Postural Drainage Percussion Instructions

Postural drainage and percussion (PD & P) therapy is a method of loosening mucus and secretions from the lungs so they can be coughed out more effectively. Commonly used on people with cystic fibrosis, especially babies and children, PD & P relies on positioning the child in different positions to maximize drainage from each of the five lobes of the lungs, and tapping, or percussing, over the lungs with a cupped hand or rubber percussion cup.

Instructions

• 1

  Perform PD & P before meals or two hours after eating. Early morning and bedtime sessions are recommended, but PD & P can be performed more often if the child is especially congested. Each session can last 20 to 40 minutes.

• 2

  Use a towel to cover the area being percussed. Do not perform percussion on bare skin. A tee shirt or other soft clothing is best. No tight fitting clothing, buttons, zippers or other hard decorations or jewelry should be worn. The caregiver should not have rings or jewelry on their hands.

• 3

  Tap with your hand slightly cupped, fingers together. Your hand should make a dull, hollow sound as it taps the chest, not a slapping sound. There are rubber cups available for performing PD & D. Ask your doctor about obtaining one if you do not wish to use your hand. Tapping should be firm, but not painful. Correct tapping is only done over the rib cage.

• 4

  Sit the child on a flat surface or bed, leaning back against pillows so the child is at a 30 degree angle. Stand behind the child, and percuss between the collar bone and top of shoulder blade on both sides. This drains the top of the upper lobes.

• 5

  Position the child sitting up and leaning forward at a 30 degree angle over a folded pillow. Stand behind the child and percuss the upper back on both sides. This drains the back of the upper lobes.

• 6

  Lie the child down flat on his back. Tap between the collarbone and nipple line on both sides, avoiding the breastbone. This drains the front of the upper lobes.

• 7

  Place the child so his head is lower than his feet. Adjust drainage table if you are using one, or use pillows or props to raise the feet 12 inches higher than the head. The child should lie on their right side, rotated slightly backward. Use a pillow to make it easier. Tap just outside the left nipple area. This drains the center, or lingula, of the left lung.

• 8

  Turn the child to the left side, and rotate slightly backward. Use a pillow to make it easier. The feet should be 12 inches higher than the head. Tap just outside the right nipple area. This drains the middle lobe of the right lung.

• 9

  Elevate the feet 18 inches higher than the head. Place the child on his left side with a pillow behind his back. Percuss over the lower ribs on the right side. Have child turn onto his right side, with pillow behind back. Percuss over the lower ribs on the left side. This drains the lower lobes.