How to help a patient with secretions: A comprehensive guide

September 26, 2025 •

4 min read

Nearly every aspect of patient care can be impacted by effective secretion management, yet it remains a critical challenge for many families and healthcare providers. This guide provides evidence-based, practical strategies for how to help a patient with secretions, from simple positioning to advanced techniques, ensuring a clear airway and improved quality of life.

Quick Summary

Assisting a patient with secretions involves combining proper positioning to utilize gravity, airway clearance techniques like percussion or suctioning, and, when appropriate, pharmacological interventions to alter mucus thickness or reduce saliva production. Clear communication and consistent oral care are also essential components of effective management.

Key Points

Positioning is Key: Use gravity by strategically positioning the patient, such as rolling them onto their side or tilting their head, to help secretions drain passively.
Consider Non-Invasive First: Start with non-pharmacological methods like postural drainage, chest percussion, or using PEP therapy devices before moving to more invasive techniques.
Oral Hygiene is Preventative: Regularly cleaning the patient's mouth with moist swabs helps prevent the buildup of thick, dried secretions and reduces the risk of infection.
Know When to Use Suctioning: Employ gentle suctioning for oral and upper airway secretions, especially when the patient's cough or swallow reflex is weak, but use it with proper technique to avoid irritation.
Consult a Professional for Medication: Pharmacological agents like anticholinergics or mucolytics should only be used under a doctor's guidance, as they have potential side effects and are for specific scenarios.
Educate and Support Caregivers: Ensure that family members and caregivers are properly trained on techniques and understand the nature of secretions to reduce anxiety and provide effective support.

Understanding the Causes and Types of Secretions

Respiratory secretions, or mucus, are a normal part of the body's defense system, trapping irritants and pathogens. However, in certain medical conditions, a patient's inability to effectively clear these secretions can lead to significant respiratory distress. These conditions can include pneumonia, COPD, neuromuscular diseases, and weakened states due to illness. Secretions can range in consistency from thin and watery to thick and tenacious, and their management strategy must be adapted accordingly. An understanding of the underlying cause, such as infection, dehydration, or an inability to cough, is the first step toward effective intervention.

Non-Pharmacological Strategies for Airway Clearance

Simple, drug-free methods are often the first line of defense and can provide immediate relief.

Positioning and Postural Drainage

Using gravity is a powerful, passive way to help clear secretions.

Side-Lying Position: Rolling a patient onto their side can help drain oral secretions from the mouth.
Head Down Positioning: In some cases, a doctor might recommend lowering the head of the bed slightly (Trendelenburg position) to help drain secretions from the lungs.
Upright Positioning: For patients who can sit up, an upright position can help secretions move down and be easier to cough up or swallow.

Chest Physical Therapy (CPT)

CPT uses rhythmic techniques to loosen mucus in the chest so it can be cleared more easily.

Manual Techniques

Chest Percussion: A caregiver uses cupped hands to rhythmically clap the chest wall, creating vibrations that dislodge mucus.
Chest Vibration: After percussion, a flat hand can be used to vibrate the chest wall as the patient exhales.

Mechanical Devices

High-Frequency Chest Wall Oscillation (HFCWO): A vest-like device that vibrates the chest at high frequencies to loosen and thin mucus.
Positive Expiratory Pressure (PEP) Therapy: The patient exhales against a resistance, creating pressure that helps move secretions forward for clearance.

Medical Interventions and Pharmacological Aids

When non-invasive methods are insufficient, a healthcare provider may prescribe medications or other medical techniques.

Oral and Nasal Suctioning

For patients unable to clear oral or upper airway secretions, gentle suctioning can provide relief.

A suction machine is used with a soft catheter to remove fluids from the mouth or nose.
It is crucial to use proper technique to avoid discomfort or tissue damage.
Deep suctioning is sometimes required but should only be performed by trained medical professionals.

