Is an airway clearance technique that combines :
1 ) Positioning or postural drainage (allowing gravity to help drain secretions into central airways ) .
2 ) Rhythmic percussion of the chest wall (to help loosen secretions) .
3 ) Vibration
4 ) Coughing and breathing .
These procedure done :
– Before morning meal .
– At bed time (if the child is subject to nighttime mucous retention , plugging of airways , and coughing) .
– If infection is present .
– Bronchodilator is administered by nebulizer .
1) Ensure that several hours have passed since the child has eaten .
2) Perform a baseline respiratory assessment. Place the child on a pulse oximeter .
3) Place the child in the position to permit gravity drainage of secretion .
4) Administer the bronchodilator , if ordered , to relax the airway muscles .
1) Oxygen mask , baby bottle nipple (for infant) .
2 ) Emesis basin or sputum cup .
3 ) Pulse oximeter .
4 ) Tissues
During postural drainage , 2 maneuvers can be done to aid drainage :
1) Percussion :
1) If using the hands to percuss the chest , hold the hands cupped with fingers and thumb together . Keep the wrists loose , elbows partially flexed , and strike the chest alternating the hands . Listen for a hollow sound .
2 ) Develop a rhythm with the alternate hands and cover the targeted chest area in a circular pattern for 3 – 5 minutes .
3 ) Avoid tender area , the breasts of an adolescent girl , and bony prominences such as clavicles or vertebrae .
Rationale : Percussion focused over intercostal spaces to loosening secretions.
4 ) Have the child change position to drain another area of the lungs and percuss that area for 3 – 5 minutes , continue this process until all areas of the chest have been percussed.
5 ) The positions used for each patient are based on the location of mucous obstruction.
6) Encourage the child to take a few deep
breaths and cough after percussion in
each location. Have the child expectorate
sputum into an emesis basin or cup .
The deep breaths increase the velocity of expired air & help to move the secretions toward the trachea where they can be coughed up .
7 ) Monitor the child’s cardiorespiratory status .
2 ) Vibration :
Is application of downward vibrating pressure with the flat part of the palm over the area that is being drained .
1) Position one hand flat on the chest over the involved area and the other hand on top of the first . Alternately , the hands may be placed side by side on the chest . Keep the arms and shoulders straight .
2 ) Tell the child to take deep breath , inhaling through the nose and exhaling through the mouth .
Vibration : is performed only during exhalation
3 ) Vibrate the area by tensing and relaxing your arms for 10 – 15 seconds .
Perform these tensing and relaxing actions for 3 – 5 minutes .
Move to another area of the chest and repeat the process .
4 ) Encourage coughing between vibration and expectoration of sputum into a cup or emesis basin .