ADMINISTERING PERCUSSION, VIBRATION, and POSTURAL DRAINAGE TO ADULTS

Definition: __________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________

Indication: __________________________________________________________________________________________________________________

Contraindication: ____________________________________________________________________________________________________________

Considerations: _____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Purpose:
1. _________________________________________________________________________________________________________________
2. _________________________________________________________________________________________________________________

Equipment:
1. A bed that can be placed in Trendelenburg position.
2. Towel

PROCEDURE RATIONALE 1 2 3 4 5
1. Provide visual and auditory privacy.

2. Assist the client to the appropriate position for postural

drainage.

Drainage of the upper lobe

3. Have the client lie back at a 30o angle. Percuss and vibrate
between the clavicles and above the scapulae.

166
 PROCEDURE RATIONALE 1 2 3 4 5
4. Have the client sit upright in a chair or in bed with the head
bent slightly forward. Percuss and vibrate the area between
the clavicles and scapulae.

5. Have the client lie on a flat bed with pillows under the knees to
flex them. Percuss and vibrate the upper chest below the
clavicles down to the nipple line, except for women. The
breasts of women are not percussed, because percussion may
cause pain.

Drainage of the right middle lobe and lower division of the left
upper lobe

6. Elevate the foot of the bed about 15o or 40cm and have the
client lie on the left side. Help the client to lean back slightly
against pillows extending at the back from the shoulder to the
hip. A pillow may be placed between the knees for comfort.
For a male, percuss and vibrate over the right side of the chest
at the level of the nipple between the 4rth and 6 th ribs For a
female, position the heel of your hand toward the axilla and
your cupped fingers extending forward beneath the breast to
percuss and vibrate beneath the breast.

7. Elevate the foot of the bed as in step 6, and have the client lie
as in step 6 except on the right side.Percuss and vibrate the
right side of the chest as in step7.

PROCEDURE RATIONALE 1 2 3 4 5

167
Drainage of the lower lobes
8. Have the client lie on the abdomen on a flat bed, and place
two pillows under the hips. Percuss and vibrate the middle
area of the back on both sides of the spine.

9. Have the client lie on the unaffected side, with the upper arm
over the head. Elevate the foot of the bed about 30o or 45
cm , or to the height tolerated by the client. Place one pillow
between the knees. Another under the head is
optional.Percuss and vibrate the affected side of the chest over
the lower ribs, inferior to the axilla.

10. Have the client lie partly on the unaffected side and partly on
the abdomen. Elevate the foot of the bed about 30o or 45cm
(18in.), or to the height tolerated by the client. As an
alternative, elevate the hips with pillows. Percuss and vibrate
the uppermost side of the lower ribs.

11. Have the client lie prone. Elevate the foot of the bed about 30o
or 45cm (18in.), or to the height tolerated by the client.
Elevate the hips on two or three pillows to produce a jackknife
position from the knees to the shoulders.Percuss and vibrate
over the lower ribs on both sides close to the spine, but not
directly over the spine or the kidneys.

PROCEDURE RATIONALE 1 2 3 4 5
PERCUSSION

168
12. Ensure that the area to be percussed is covered.

13. Ask the client to breath slowly and deeply.

14. Cup your hands,ie, old your fingers and thumb together , and
flex them slightly to form a cup, as you would to scoop up
water.

15. Relax your wrists, and flex your elbows.

16. With both hands cupped, alternately flex and extend the wrists
rapidly to slap the chest. The hands must remain cupped so
that air cushions the impact , to avoid injuring the client.

17. Percuss each affected lung segments for 1-2 minutes.

169
 PROCEDURE RATIONALE 1 2 3 4 5
VIBRATION
18. Place your flattened hands, one over the other (or side by
side) against the affected chest area.

19. Ask the client to inhale deeply through the mouth and exhale
slowly through pursed lips or the nose.

20. During the exhalation, straighten your elbows, and lean

slightly against the client’s chest while tensing your arm and
shoulder muscles in isometric contractions.

21. Vibrate during five exhalations over one affected lung

segment.

22. Encourage the client to cough and expectorate secretions into

the sputum container. Offer the client mouthwash.

23. Auscultate the client’s lungs, and compare the findings to the
baseline data.

24. Document the percussion, vibration, and postural drainage and

assessments. Note the amount, color, and character of
expectorated secretions.

170