Definition
Performing chest physiotherapy (CPT) is a therapeutic technique used to mobilize and clear mucus from the lungs, especially in patients with conditions like cystic fibrosis, bronchiectasis, pneumonia, or neuromuscular disorders. It combines postural drainage, percussion, and vibration to enhance airway clearance and improve breathing.
Purpose
To remove tenacious secretions from bronchial walls in conditions like bronchiectasis and chronic bronchitis
Indications
- Patients who bring out copious sputum.
- Patients who are at risk of atelectasis.
Articles
- Pillows.
- Sputum cup with disinfectant.
- Paper tissues.
- Adjustable bed.
- Kidney tray
- Stethoscope.
Contraindications
- Undrained lung abscess
- Lung tumor.
- Pneumothorax
- Diseases of chest wall
- Lung hemorrhage/hemoptysis.
- Painful chest condition e.g. pleural effusion.
- Tuberculosis.
- Increased intracranial pressure.
- Spinal injuries
- Osteoporosis
Procedure
| Nursing action | Rationale |
| Before procedure 1. Identify patient and check instruction of physician and nursing care plan 2. Explain procedure to patient and check time of last meal. During procedure 3. Wash hands and dry. 4. Instruct patient to perform diaphragmatic breathing. 5. Position patient in prescribed postural drainage position, after consulting with physician (refer postural drainage procedure.) 6. Cover area with towel. 7. Percussion Clap with cupped hands over chest wall for 1-2 minutes in each lung area. Percuss from: a. Lower ribs to shoulder on the back. b. Lower ribs to top of chest in front. c. Avoid clapping over spine, liver, kidney, spleen, breast, clavicle or sternum. 8. Vibration Remove towel and place hand, palm down on chest area to be drained with one hand over the other and fingers together or place hands side. 9.Instruct patient to inhale deeply and exhale slowly through pursed lips and perform abdominal breathing. 10.Tense all the muscles of hand and arm and vibrate the hand, especially heels with moderate pressure during exhalation. 11.Stop vibration and relieve pressure on inspiration 12. Vibrate for 5 exhalations over each lung area which is affected. After 3-4 vibrations, encourage patient to cough/huff and expectorate sputum into sputum cup. 13. Allow patients to rest for several minutes. 14. Auscultate with stethoscope for change in breath sounds. 15. Repeat percussion and vibration cycles according to patient’s tolerance and clinical condition, usually for 10-15 minutes. After procedure 16. Wash hands. 17. Assist patient to comfortable position, 18. Assist with oral hygiene. 19. Record procedure and patient’s response in nurse’s record | Ensures that right procedure is done on the right patient Reassures patients and promotes cooperation. Postural drainage should be avoided immediately after mealtimes as it can induce vomiting. Reduces transmission of microorganisms. This method of berating helps patients to relax and widens airways. Position should be selected according to the area of lung that is to be drained. Percussion helps in dislodging mucous plugs and mobilizes secretions into main stem bronchi and trachea. The air trapped under cupped hand sets up vibration through chest wall freeing secretions. Percussion over these areas may cause injuries. Vibration frees the mucus from bronchial walls Pressure applied to chest wall inhibits chest expansion during Inspiration Coughing or huffing aids in the movement and expulsion of s from the respiratory tract. Presence of crackles/rhonchi Indicates mucus present in bronchi Reduces risk of transfer of microorganisms. Promotes comfort by removing the bad taste of sputum in the mouth. Enables communication between staff members. |
Special Considerations
- Perform chest physiotherapy 1 hour before meals or 1-3 hours after meals.
- Administer bronchodilator/metered-dose inhaler if ordered or nebulize 15 minutes before procedure.
- Observe patient during treatment for tolerance-such as breathing pattern cyanosis, etc.
- Splint incision area, so that pain is tolerable. Administer pain medications. if ordered, 15-20 minutes before procedure.
- Stop procedure if there is tachycardia, fall in BP, palpitation, dyspnoea or chest pain which indicates hypoxemia.
- Gentle mechanical vibration may be indicated for patients who cannot tolerate manual percussion
Paediatric Variations
- For infants, a soft circular mask or a percussion cup is used for percussing small areas.
- A popping, hallow sound should be the result and not a slapping sound.
- The procedure is done over the rib cage only and should be painless.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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