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chest physical therapy and airway clearance

what is CPT

a general term used for clearing the airway of secreation and improving distribution of ventilation through better use of inspiratory muscles.

what are the techniques for cpt

postural drainage, chest percussion and vibration, cough techniques, and breathing exercise training

what are the goals of cpt

prevent accumulation of pulmonary secretions, improve mobilization of retained secretions, improve distribution of ventilation, improve cardiopulmonary exercise tolerance

if ordered with a SVN, IPPB or MDI when should you do CPT


what are indications for CPT

retained secretions, decreased cilia function, ineffective cough, v/q abnormalities retain from secretions

what diseases indicate CPT

bronciactisis, CF, COPD, Pneumonia, Acute atelectasis, any condition with copius secretions

what is postural drainage

postural drainage uses gravity to aid in mobilizing secretions this is accomplished bypositioning the body for optimal drainage to the segments needing to be drained


face down


face up on your spine


sitting straight up


semi reclined position


head down feet up body straight 18-30 degree angle

semi trendelenburg

12-15 degree angle head down feet up body straight

reverse trendelenburg

body straight head up feet down

hazards of PD

aspiration, increase ICP, hypoxemia

contraindications of PD

unstable head/neck injuries, spainal injury, hemoptysis, hemorrahage, hemodynamic instability, pulmonary edema associated with CHF, large pleural effusion, rib fracture, pulmonary embolism, ICB > 20mm hg, empyema, surgical wound or healing tissue

when should trendelenburg position not be used

with head trauma patients, aneurysm, uncontrolled hypertension, post neurosurgery, eye surgery, or estophagel surgery

what is percussion

is almost always used in conjuction with posterial drainage it may be administered manually by "clapping" with a cupped hand over the appropriate are, or with one of various percussion devices

what is the purpose of percussion

mechanically dislodge secreations

what are indication for percussion

when secreations are hard to dislodge

what are contraindications for percussion

rib cage trauma, soft tissue trauma, hemoptysis, metastatic conditions, pulmonary emboli, pulmonary abscess, head trauma, unstable cardiovascular system, unstable post op status,untreated tb, recent epidural spianl infusion or spinal anesthesia, sub q emphysema, recent skin grafts on thorax, burns, open wounds, skin infections, recently placed pacemaker

how long should you wait to do CPT on a patient whom has just eaten?

one hour/try to coordinate with pain meds

percussion should never be performed over

clavicals, scapulas, sternum, spine, breast

When vibration is used in conjuction with PD when is it performed?

on exhalation

what is the purpose of vibration

to move secreations to larger airways

what are contraindications for vibration

rib cage trauma, soft tissue trauma

how do you monitor effectiveness of CPT through patient assesments

breath sounds, texture, color, chest expansion, cough improvement, toleration, vital signs, chest xrays

when should you discontinue CPT

clear breath sounds, clear xrays, patient is ambilating well, strong cough, afebrile for 24 hours

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