Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬

Ministry of Health ‫وزارة الصحة‬

G. Directorate of Health Affairs - Najran ‫المدرية العامة للشؤون الصحية بنجران‬
Sharourah General Hospital ‫مستشفى شرورة العام‬

INTERNAL POLICY AND PROCEDURE (IPP)

Department Section

Title CHEST PHYSIOTHERAPY Policy Code

Effective Date Replaces Number

Review Due No. of Pages

Applies to

1. PURPOSE:
To standardize a protocol of chest physiotherapy to help patients breathe more freely and to get more oxygen
into the body.

2. DEFINITION:
Chest Physiotherapy:
Is the term for a group of treatments designed to improve respiratory efficiency, promote expansion of the
lungs, strengthen respiratory muscles and eliminate secretions from the respiratory system.
Chest physiotherapy consists of a variety of procedures that are applied depending on the patient’s health and
condition.
Chest physiotherapy includes postural drainage, chest percussion, and chest vibration, turning, deep breathing
exercises and coughing. It is usually done in conjunction with other treatments to rid the airways of secretions
to remove secretions from the airways. These other treatments include suctioning, nebulizer treatments and the
administration of expectorant drugs.

3. RESPONSIBILITY:
3.1 Physiotherapy Head of Department
3.1.1 To make sure the implementation of this protocol by the PT staff.
3.2 Physiotherapy Physician
3.2.1 To comply with this procedure in dealing with patients indicated for chest physiotherapy defined in
this policy.
3.2.2 To exclude contraindications of chest physiotherapy.
3.2.3 To write the plan of management for patients.
3.3 Physiotherapy Technician
3.3.1 To follow the PT plan written by the PT physicians.

4. CROSS REFERENCES:
N/A

5. POLICY:
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 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
G. Directorate of Health Affairs - Najran ‫المدرية العامة للشؤون الصحية بنجران‬
Sharourah General Hospital ‫مستشفى شرورة العام‬

5.1 Chest physiotherapy can be used with newborns, infants, children, and adults.
5.2 Depending on the circumstance, chest physiotherapy may be performed by anyone from a respiratory
care therapist to a trained member of the patient’s family. Different patient conditions warrant different
levels of training.
5.3 Indications of chest physiotherapy
Some people who may receive chest physiotherapy include:
5.3.1 Cystic fibrosis
5.3.2 Neuromuscular diseases like Guillain-Barre Syndrome
5.3.3 Progressive muscle weakness (Myasthenia Gravis)
5.3.4 Tetanus
5.3.5 Bronchitis
5.3.6 Pneumonia
5.3.7 Chronic Obstructive Pulmonary disease
5.3.8 People who are likely to aspirate their mucous secretions because of diseases such as cerebral palsy
or muscular dystrophy
5.3.9 People, who are bedridden, confined to a wheelchair, or who cannot breathe deeply because of
postoperative pain.
5.4 Contraindications of chest physiotherapy
Chest physiotherapy should not be performed on people with:
5.4.1 Bleeding from the lungs
5.4.2 Neck or head injuries
5.4.3 Fractured ribs
5.4.4 Collapsed lungs
5.4.5 Damaged chest walls
5.4.6 Tuberculosis
5.4.7 Acute asthma
5.4.8 Recent heart attack
5.4.9 Pulmonary embolism
5.4.10 Lung abscess
5.4.11 Active hemorrhage
5.4.12 Some spine injuries
5.4.13 Recent surgery, open wounds or burns
5.5 Chest physiotherapy can be performed in a variety of settings include:
5.5.1 Critical care units
5.5.2 Hospitals
5.5.3 Nursing homes
5.5.4 Outpatient clinics
5.5.5 Patient’s home
5.6 Hospitalized patients should be reevaluated frequently to establish which procedures are most effective
and best tolerated.
5.7 Patients receiving long term chest physiotherapy are reevaluated about every three months.

6. PROCEDURE:
6.1 Patient Preparation
File Name
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 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
G. Directorate of Health Affairs - Najran ‫المدرية العامة للشؤون الصحية بنجران‬
Sharourah General Hospital ‫مستشفى شرورة العام‬

6.1.1 Evaluate the patient’s condition to exclude the contraindications mentioned above (5.4).
6.1.2 Determine the most beneficial chest physiotherapy technique for the patient.
6.1.3 Mobilization and activity: passive and active movement for all limbs.
6.1.4 Positioning: put the patient in a comfortable and relaxed and loosen light clothing before starting.
The positions in which postural drainage is done are modified to meet the patient’s medical or
surgical problems.
6.1.5 Breathing control: good inspiration and expiration (teach patient deep breathing and an effective
cough prior to positioning).
6.1.6 Do suctioning.
6.2 Turning
Turning from side to side permits lung expansion. Patients may turn themselves or be turned by a
caregiver. The head of the bed is also elevated to promote drainage if the patient can tolerate this
position. Critically ill patients and those dependent on mechanical respiration are turned once every one
to two hours around the clock.
6.3 Coughing
Coughing helps break up secretions in the lungs so that the mucus can be suctioned out or expectorated.
Patients sit upright and inhale deeply through the nose. They then exhale in short puffs or coughs.
Coughing is repeated several times a day.
6.4 Deep breathing
Deep breathing helps expand the lungs and forces better distribution of the air into all sections of the
lung. The patient either sits in a chair or sits upright in bed and inhales, pushing the abdomen out to
force maximum amounts of air into the lung. The abdomen is then contracted, and the patient exhales.
Deep breathing exercises are done several times each day (3-4 repetitions each time) to avoid
hyperventilation.
6.5 Postural drainage
Postural drainage uses the force of gravity to assist in effectively draining secretions from the lungs and
into the central airway where they can either be coughed up or suctioned out. The patient is placed in a
head or chest down position and is kept in this position for up to 15 minutes. Critical care patients and
those depending on mechanical ventilation receive postural drainage therapy four to six times daily.
Percussion and vibration may be performed in conjunction with postural drainage. Positions are
dependent on the areas of the lungs affected.
6.6 Percussion
Percussion is rhythmically striking the chest wall with cupped hands. It is also called cupping,
clapping, or tapotement. The purpose of percussion is to break up thick secretions in the lungs so that
they can be more easily removed. Percussion is performed on each lung segment for one to two
minutes at a time.
6.7 Vibration
As with percussion, the purpose of vibration is to help break up lung secretions. Vibration can be either
mechanical or manual. It is performed as the patient breathes deeply. When done manually, the person
performing the vibration places his or her hands against the patient’s chest and creates vibrations by
quickly contracting and relaxing arm and shoulder muscles while the patient exhales. The procedure is
repeated several times each day for about five exhalations.
6.8 Exercise
Exercises that combine movements of the trunk and extremities with deep breathing to mobilize the
File Name
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 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
G. Directorate of Health Affairs - Najran ‫المدرية العامة للشؤون الصحية بنجران‬
Sharourah General Hospital ‫مستشفى شرورة العام‬

chest.
6.9 Frequency of treatment
Frequency of treatment will depend upon the pathology of the patient’s condition:
6.9.1 2-4 times per day if mucus is thick and copious.
6.9.2 Maintenance: 1 to 2 times per day.
6.9.3 Total duration: 30-40 minutes.

7. FORMS:
N/A
8. EQUIPMENT:
N/A
9. REFERENCES:
9.1 Cystic Fibrosis Foundation. 6931 Arlington Road, MD 20814. (800) 344-4823. http://www.cff.org.
9.2 Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.
10. APPROVAL:
NAME POSITION Signature Date
Prepared by

Reviewed by
Approved by

File Name
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