CHEST PHYSIOTHERAPY

Chest Percussion
And
Postural Drainage

By: JOJO B. JUSTO RN MSN

Chest Percussion
refers to a series of manipulative techniques designed
to assist with bronchial hygiene: the mobilization of
secretions from the tracheobronchial tree.
Chest Percussion
Goals
 Prophylaxis to prevent retained secretions
 Improve mobilization of secretions
 Improve distribution of ventilation
 Promote more efficient breathing patterns
 Promote effective cough
Chest Percussion
Indications
 Acute conditions
Acute pulmonary disease with copious secretions
Acute lobar atelectasis
 Acute conditions of questionable benefits
Exacerbation of COPD w/scant secretions
 < 25 ml per day
Pneumonia w/o sputum production, e.g., viral
Status asthmaticus
Status Post (S/P) coronary artery bypass graft surgery
(CABG)
Chest Percussion
Indications
 Chronic conditions
Chronic production of large amounts (>30 ml/day) of
secretions
 Cystic fibrosis
 Bronchiectasis
 Chronic bronchitis
 Lung abcess
 Collection of pus within the lungs as opposed to empyema, which is pus in
the pleural space. Chest tube drainage is required for empyema.
Chest Percussion
Hazards/Complications
 Hypoxemia when affected side is dependent
 Cardiovascular instability
 Internal hemorrhage post Sx
 Hemoptysis after lung surgery
 Fractured ribs, e.g., osteoporosis
 Increased ICP
 Dyspnea
 Pain
Chest Percussion
Hazards/Complications
 Vomiting
 Wheezing
 Bronchospasm
 Acute hypotension
 Aggravate lung contusion
Chest Percussion

Contraindications
 Hemoptysis after lung resection
 Uncontrolled hypertension
 ICP > 20 mm Hg
 S/P neurosurgery, aneurysm, eye surgery
 Suspected TB
 Osteomyelitis
 Osteoporosis
 Chest pain
 Resected tumors of the thorax or neck
Percussion Techniques
Hand
 Cupped hand will trap air to cause a popping sound on
contact
 Use the cover sheet or patient gown over skin
Vibes
 Arms extended; tensed when pushing firmly against pt’s
chest during exhalation
Shaking
 Shaking hands on pt’s chest during exhalation
Percussion Principles
 It is best to do CPT before meals or at least one to two hours after eating.
This will make it less likely that a patient will feel sick to the stomach or
throw up.

The best times for CPT are early morning and at bed time. Early morning
CPT helps remove the mucus that built up over night. Bed time CPT takes
out the mucus of the day, and helps the child cough less at night.

 The person doing the CPT should take off all rings and jewelry on the
hands or wrists.

If the patient’s clothing is tight or has thick seams, remove it.

If the patient is wearing clothes with buttons, remove it.

