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 .

Preparation :

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 :

Produces chest

vibrations that

dislodge retained

secretions .


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 .

Rationale :

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 .

Procedure :

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 .

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Posted in Nursing Care Plans, Nursing Intervention, Respiratory

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