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Incentive spirometry: Clinical skills notes

Notes

Notes

Respiratory

Incentive Spirometry

Introduction

Incentive spirometry is a respiratory exercise to help clients improve their lung expansion, prevent fluid and mucus from collecting in the lungs, and reduce the risk of developing respiratory complications, like pneumonia and atelectasis. It is especially important for people with underlying lung diseases, those who are overweight or have other chronic diseases, as well as those recovering from surgery. 

Device and components

Incentive spirometry is performed with a special device called an incentive spirometer, which is made up of a mouthpiece attached to a breathing tube that connects to an air chamber with an adjustable volume indicator. The flow oriented (Fig. 1a) incentive spirometer uses balls to indicate volume, while the volume oriented (Fig. 1b) spirometer uses pistons.  

Figure 2: Two types of spirometers are A. flow oriented, and B. volume oriented incentive spirometers.

Common care tips

  • Clients who are experiencing pain, motor function impairments, and people with dementia or other cognitive impairments might be unable to perform incentive spirometry exercises. 
  • Those who can, should do incentive spirometry 5–10 times every hour while awake.
  • After performing the test, people sometimes feel dizzy and out of breath for a short period of time.  

Procedure

When performing incentive spirometry, first make sure the client is in the sitting or the most erect position possible, ideally in the high-Fowler’s position (Fig. 2a). Set the volume indicator at the target volume level.
  1. Ask them to exhale completely through the mouth. Then, tell them to place their lips tightly around the mouthpiece and inhale through the mouth by taking a slow, deep breath (Fig. 2b). As they inhale, you’ll see the piston or balls rise inside the air chamber. This shows how deeply the client can inhale. 
  2. Maximal inspiration is the volume reached when they cannot inhale any more (Fig. 2c). At this point, ask them to hold their breath for as long as possible; ideally this should be at least three seconds. You’ll see the piston or balls slowly fall. 
  3. Once the balls reach the bottom of the spirometer, tell them to exhale normally through the mouth and to rest for a few seconds (Fig. 2d). 

Reposition the indicator at the level of maximal inspiration and repeat this process 5–10 times or whatever number of repetitions is indicated in their care plan. 

Figure 2: Steps when using an incentive spirometer.

Documentation

There are a few things you should report to the healthcare provider. These include:
  • any values that differ significantly from previous measurements 
  • if the client is unable to reach the target volume
  • if the client has signs or symptoms of respiratory distress

Document:
  • how many times they performed it throughout the day 
  • their maximal inspiration volume 
  • any problems preventing them from performing the exercise