Chest Physiotherapy it include definition, steps of CPT for more details www.vipinpatidar.wordpress.com

1. Chest physiotherapy
VIPIN PATIDAR
Tutor/Clinical Instructor
College of Nursing,
AIIMS Deoghar
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2. DEFINITION
• It is a method of facilitating respiratory
functions by removing thick, tenatcious
secretions from the using technique of
percussion, vibration and postural drainage.
• It can be performed using either cupped hands or a mechanical airway
clearance device.
• that involves clapping on the chest and/or back to help loosen thick
secretions.
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3. Purposes
1. To removing thick, tenatcious secretions from
bronchial wall.
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4. Indications
1. Preoperative patients with excessive secretions by
any cause such as chronic bronchitis, smoking etc
2. Post-operative patients with excessive secretions.
3. Bronchial or lobar pneumonia.
4. Risk of atelectesis.
5. patient is unable to initiate a voluntary cough or
effort to expel the sputum
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5. Contraindications
1. Undrained lung abscess.
2. Unstable head and neck Injury.
3. Increased ICP
4. Active Hemorrhage.
5. pneumothorax
6. Bronchopleural fistula.
7. Rib Fracture
8. Lung Tumor.
9. Chest wall Disorder.
10. Painful chest condition.
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6.  To be most effective, postural drainage should be accompanied by chest
physiotherapy, which includes percussion and vibration, deep breathing
and coughing.
 Once a patient assumes the correct postural drainage position, the
caregiver performs chest percussion and vibration to the desired area.
 Chest physiotherapy is generally performed for 3-5 minutes on each
segment.
 During this time, the patient is encouraged to take a slow, deep breath
followed by a vigorous cough in an attempt to clear the airways of mucus.
 This technique should be repeated several times during the chest
physiotherapy session.
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7. Chest Percussion
• Clap with cupped hands over chest wall for
1-2 min in each lung area.
• Lower ribs to shoulder on the back.
• Lower ribs to top of chest in front.
• Avoid clapping over spine, liver, kidney, spleen, breast,
clavicle etc.
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9. Vibration
• Vibration is an airway clearance technique, Vibration helps to
gently shake mucus and secretions into the large airways, making
them easier to cough out.
• 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.
• Ask patient to breathe in deeply during vibration therapy, and
exhale slowly and completely. Taking a deep breath and then
exhaling slowly and forcefully without straining will hopefully stimulate
a productive cough.
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12. Articles
1. Comfortable Surface (hospital Bed, Chair)
2. pillows (01 to 04)
3. Towel.
4. Sputum Mug with antiseptic solution.
5. stethoscope.
6. screen to maintain privacy
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13. Preparations
• Identify the patients and check physicians order
regarding specific position.
• Assess the airway patency.
• check the last meal time.
• identify the ways/sign and symptoms that indicate
need of procedure.
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14. Procedure
• Wash hands.
• Instruct the patient to perform Diaphragmatic Breathing.
• Position the patient in prescribed postural drainage position.
• Cover area with Towel.
• PERCUSSION: Clap with cupped hands over chest wall for 1-2 min in each lung area.
• Lower ribs to shoulder on the back.
• Lower ribs to top of chest in front.
• VIBRATION: Remove towel and place hand, palm down on chest
area to be drained with one hand over the another, finger toghter.
• instruct patient to inhale deeply and exhale slowly though persed lip.
• Tense all muscle of hand and arm and vibrate the hand with light
pressure.
Wednesday,
November 23,
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15. Procedure
• Stop vibration and relieve pressure on inspiration.
• vibrate for 5 exhalation over each lung area, after that encourage the
patient for cough out (huff Technique).
• allow patient to rest for 3-5 min.
• ascultate for any changes in breath sound.
• repeate the procedure as per patient tolerance. (usually 10-15 min)
• wash hands.
• assist him/her in comfortable position.
• documents the findings
• replace the articles.
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16. Special Points to Remember
• Provide Inhalation using bronchodilator 20 min before the
procedure to prevent bronchospasm.
• in case of severe hemoptysis, stop the Procedure.
• best time to perform.
–in morning Before 1 hour of meal.
–1-3 hour after meal.
• do not perform chest physiotherapy after taking food.
• The length of the treatment depends on the tolerance of the
patient.
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17. Thank you…
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