Program title: BPT-VIII

SEMESTER

Course Code:06ABPTR17811

Course Title: Cardiovascular and

Respiratory PT

UNIT IV: Physiotherapy skills

 Sub-unit title:
 4.1(b)-Physiotherapy techniques to
clear secretions – hydration,
humidification &nebulization,
mobilization and breathing
exercises.postural drainage, manual
techniques – percussion, vibration and
shaking, rib springing, ACBT,
autogenic drainage, mechanical aids –
PEP, flutter, IPPB, facilitation of cough
and huff, nasopharyngeal suctioning
Techniques to clear secretions
Expected learning outcome

At the end of the session the Manual techniques to clear Mechanical techniques to
student will have an secretions clear secretions
overview of
CONTRAINDICATIONS

Unstable head or Active

Increased ICP Hemoptysis
neck injury hemorrhage

Recent spinal Bronchoplueral

Empyema Flail chest
injury fistula

Rib or vertebral
Uncontrolled fractures
hypertension • Tuberculosis
Pulmonary embolism.

aged, confused, or
anxious patients who
don't tolerate position
changes
 Loosen the dress

Sputum cup

PREPARATIONS
Pillows

Explain the Rx and teach the

patient deep breathing and
cough
 PROCEDURE

 Determine segments
 Vital signs
 Position the patient
 Stand in front of pt
 Maintain position
 Apply manual techniques
 Do coughing or suctioning
 MANUAL
TECHNIQUES
 This is used to mobilize secretions by mechanically
dislodging viscous or adherent mucus from the
lungs

It is done by the cupped hand over the lung

segments being drained

Here the PTs cupped hand alternatively strikes the

Percussion patients chest wall in a rhythmic fashion to help
loosen thick secretions

The PT should try to keep his shoulder elbow and

wrist loose and mobile during the maneuver

The procedure should not be painful

Chest Percussion
 To prevent irritation patient, wear a light gown or
shirt
Contraindication to percussion
 Over #
 Osteoporotic bone
 Spinal fusion
 Over tumor area
 Pulmonary embolus
 Condition in which hemorrhage could easily occur (low
platelet count ,anticoagulation therapy)
 Patient with unstable angina
 Case of chest wall pain (after any surgery CABG or
trauma
  Vibration

 This is done in conjunction with percussion

 It is applied only during expiration
 It is applied by placing both hands directly over the chest wall or one hand on top of
other and gently compressing
 The therapist stiffen his arm and shoulder and apply light pressure and rapidly
vibrating the chest wall as the patient breaths out
The vibrating action is achieved by the
PT isometrically contracting the muscles
of the upper extremity from shoulder to
hand

Ask the patient to breathe in deeply and

exhale slowly and completely.

Taking a deep breath and then exhaling

slowly and forcefully without straining
will hopefully stimulate a productive
cough
 It is a more vigorous form of vibration which
is applied during exhalation using an
intermittent bouncing maneuver coupled with
wide movements of the PTs hand

The PTs thumb are locked together the open

hands are placed directly over the patients
Shaking chest the fingers are wrapped around the
chest wall

The PT simultaneously compress and shake

the chest wall
SEGMENTS
 LOBE - Apical Segments
UPPER

• To drain mucus from the upper lobe apical

segments, the patient sits in a comfortable
position on a bed or flat surface and leans
on a back rest.
• The PT percusses and vibrates over the
muscular area between the collar bone and
very top of the shoulder blades on both sides
for 3 to 5 minutes.
• Encourage the patient to take a deep breath
and cough during percussion in order to help
UPPER LOBE - Apical Segments
 Po s t e r i o r Segments (right)

 The patient lie on his left side and then turn

45º on to his face , resting against a pillow
with an another pillow supporting his head
 The left arm should kept comfortably behind
his back with right arm resting on a pillow, the
right knee should be flexed
Po s t e r i o r Segments (right)
 The patient lie on his right side
and then turn 45º on to his face
Posterior with 3 pillows to raise the
shoulder 30cm (12 in) from the
bed.
Segments
The right arm should kept
comfortably behind his back
(left) with left arm resting on a
pillow, both knee should be
slightly flexed
Po s t e r i o r Segments (left)
 The patient lies flat on the
bed or table with a pillow
under his head and legs and
Upper lobe- arms relaxed by his side.
anterior

