surgery, with pain or when lying in bed, people breathe shallowly and cough less. The lung bases collapse (atelectasis) and secretions stay in the airways, which raises the risk of pneumonia. Deep breathing, the incentive spirometer, splinted coughing and huff coughing are simple, low-cost measures that the nurse teaches, supervises and records. Oscillating positive expiratory pressure devices add vibration when the person breathes out, which loosens mucus; they need an order and are taught together with respiratory therapy.

Indications

  • After surgery, especially of the chest or abdomen, and after anaesthesia.
  • Shallow breathing because of pain, reduced mobility or long bed rest.
  • Retained secretions in chronic lung disease, with the device and plan set by the treating team.
  • Weak cough, with technique adapted to the person.

Contraindications and precautions

  • If pain stops deep breaths, ask for the prescribed pain relief beforehand.
  • If the person feels dizzy or light-headed, stop, take a few normal breaths and then continue.
  • Stop and assess if there is new breathlessness, chest pain or fever.
  • Patients with low oxygen often feel worse lying flat; avoid the supine position.
  • Oscillating devices only with an order and after teaching; each patient uses their own labelled device.

Equipment

  • Single-patient incentive spirometer with the target marker set.
  • Pillow or folded blanket for splinting.
  • Tissues, a bag for secretions and hand gel.
  • Pulse oximeter.
  • Oscillating positive expiratory pressure device, if ordered.

Step by step (and why)

  1. Explain the purpose and check breath sounds, saturation and pain — a baseline shows whether the exercises help.
  2. Sit the patient upright or on the edge of the bed — the diaphragm drops and the lungs expand more.
  3. Deep breathing: breathe in slowly, hold 2 to 5 seconds, breathe out slowly through pursed lips — reopens collapsed alveoli.
  4. Spirometer: breathe out, seal the lips, breathe in slowly keeping the indicator centred, hold 3 to 5 s — fills the lung bases.
  5. Repeat about 10 times each hour while awake, resting between breaths — prevents tiredness and dizziness.
  6. Hug a pillow over the incision, take a deep breath and cough strongly a few times — splinting eases pain.
  7. If the cough is weak, teach the huff: medium breath, then push air out fast with the mouth open — moves mucus with less effort.
  8. Oscillating device: sit up, breathe in deeply, blow out steadily into it several times, then huff — vibration loosens mucus.
  9. Record the number of breaths, the volume reached, secretions and tolerance — shows progress and guides the plan.

Complications

  • Dizziness or tingling from breathing too fast.
  • Incision pain when coughing without splinting.
  • Tiredness in weak or breathless patients.
  • Atelectasis or pneumonia when the exercises are not done.

Next step: when to call for help

  • Call if oxygen saturation falls or breathlessness increases.
  • Call for sharp chest pain when breathing, fever, or secretions that are thick, coloured or bloody.
  • Call if the volume reached falls day by day, or pain stops the patient from doing the exercises.

Test yourself

Think of the answer, then tap the question to see it.

How should a patient breathe in through an incentive spirometer?

Slowly and deeply, keeping the indicator centred, then holding the breath for about 3 to 5 seconds before breathing out.

Why is a pillow held over the incision during coughing?

Splinting supports the wound and reduces pain, so the patient can take a deeper breath and cough effectively.

What is a huff cough and who is it for?

After a medium breath, the patient pushes air out quickly with the mouth open. It helps patients who cannot cough well.

What should the patient do if they feel dizzy while using the spirometer?

Remove the mouthpiece, take a few normal breaths and then continue more slowly.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Nursing Fundamentals, 8.2: Oxygenation Basic Concepts (Open RN (Chippewa Valley Technical College), LibreTexts, 2021); Using an incentive spirometer: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Deep breathing after surgery: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026).

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