Chest physiotherapy
Description
Chest physiotherapy (CPT) techniques: postural drainage, chest percussion and vibration, and coughing and deep-breathing exercises
Mobilizes and eliminates secretions, reexpands lung tissue, and promotes efficient use of respiratory muscles
For the bedridden patient: helps to prevent or treat atelectasis and may also help prevent pneumonia — two respiratory complications that can seriously impede recovery
Postural drainage: performed in conjunction with percussion and vibration, encouraging peripheral pulmonary secretions
to empty by gravity into the major bronchi or trachea; accomplished by sequential repositioning of the patient
Lower and middle lobe bronchi usually emptying best with the patient in the head-down position; upper lobe bronchi, in the head-up position
Percussing the chest with cupped hands (or special devices for percussing small areas): mechanically dislodges thick, tenacious secretions from the bronchial walls
Vibration: can be used with percussion or as an alternative in a patient who’s frail, in pain, or recovering from thoracic surgery or trauma
Candidates for CPT: patients who expectorate large amounts of sputum, such as those with bronchiectasis and cystic fibrosis
Equipment
Stethoscope ♦ pillows ♦ tilt or postural drainage table (if available) or adjustable hospital bed♦emesis basin♦facial tissues ♦ suction equipment ♦ equipment for oral care ♦trash bag ♦ optional: sterile specimen container, mechanical ventilator, supplemental oxygen, stuffed toy, straw, soap bubbles, cotton balls, and tissues
Essential steps
Explain the procedure to the child and his parents, provide privacy, and wash your hands.
Administer bronchodilators, if ordered, before CPT to enhance airway clearance.
Auscultate the child’s lungs to determine his baseline respiratory status.
Position the child as ordered.
Performing postural drainage
In generalized disease, drainage usually begins with the lower lobes, continues with the middle lobes, and ends with the upper lobes.
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