Secretion-Altering Medications

Anticholinergics: These medications (e.g., scopolamine, glycopyrrolate) help reduce the production of saliva and mucus, particularly useful in end-of-life care.
Mucolytics and Expectorants: Expectorants like guaifenesin can thin mucus, making it easier to clear. Mucolytics directly break down the chemical bonds in mucus, reducing its viscosity.

Oral Hygiene: A Crucial Preventative Measure

Regular and thorough oral care is vital for preventing the buildup of thick, hardened secretions. It also helps prevent aspiration pneumonia by reducing the bacterial load in the mouth.

Use moist swabs or a soft toothbrush to clean the mouth and tongue frequently.
Remove and clean dentures, if applicable.
Apply a moisturizing agent to the lips to prevent cracking and discomfort.

A Comparison of Secretion Management Techniques


Technique	Pros	Cons	Best For
Repositioning	Simple, non-invasive, low cost.	May not be sufficient for thick secretions.	Passive drainage of oral and upper airway secretions.
CPT	Very effective for mobilizing thick chest mucus.	Can be labor-intensive, requires training.	Patients with thick, trapped respiratory secretions.
Suctioning	Provides immediate, targeted relief for oral secretions.	Can cause discomfort, risk of tissue damage if done incorrectly.	Patients with impaired swallowing or cough reflex.
Anticholinergics	Reduces production of saliva and mucus.	Can cause dry mouth, confusion, or urinary retention.	End-of-life care when non-invasive methods fail.

Training and Support for Caregivers

Effective secretion management often falls to family caregivers, who require proper training. Healthcare providers can offer guidance on techniques such as positioning, basic suctioning, and understanding medication side effects. Patient and family education are vital components of palliative care and can help reduce anxiety by demystifying the patient's breathing noises, like the "death rattle" which is often more distressing to observers than to the patient themselves. Providing emotional support alongside technical instruction ensures a holistic approach to patient care. In advanced cases, consulting with a respiratory therapist or palliative care team can provide specialized expertise and access to more complex equipment.

Conclusion: Prioritizing Comfort and Effective Care

Learning how to help a patient with secretions is a critical skill for any caregiver or family member. By understanding the different causes and types of secretions, and implementing a combination of non-pharmacological, pharmacological, and preventative measures, patient comfort can be significantly improved. Always consult with the patient’s healthcare team to develop a personalized and safe care plan. For more medical information and resources, it is beneficial to consult trusted sources like the National Institutes of Health (NIH).

Frequently Asked Questions

For a patient who cannot swallow, gentle oral or nasal suctioning is often the most effective method. Repositioning the patient on their side can also help drain excess saliva and secretions, preventing them from pooling in the back of the throat.

Signs of serious secretion problems include difficulty breathing, wheezing, rattling sounds in the chest, and changes in the patient's skin color (e.g., bluish tint). If these signs occur, or if the patient shows significant distress, seek immediate medical attention.

The 'death rattle' is the sound of secretions pooling in the throat of a patient who is too weak to clear them, often during end-of-life care. Repositioning the patient on their side or using a mild anticholinergic medication, if prescribed, can help manage the sound, which is typically not distressing to the patient but can be upsetting to family.

Yes, maintaining adequate hydration and using a cool-mist humidifier can help thin secretions, making them easier to clear. However, for some conditions, excessive fluids can worsen the problem, so always follow a doctor's advice.

When done correctly, chest percussion is a safe and effective technique. It can be harmful if performed too forcefully, on a fragile patient, or over areas like the spine, kidneys, or breastbone. Proper training is essential to avoid injury.

A suction machine is necessary when a patient has a compromised cough or swallow reflex and non-invasive methods cannot clear oral or upper airway secretions. Consult with a healthcare provider to determine if and what type of suction machine is appropriate.

While anecdotal evidence suggests certain foods can increase mucus production, there is no strong scientific consensus. However, ensuring the patient is well-hydrated is known to help thin secretions. Discuss any significant dietary changes with a healthcare provider.