Chest Physiotherapy

Critical Elements

• Safe positioning of patient.
• CPT completed over ribs only, not below the ribs or over the stomach.
• Percussion follows order for location and length of time.

Procedure

Prior to Treatment: (Critical Thinking)

• Assess patient's need for treatment.
• Confirm order.
• Consider completing procedure before meals or at least 1-2 hours after. Best results more likely in the early morning and at bedtime.
• Consider administration of small volume nebulizer or metered dose inhaler prior to procedure.
• Administer pain medication if needed.
• Gather appropriate equipment: pillows, table, or bed for proper and comfortable positioning, hand or percussor, clock or timer, tissues or sputum cup.

Patient Interaction: (Safety)

• Patient identifiers.
• Provide for privacy.
• Wash hands.
• Explain procedure.
• Educate patient about reporting discomfort.

Steps of the Procedure: (Safety)

1. Position patient into a comfortable position to best reach target area.
2. Place hands in a “cupping” position and slap on target area.
3. Encourage coughing during and after the procedure.

After Procedure (Patient Centered Care)

• Pulmonary assessment.
• Place tissue near patient and encourage coughing and expectoration of loose secretions.
• Straighten room making patient comfortable, replace call light.
• Wash hands before leaving the room.

Documentation (Informatics, Communication)

• Patient’s response to the procedure including lung sounds, sputum production (amount and color), and tolerance of procedure. 

Resources

• How to do Chest Physical Therapy (CPT): Children, Adolescents, and Adults. Phoenix Children’s Hospital, 2009.