3.13 Abdominal Cough Assist & Bicostal (Costophrenic) Cough Assist
Category: UWHC Clinical Policy
Policy number: 3.13
Effective Date: April 1, 2016
Section: Respiratory Care Services
Abdominal/bicostal (costophrenic) cough assists facilitate the removal of bronchial secretions by mimicking the
contraction of muscles that are now impaired secondary to spinal cord injury (SCI) or neuromuscular disease.
Abdominal/bicostal (costophrenic) cough assists may be contraindicated in patients who present with the
A. New incisions or dressings over abdominal or lateral thoracic areas.
B. Patients with any type of intra-abdominal vessel graft (i.e. after AAA surgery).
C. Patients with very low or any unstable spinal/vertebral injuries.
D. Rib fractures
E. Flail chest.
A. All patients will be assessed by the Respiratory Care Practitioner (RCP)
B. Therapy will be provided in accordance with a provider’s order.
A. Review and acknowledge the provider’s order.
B. Review patient’s chart.
C. Introduce yourself to the patient and/or family. Explain the reason for the procedure.
D. Abdominal Cough Assist.
1. When performing an abdominal cough assist, the patient may be in various positions, with
supine being the most common.
2. To do the abdominal cough assist, stand alongside the patient. The heel of one hand is placed
on the abdomen above the navel and below the lower rib border. (Two hands may be used
with the heel of one hand overlapping the other.)
3. The abdominal cough assist should be coordinated with the efforts of the patient’s own
spontaneous cough. The patient is instructed to take a deep breath and hold the air in the lungs
(by the closure of the glottis). The patient is then asked to exhale as the force of the RCP’s hand
is directed into the abdomen and upward toward the head and must be delivered midline
(never off to the side). The hand should never press on the lower ribs or sternum.
E. Bicostal (costophrenic) cough assist
1. When performing a bicostal cough assist, the patient should be in a supine position for best
results, but a semi-fowlers position can be used as well.
2. To do the bicostal cough assist, stand alongside the patient, placing your hands on the
costophrenic angles of the rib cage.
3. The patient should be instructed to take a deep breath. Just prior to instructing the patient to
cough, apply strong pressure to the lateral aspect of the rib cage
Respiratory Care Services P&P:
A. #1:02 “Respiratory Care Services Safety Policy”
B. #3.02 “IPPB”
C. #3.16 “Cough Assist Machine”
Approved by Director and Medical Director of Respiratory Care:
Original copy of this Policy & Procedure is available in the Respiratory Care Office [E5/489].