Respiratory: Chest physiotherapy

Chest physiotherapy, or simply CPT, is a technique that can be performed by certain healthcare workers for people suffering from diseases that impair mucus clearance, such as chronic obstructive pulmonary disease, bronchitis, and cystic fibrosis.

The goal of CPT is to help the client clear excessive mucus secretions from the lungs in order to prevent complications, like mucus plugs, infections, and atelectasis.

Before performing this procedure, be sure this is within your scope of practice and is allowed by your facility's policy.

To start, first gather the supplies you’ll need, including gloves, face shield, and gown for you and pillows for the client’s comfort.

In addition, keep suction machine equipment available to assist in clearing airway secretions in case the client’s ability to cough and clear their airway is ineffective.

Make sure you know if the client is feeling weak, anxious, or in pain. CPT must be scheduled according to the client’s needs and daily routine and activities.

Individuals in pain can take analgesics 20 minutes before beginning CPT. Each CPT session usually lasts between 20 and 40 minutes which can be very exhausting, so try to schedule it between rest periods.

Avoid performing CPT around 1 to 2 hours before and after meals. The best times to perform CPT are in the morning to clear secretions that may have accumulated over night as well as at night to clear the lungs before bedtime.

Frequency of CPT varies for each client from just once daily to as frequent as every 2 hours. This will depend on each client’s needs and capabilities as well as the healthcare professional orders, so make sure to check the nurse charts.

Now, CPT includes postural drainage, percussion, vibration, and shaking. It involves a lot of touching, so before you begin, make sure you always explain to the client where and how you’ll be touching.

Postural drainage involves placing the individual in different positions for 10 to 15 minutes, using gravity to help clear lung secretions.

Each position drains a corresponding lung section into the trachea, so before starting, you should know which lung segments require postural drainage to ensure the therapy is appropriate to the client's needs.

Each position in postural drainage is followed by percussion over the lung area to be drained. To perform percussion, clap on the client’s chest wall with your hands cupped for 2 to 5 minutes to help clear the mucus from the bronchi into the larger airways.

Most movement should come from the elbows and wrists. Vibration can be applied by placing both hands over the same percussed area, one over the other, and performing a fine shaking movement for about 15 seconds or five exhalations.

Finally, tell the client to cough forcefully to eliminate the lung secretions. Perform a total of three to four CPT sets, and make sure there’s suction machine equipment available to assist the client if needed.

All right then! Let’s start with the left and right upper lobes. To drain the anterior apical bronchi, position the client leaning back in a chair or in high-Fowler’s.

Next, stand in front of the client, and place your hands at the shoulders and your fingers over the clavicles. Percuss and vibrate with the heels of the hands on the client’s chest.

Make sure you do both sides at the same time. To drain the posterior apical bronchi, position the client in a chair, only this time, leaning forward on a pillow.

Then, place your hands on the upper back to percuss and vibrate both sides at the same time. Remember to never percuss directly over the spine.

To drain the anterior part of the upper lobes, position the client lying back flat with a small pillow under the knees. To percuss and vibrate, place your hands just below the clavicles. Remember to never percuss directly over the sternum.

To drain the lingula, which is a projection in the lower part of the left upper lobe, position the client lying on the right side with the arm overhead, and put the bed in Trendelenburg position with the foot of the bed raised 30 cm or 12 inches.

Then, place a pillow behind the client to roll a bit onto it. Then, place your hands lateral to the left nipple just below the armpit to percuss and vibrate.

Now, to drain the right middle lobe, follow these same steps, but position the client to the left side. Finally, there’s the lower lobes.

To drain the superior bronchi of the right and left lower lobes, position the client lying flat on their stomach with a pillow underneath. Place your hands below the scapula on both sides to percuss and vibrate.