Chest physiotherapy refers to a group of therapies used to mobilize pulmonary secretions and includes techniques like postural drainage, percussion, vibration, and breathing exercises. It aims to drain secretions from the lungs using gravity by having patients assume different positions. Key techniques involve percussing and vibrating areas of the lungs in specific postural drainage positions to loosen mucus, followed by coughing to clear the airways. Chest physiotherapy requires proper training and is used to treat patients with excessive secretions or retained mucus in the lungs.

1. PROCEDURE DEMONSTRATION
ON
CHEST PHYSIOTHERAPY

2. Introduction
• Chest physiotherapy (CPT) refers to a group of
therapies used in combination to mobilize
pulmonary secretions. CPT is helpful to
mobilize or loosen the secretions in the lungs
and respiratory tract especially for patients
with large amount of secretions or ineffective
cough.

3. • It includes postural drainage, chest
percussion, vibration, coughing and deep-
breathing exercises.

4. Definition
• Chest physiotherapy consists of external
mechanical maneuvers, such as chest
percussion, postural drainage, vibration, to
augment mobilization and clearance of airway
secretions, diaphragmatic breathing with
pursed-lips, coughing and controlled
coughing.

5. Anatomy and physiology
The respiratory tract:
• The upper airways or upper respiratory tract
includes the nose, paranasal sinuses,
the pharynx, vocal cords.
The lungs:
• Located in the chest on either side of the
heart

6. • Conical in shape with a narrow rounded apex
at the top and a broad base that rests on
the diaphragm
• The left lung shares space with the heart, with
an impression in its medial surface called
the cardiac impression.

7. Blood supply:
• Dual blood supply:
• Lungs receive oxygenated blood via
the bronchial circulation
• The pulmonary arteries that supply
deoxygenated blood for purification

8. Nerve supply:
• Parasympathetic nervous system
- Vagus nerve
• Sympathetic nervous system
-Phrenic nerve

11. Indications of chest physiotherapy
Chest physiotherapy is indicated in the patients
with
• Excessive bronchial secretions who has
difficulty clearing secretions with
expectorated sputum production greater than
25 ml per day
• Evidence or suggestion of retained secretions
in the presence of an artificial airway

12. • Lobar Atelectasis caused by or suspected of
being caused by mucus plugging.
• To mobilize the secretions
• To re expand lung tissue
• To promote efficient use of respiratory
muscles.

13. Contraindications of chest
physiotherapy
Chest physiotherapy is contraindicated in the
patients with
• Hematoma
• Carcinoma
• Induced bronchospasm

14. Postural drainage facilitation
• Chest physiotherapy consists of percussion,
vibration and postural drainage. Percussion
and vibration are manual or mechanical
techniques used to augment postural
drainage.

15. • Postural drainage uses the principle of gravity
to assist in bronchial drainage.
• Percussion and vibration are used after the
patient has assumed a postural drainage
position to assist in loosening the mobilized
secretions.

16. • Percussion, vibration and postural drainage
may assist in bringing secretions into larger,
more central airways.
• Effective coughing is then necessary to help
raise these secretions.

17. • After each drainage position change, the
patient should be given time to cough and
deep breathe.
• These techniques are individualized based on
the patients pulmonary condition and
response to initial treatment.

18. • Sometimes it takes several hours after
physiotherapy for secretions to be
expectorated.
• It is important to evaluate physiotherapy for
both its effectiveness and relief of the patients
symptoms.

19. • Chest physiotherapy should be performed by
an individual who has been properly trained.

20. Techniques
• Percussion
• It is performed in the appropriate postural
drainage position with the hands in cuplike
position.
• Then hands are cupped and the fingers and
thumbs are closed. The cupped hand should
create an air pocket between the patients
chest and hand.

21. • Both hands are cupped and used in an
alternative rhythmic fashion.
• Percussion is accomplished with flexion and
extension of the wrist. A hollow sound should
be heard.
• The air cushion impact facilitates the
movement of thick mucus.

22. • A thin towel should be placed over the area to
be percussed, or the patient may choose to
wear a T shirt or hospital gown.
• The patients face should be in clear view
when percussing in case a mucus plug
occludes the airway and the patient is unable
to speak.

23. Areas to avoid percussion
• Percussion should not be performed over the
kidney, sternum, spinal cord, bony
prominences, or any tender or painful area.

24. Vibration
• Vibration is accomplished by tensing the hand
and arm muscles repeatedly and pressing
mildly with the flat of the hand on the
affected area while the patient slowly exhales
a deep breath.
• Isometric contractions of the arm and hands
are also appropriate.

25. • The vibrations facilitate movement of
secretions to larger airways.
• Mild vibration is tolerated better tolerated
than percussion and can be used in situations
where percussion may be contraindicated.

26. Postural drainage
• The lungs are divided into 5 lobes, with there
on the right and two on the left side. There
are 18 segments in the lungs, which can be
drained in 18 positions.

29. • The purpose of various positions in postural
drainage is to drain each segment toward the
larger airways.
• The postural drainage position are determined
by areas of involved lungs, which are assessed
by chest x ray, percussion , palpation and
auscultation.