Have the patient wear a t-shirt or put a soft cloth over the spot that will be
percussed.
Vibration helps to gently shake mucus and secretions into the large airways,
making them easier to cough up.During vibration, place your flat hand firmly
against the chest wall, atop the appropriate lung segment to be drained. Stiffen
your arm and shoulder, apply light pressure and create a shaking movement,
similar to that of a vibrator.
Postural Drainage
Defn: method of removing pooled secretions in the
tracheobronchial tree by positioning the patient to
allow gravity to assist in the movement of secretions.
Postural Drainage
Goals
 Facilitate mobilization of secretions in the bronchial
tree
 Improve distribution of ventilation
 Improve gas exchange by improving V/Q mismatch
Indications
 Same as for chest percussion
 OK for those who do not tolerate percussion
Postural Drainage
Contraindications
 Unstable hemodynamic
 Untreated hypertension
 Internal and external head injuries
 Gross obesity
 Empyema
 Severe dyspnea at rest in high Fowlers or supine
 Recent meals or tube feedings (allow ≥ 30 mins after)
 Spinal cord injuries
Principles of Postural Drainage:
The patient is positioned so that the diseases area
are in near vertical position.
The position assumed are determined by location,
severity, and duration of mucus obstruction.
Discontinue the procedure if tachycardia,
palpitations, dyspnea, chestpain or other symptoms
occur.
Postural Drainage
Moving patients into position
 Explain to patient what you will be doing
 If patient alert, let him or her know to let you know if he
or she experiences SOB, headache, pain, etc.
 If patient is ambulatory, ask him or her to move into
position; assist if necessary
 Ask for help if patient is unconscious and large
 Move patient into position prior to placing bed into
Trendelenburg
Postural Drainage
Positioning patient for safety and comfort
 Patient should always be turned and face YOU
 Monitor patient’s facial expressions for pain, discomfort,
and signs of breathing distress
 Adjust patient’s arms and legs using pillows b/t the
knees: avoid bone to bone contact
 Support the head with a pillow
 Tuck pillow behind back and abdomen for stability
 Watch those IV lines and urinary catheter
 Urinary catheter should be on your side
 Make sure side rails are up opposite you
STEPS
1. Instruct the client to use diaphragmatic breathing.
2. Position the patient in prescribed postural drainage
position.
3. Percuss with cupped hands over the chest wall for 1-
2 minutes.
 Avoid clapping over the spine, liver, kidneys, spleen,
breast, scapula, clavicle, or sternum.
4. Instruct the patient to inhale slowly and deeply.
Vibrate the chest wall as the patient exhale
slowly through purse lip breathing.
a. Place one hand on top of the other over affected
area or place one hand on each side of the rib
cage.
b. Tense the muscles of the hands and arms while
applying moderate pressure downward and
vibrate arms and hands.
c. Relieve the patients thorax as the patient
inhales.
d. Encourage to cough after 3-4 vibrations.
To drain mucus from the upper lobe apical segments, the patient sits in a comfortable position on
a bed or flat surface and leans on a pillow against the headboard of the bed or the caregiver.

The caregiver percusses and vibrates over the muscular area between the collar bone and very
top of the shoulder blades (shaded areas of the diagram) on both sides for 3 to 5 minutes.
Encourage the patient to take a deep breath and cough during percussion in order to help clear
the airways. Do not percuss over bare skin.
The patient sits comfortably in a chair or the side of the bed and leans over, arms
dangling, against a pillow. The caregiver percusses and vibrates with both hands
over upper back on both the right and left sides.
In position #3, the patient lies flat on the bed or table with a pillow for comfort
under his or her head and legs. The caregiver percusses and vibrates the right and
left sides of the front of the chest, between the collar bone and nipple.
The patient lies with their head down toward the foot of the bed on the right side, hips and legs
up on pillows. The body should be rotated about a quarter-turn towards the back. A pillow can
also be placed behind the patient and their legs slightly bent with another pillow between the
knees. The caregiver percusses and vibrates just outside the nipple area.
The patient lies head-down on his left side, a quarter-turn toward the back with
the right arm up and out of the way. The legs and hips should be elevated as high
as possible. A pillow may be placed in back of the patient and between slightly
bent legs. The caregiver percusses and vibrates just outside the right nipple area.
The patient lies on his right side with his head facing the foot of the bed and a
pillow behind his back. The hips and legs should be elevated as high as
possible on pillows. The knees should be slightly bent and a pillow should be
placed between them for comfort.
The patients lies on his or her stomach, with the hips and legs elevated by pillows.
The caregiver percusses and vibrates at the lower part of the back, over the left and
right sides of the spine, careful to avoid the spine and lower ribs.
The patient lies on his right side, leaning forward about one-quarter of a turn with hips and legs elevated
on pillows. The top leg may be flexed over a pillow for support and comfort.

The caregiver percusses and vibrates over the uppermost portion of the lower part of the left ribs, as
shown in the shaded area. This should then be repeated on the opposite side, with percussion and
vibration over the uppermost portion of the right side of the lower ribs.
The patient lies on his stomach on a flat bed or table. Two pillows should be placed
under the hips.The caregiver percusses and vibrates over the bottom part of the shoulder
blades, on both the right and left sides of the spine, avoiding direct percussion or
vibration over the spine itself.
Infant Chest Physio
Therapy (CPT)
Upper lobe; anterior segment (sitting,
leaning back slightly)
Upper lobe; apical segment (sitting,
leaning forward slightly)
Upper lobe; anterior segment (lying flat
on back)
Middle lobe (on side, tilted back slightly)
Posterior lobe (lying on stomach)
Lingula (lying on side)
Lower right lobe (lying on side, tilted
forward)
Lower left lobe (lying on stomach
Thank you