Chest Percussion Therapy (CPT) is a physical technique used to assist in the removal of thick, sticky secretions from the lungs. This manual treatment involves rhythmically clapping on the chest or back to generate vibrations that travel into the airways. CPT’s primary purpose is to dislodge mucus that has built up due to conditions like cystic fibrosis or chronic obstructive pulmonary disease (COPD). By shaking the sticky mucus loose, the therapy helps move it from the smaller air passages into the larger ones, where it can be more easily coughed out, improving breathing and lung function.
Essential Preparation and Patient Positioning
Preparation for Chest Percussion Therapy begins with ensuring the patient’s comfort and safety. The treatment should not be performed on bare skin; a thin layer of clothing, such as a t-shirt, towel, or sheet, must cover the area being percussed to prevent irritation and soften the contact. It is recommended to wait at least an hour and a half after a meal to prevent nausea and the risk of aspiration, as the therapy can encourage coughing.
The most important step is positioning the patient using postural drainage techniques. These positions utilize gravity to help drain mucus from specific segments of the lungs into the central airways. Depending on the lung area needing clearance, the patient might be placed lying on their back, stomach, or side, often with the head slightly lower than the hips. For instance, draining the lower lobes of the lungs often requires elevating the foot of the bed or table so the patient’s head is down at about a 30-degree angle.
A respiratory therapist or healthcare provider typically tailors these positions to the individual’s specific needs, determining which areas of the lungs require the most attention. Pillows and wedges are used extensively to maintain the correct angle and keep the patient comfortable for the duration of the treatment.
Executing the Percussion Technique
The physical act of chest percussion relies on a specific hand technique to be effective and safe. The caregiver must form their hand into a rigid, cupped shape, similar to how one would hold water, with the fingers and thumb held together. This precise contour traps a cushion of air between the hand and the chest wall upon impact. This air cushion prevents the treatment from causing pain or stinging and maximizes the transmission of the vibrational force into the lungs.
The motion itself is a steady, rhythmic clapping that should sound hollow, like a cup tapping a surface. If the sound is a flat slap, the hand is not cupped correctly and needs adjustment. The movement should primarily originate from the caregiver’s wrist and elbow, allowing the forearm to remain relaxed, which helps maintain the rhythm and prevents quick fatigue. The rhythmic force applied creates pressure changes in the chest wall that are transmitted to the lung tissue, helping to dislodge secretions from the airway walls.
It is crucial to be precise about the areas where percussion is performed to avoid injury. The technique should only be applied over the rib cage, avoiding sensitive and vulnerable regions of the body. The percussion should be focused over the lung segment that is elevated and positioned for drainage. Caregivers must not clap directly over the following areas:
- The spine
- The breastbone (sternum)
- The lower ribs where internal organs are located
- The abdomen
Duration, Frequency, and Safety Considerations
Percussion is typically performed for a duration of three to five minutes over a single targeted lung segment while the patient is in the correct postural drainage position. Following the percussion, a brief period of vibration is sometimes applied, and the patient is encouraged to cough forcefully to clear the now-mobilized secretions.
The overall frequency of CPT sessions is often determined by the patient’s underlying condition and the volume of secretions, but it is commonly done two to four times a day. The best time to schedule these sessions is before a meal or at least 90 minutes afterward to minimize the risk of vomiting or aspiration.
Safety is paramount, and CPT must be stopped immediately if the patient experiences sharp pain, sudden shortness of breath, a significant change in heart rate, or begins coughing up blood (hemoptysis). Certain medical conditions are considered contraindications, making the procedure unsafe. These include:
- Recent rib fractures
- Severe osteoporosis
- Recent spinal surgery
- Active bleeding disorders
- Unstable medical status such as uncontrolled high blood pressure or a high risk of pulmonary embolism