30. • Aerosolized bronchodilators and hydration
therapy are frequently administered before
postural drainage.
• The chosen postural drainage position is
maintained for 5-15 min or during percussion.
The degree of slope can be obtained with
pillows, blocks or tilt board.

31. • The frequency and choice of postural drainage
positions depends on location of retained
secretions and patient tolerance to dependent
positions.
• A common order is 2-4 times per day. The
procedure should be planned to occur and
completed at least 1 hour before meal and 3
hours after meal.

32. • If patients has difficult in assuming various
positions, adaptations will be needed to
reduce the angle or length of time of the
procedure.
• A side lying position can be used for patients
who cannot tolerate a head down position.

33. • Some positions of postural drainage
(Trendelenburg should not be performed for
patients with chest trauma, heart disease,
head injury.)

34. Points to remember during postural
drainage
• Instruct the patient to always inhale through
the nose. This permits filtration,
humidification, and warming of air.
• Instruct the patient to breathe slowly in a
rhythmic and relaxed manner. This will help in
complete exhalation and emptying of lungs.

35. • Each position for postural drainage is held for
3 to 15 minutes.
• The procedure should be discontinued if
patient is having symptoms of hypoxemia like
tachycardia, palpitations, dyspnea, or chest
pain.

36. • Nebulize the patient with Bronchodilators or
mucolytic agents before postural drainage and
chest percussion to decrease thickness of
mucus and sputum thereby enhancing
removal of secretions.

37. • Patient should be made comfortable before
the procedure and while assuming each
positions.
• Auscultation of the chest should be performed
to determine the areas of needed drainage.

38. • Encourage the patient to deep breathe and
cough after performing postural drainage.
• Encourage diaphragmatic breathing
throughout postural drainage as this helps to
widen airways so that secretions can be
drained

39. ARTICLES
• Stethoscope
• Pillows for positioning
• Gloves
• Emesis basin
• Face towel
• Kidney tray

40. Procedure of chest physiotherapy
• Perform procedure one hour before meal or 1-
3 hours after meal
• Administer bronchodilator 15 minutes before
procedure
• Collect needed equipments

41. • Help patient assume correct position for
postural drainage based on findings from X-
ray, auscultation, palpation and percussion of
chest.
• Position should be maintained for 5-15 min to
mobilize secretion via gravity

42. • Observe patient during treatment for
tolerance
• Have patient take several deep abdominal
breaths
• Percuss for 1-2 min keeping patients face in
full view
• Vibrate the same area while the patient
exhales 4-5 deep breaths

43. • Assist the patient to cough while assuming
same position. Splinting with towel or hands
may be necessary to aid in effective coughing.
• Patient may need to assume sitting position to
generate enough airflow to expel secretions.
• Suction may be necessary if coughing is not
effective
• Repeat percussion, vibration and coughing
until patient no longer expectorates mucus

44. • After procedure help patient assume
comfortable position and provide oral hygiene
• Monitor for hypoxemia, if patient having any
respiratory difficulty or distress
• Evaluate and chart the effectiveness of
treatment by amount of sputum secretion and
patient tolerance.

45. Lower Lobes: Posterior Basal
Segments

46. Lower Lobes: Lateral Basal Segments

47. Lower Lobes: Anterior Basal Segments

48. Lower Lobes: Superior Segments

49. Right Middle Lobe: Medial and
Lateral Segments

50. Left Upper Lobe: Superior and Inferior
Segments, Lingular Portion

51. Upper Lobes: Anterior Segments

52. Upper Lobes: Apical Segments

53. Upper Lobes: Posterior Segments

54. After care
• Replace articles and dispose sputum
appropriately.
• Monitor patients condition such as vital signs,
level of consciousness.
• Note relief of breathing distress and
subsidence of symptoms

55. • Instruct for deep breathing and coughing
exercises
• Report any adverse effects such as blood in
sputum, bronchospasm, worsening of
symptoms and inform physician immediately.

56. Complication
• Fractured ribs
• Bruising
• Hypoxemia
• Discomfort to patient
• Broncho-spasm

57. Summary
• Today we have discussed about chest
physiotherapy, its introduction, definition,
indications, contraindications, postural
drainage facilitation, techniques, articles,
procedure, aftercare and complications of
chest physiotherapy.

58. Conclusion
• Chest physiotherapy is a treatment whereby
breathing is improved by the indirect removal
of mucus from the breathing passages of
a patient. It includes percussion, vibration and
postural drainage to facilitate mucus removal
from respiratory tract.

59. Bibliography
• Lewis, textbook of medical surgical nursing, 7th
edition, Elsevier publication, page 646-648
• Kozier and Erb’s, textbook of fundamental
nursing, 8th edition, Pearson publication, page
1332
• Potter and Perry, textbook of fundamental
nursing, 7th edition, Elsevier publication, page 931
• http://www.nsgmed.com/nursing-
procedures/chest-physiotherapy-cpt-postural-
drainage/

60. Thank you