Segment The chest PT is given to

right and left sides of the
front of the chest, between
the collar bone and nipple.
Upper lobe- a n t e r i o r Segments
 Patient lie on his back with his body quarter turned
to the left maintain by a pillow under right side
from shoulder to hip

Middle
lobe Arm should relaxed by his side

( l a t e r a la
nd medial Foot of the bed should be raised 35cm (14in) from
the ground
segment)
Chest is tilted to an angle of 15º
Middle lobe ( l a t e r a l and
medial segment)
 Patient lie on his back with his body quarter turned
to the right maintain by a pillow under left side
from shoulder to hip

Lingula ( s u p Arm should relaxed by his side

erior and
inferior Foot of the bed should be raised 35cm (14in) from
the ground
segment)
Chest is tilted to an angle of 15º
Lingula (superior and
inferior segment)
 Patient lie prone with the
head turned to one side

Lower
Arm relaxed in a
lobes
comfortable position by
(apical the side
segment)
A pillow under his hips
Lower lobes(apical segment)
 Patient lie flat on his back with
the buttocks resting on a pillow
and knees are flexed

Lower The foot of the bed is elevated

l obes( ant er i o 46cm (18 in) from the ground
r basal
segment)
The chest is tilted to an angle of
20º
Lower l o b e s ( a n t e r i o r basal
segment)
  Patient lie prone with his head turned to
Lower one side

l obes( post  Arms in a comfortable position by the

side
er i or  A pillow under his hip

basal  The foot of the bed is elevated 46cm

(18 in) from the ground
segments)  The chest is tilted to an angle of 20º
Lower lobes(posterior
basal segments)
 Patient lie on his right side
with a pillow under his hips

Lower
lobes(medial The foot end is raised 46cm
basal) (18in) from the ground

The chest is tilted to an

angle of 20º
Lower lobes(medial basal
or cardiac
segment)
Lower lobes(lateral basal
segment)

Patient lie on his The foot end is

left side with a raised 46cm The chest is tilted
pillow under his (18in) from the to an angle of 20º
hips ground
Lower l o b e s ( l a t e r a l basal
segment)
PEP DEVICES

• One of the most frequently prescribed airway clearance therapy

(ACT) options for patients with chronic lung conditions or decreased
lung volumes are positive expiratory pressure therapy (PEP) devices.
• During PEP therapy, the patient exhales against a fixed-orifice
resistor, generating pressures during expiration that usually range
from 10 to 20 cm H2O.(14-24) PEP does not require a pressurized
external gas source[2]
• The therapy, which is administered by
breathing through a special device helps:
1.Air gets behind the mucus
2. Move mucus from lung and airway walls
3. To hold the airways open for longer [
• Mechanism of PEP
1. Promotes collateral ventilation, allowing
pressure to build up distal to the obstruction
2. Retains airways from collapsing and
prolongs expiratory flow
3. Effective airway clearance promotes the
movement of mucus proximally
INDICATIONS

•Acute and chronic respiratory failure for reasons of

surgery [8]
•Neurological or musculoskeletal dysfunction[8]eg MND
•Old age and immobility[8]
•To increase lung volume by increasing FRC and VT[8]
•Reduce hyperinflation[8]/ Air trapping [9] in eg :
emphysema, bronchitis, asthma[9]
•Improve airway clearance[8] in; cystic fibrosis (over 4 y.o);
chronic bronchitis; bronchiectasis; bronchiolitis obliterans
[9]

•To maximise the delivery of bronchodilators in patient's

 Relative Contraindications for PEP

•Untreated pneumothorax
•Active haemoptysis
•Recent trauma or surgery to skull, face, mouth, or oesophagus
•Patient with acute asthma attack or acute worsening of
Chronic Obstructive Pulmonary Disease (COPD) unable to tolerate
increased work of breathing [9]
•Nausea
There are no absolute contraindications to PEP that have been noted
by literature
Sway Link

https://sway.office.com/3ofnL7ur0M1FkyZM?ref=Link
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