Chest Physiotherapy

Outlines
• Definition of chest physiotherapy.
• Purposes of chest physiotherapy
• Equipment of chest physiotherapy.
• Chest physiotherapy steps for children.
• Chest physiotherapy steps for neonate.
• Documentation .
 Objectives
• Define chest physiotherapy.
• Mention the purposes of chest physiotherapy.
• List the equipment needed for applying chest
physiotherapy.
• Appling chest physiotherapy on children.
• Appling chest physiotherapy on neonate .
• Document the procedure.
Definition of Chest Physiotherapy
• A treatment used with children who have had
heart surgery and who may have partial
collapse of their lung tissue or lung secretions
which they are unable to clear by themselves.
 The Purposes
1. Keep child airway clearance.
2. Comfort the child.
3. promote child respiratory condition.
4. Provide the caregiver with instruction to
follow for home care.
 Chest physiotherapy techniques
1.Postural drainage- achieves gravitational clearance of airway
secretions from specific bronchial segments by using several
different body positions . Each position drains into the trachea a
specific section of the tracheobronchial tree, in the upper, middle, or
lower lung field. Positioning also may improve oxygenation.
2.Percussion - involves clapping the chest wall with cupped hands
3.vibration (chest shaking)- a sustained contraction of the upper
extremities of the caregiver, produces a downward vibrating
pressure.
4. Huffing, and coughing - performed as the patient exhales through
pursed lips, augment the natural movement of the rib cage during
exhalation and assist with secretion clearance.
Percussion, vibration, and shaking are performed only over the ribs.
 Avoid
1.Clavicles,
2.breast tissue
3.Sternum
4.Spine
5.Waist
6.abdomen are never used for
percussion and vibration.
Equipments
 The Procedure
1. Introduce your self.
2. Explain procedure to the patient and parent.
3. Wash hands

4. Position child in an upright position with his back towards you.Using cupped hand,
percuss over the lung field .
5. Keep the infant or child covered with a gown or blanket.
 CHILDREN CHEST PHYSIOTHERAPY

6. Follow the previous

techniques of chest
physiotherapy (percussion,
vibration, coughing and
deep breathing exercise,
postural drainage, positive
expiratory pressure mask
and flutter). Bronchial
drainage positions for the
main segments of all lobes.
 Perform percussion for 3 to
15 minutes over each affected
area, as tolerated.
a. Begin percussion by placing hands side by
side on appropriate part of chest wall over
area to be drained.
b. Cup hands with fingers and thumbs held
tightly together. Make sure that entire outer
portion of hand makes contact with chest
wall to avoid air leaks.
c. When clapping, apply most of arm
movement from elbow and wrist joints.
d. Alternately clap chest with cupped hands to
create rhythmic popping sound resembling
galloping horse. Perform clapping at
moderate or fast speed, whichever is more
comfortable and effective for patient.
Repeat over each affected lung area.
e. Ask patient about any discomfort (e.g.,
undue pressure, stinging of the skin).
Perform chest wall vibration over each
affected area.
a. Place flat part of hands over affected area, and have patient take
slow, deep breath through nose.
b. Gently resist chest wall as it rises during inhalation.
c. Have patient hold breath at peak inhalation for 2 seconds. 2 Then have
patient exhale through pursed lips while contracting abdominal
muscles and relaxing chest wall muscles. Note chest wall relaxing
and falling.
d. As patient exhales, gently increase downward pressure over patient's
ribs, and vibrate with flat part of hand for a series of three vibrations.
To create vibration, make all muscles in the arm and shoulder
contract and tremble. When applying pressure to ribs, follow natural
movement of rib cage.
e. Request patient to cascade cough by taking deep breath and
performing series of small coughs until end of breath. Instruct patient
not to inhale between coughs. Vibrate chest wall as patient coughs.
Allow patient to sit up and cough as needed.
f. Monitor patient's tolerance of vibration and ability to relax chest wall
and breathe properly as instructed.
g. Perform vibrations in sets of three followed by coughing so any
loosened secretions are expectorated
CHILDREN CHEST PHYSIOTHERAPY
: ’CONT
7. After percussion and vibration, have the child set up, take a
deep breath, and cough up out the mucus into a container or
tissue.
8. If child is intubated or unable to generate an effective cough,
perform suctioning as indicated.
9. Reposition child in alternate position and repeat
percussion/vibration/cough therapy. Modification may be
necessary based on child’s tolerance and condition.
10. Allow child to rest if needed between positions.
CHILDREN CHEST PHYSIOTHERAPY
’CONT
11. Upon completion of therapy assess child
respiratory status,
12. Return the child to comfortable position with
side rails up.
13. Assist child to brush teeth or rinse out mouth as
needed.
14. Return equipment to appropriate area.
15. Perform hand washing.
16. Re evaluates patient respiratory status and
relieve of dyspnea.
NEONATE CHEST PHYSIOTHERAPY
1. Check chart for orders , wash hand.
2. Ascultate lungs before and after procedure.
3. Perform procedure prior to feeding and oral
medication .
4. Perform percussion and vibration in position
best for particular premature infants,
depending on which part of lung is affected.
NEONATE CHEST PHYSIOTHERAPY
’CONT

5. Monitor O2 saturation throughout procedure

not to exceed 10 min .
6. Suction gently .
7. Place in position of comfort .
8. Return equipment.
9. Wash hands.
 Documentation
• Findings from respiratory assessment of child
before and after procedure.
• Adjunctive treatments given.
• Education provided to parent.
• Child’s response to therapy.
 PEDIATRIC CONSIDERATIONS
Handheld percussors may be used per institution standard for a child in an
oxygen-enriched environment. 8

Larger children may benefit from a more powerful percussor.

Various techniques are used in pediatric patients: chest percussion, vibration in

postural drainage positions, chest shaking, directed coughing, and slow passive
forced exhalation to trigger coughing and to help move secretions.
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Chest physiotherapy should be used with caution in infants, as it may cause

distress.
6

Airway clearance techniques are recommended for all children with cystic

fibrosis to clear sputum, maintain lung function, and improve quality of life.
1

Airway clearance techniques may have few clinical benefits for some pediatric

patients and thus should not be routinely ordered for children with respiratory
conditions. Clinical decisions to use airway clearance techniques should be made on
a patient-by-patient basis.
1

To prevent vomiting and aspiration, chest physiotherapy should not be performed

for at least 1 hour after feedings or meals, and continuous drip feeds should be
turned off at least 30 minutes before therapy.
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Thank you