A physical therapist asks contraindication to manual assisted cough on a C6 ASIA A SCI.

A physical therapist asks contraindication to manual assisted cough on a C6 ASIA A SCI.

• A. Recent placement of a PEG tube
• B. Presence of a tracheostomy tube
• C. History of urinary tract infection
• D. Use of an abdominal binder

Answer: (A)

Manual assisted cough relies on a controlled increase in intra-abdominal pressure to boost expiratory flow and help clear secretions in someone with weak cough. If a gastrostomy tube was placed recently, the abdominal wall and stomach tract are still healing. Applying abdominal pressure can disrupt the new tract, pull the tube, or cause gastric leakage and peritoneal irritation. For that reason, a recently placed PEG tube is a contraindication to manual assisted cough until the site has healed. Other conditions listed don’t pose the same healing-risk issue: a tracheostomy doesn’t automatically prevent MAC and can be accommodated with appropriate technique adjustments; a urinary tract infection and simply wearing an abdominal binder don’t directly compromise the safety of the maneuver.

Manual assisted cough relies on a controlled increase in intra-abdominal pressure to boost expiratory flow and help clear secretions in someone with weak cough. If a gastrostomy tube was placed recently, the abdominal wall and stomach tract are still healing. Applying abdominal pressure can disrupt the new tract, pull the tube, or cause gastric leakage and peritoneal irritation. For that reason, a recently placed PEG tube is a contraindication to manual assisted cough until the site has healed.

Other conditions listed don’t pose the same healing-risk issue: a tracheostomy doesn’t automatically prevent MAC and can be accommodated with appropriate technique adjustments; a urinary tract infection and simply wearing an abdominal binder don’t directly compromise the safety of the maneuver.