Children’s Community Respiratory Physiotherapy
… … //
Chest Physiotherapy Programme
…’s normal daily programme (when she is well)
 How often?
o Physiotherapy is to be performed 2 times per day.
o First thing in morning and before bedtime.
 Assess
o Assess …’s chest before treatment by palpation (see below)
 Positioning
o Ensure … is either sat up in her chair, or lying in alternate side lying in bed
 Percussion
o Ensure … has a top on or a blanket/towel over her skin to protect it.
o Pat …’s chest for 2-3 minutes using a cupped hand
o The pats should sound dull not “slappy”
o Repeat these pats in each position chosen
 Suction
o Use Yanker suction as required if …’s cough is effective
o Use a suction pressure of 120mmhg. If secretions are thick/sticky/difficult to
remove, the pressure can be increased to a maximum of 200mmhg if required.
 Reassess
o Reassess chest to ensure clear
When … has increased secretions or signs of worsening respiratory
status
 Assess
o Assess …’s chest before treatment by palpation.
 How often?
o Physiotherapy can be increased as many times a day as necessary (at least 3)
Children’s Community Respiratory Physiotherapy
 Positioning
o If you feel … has reduced expansion on one side lie her with that side
uppermost
o If you feel … has secretions more on one side than the other, then lie her with
the side that has more secretions uppermost. Note - both sides still may need
treating.
o If secretions are both sides or you cannot detect a difference between sides
then repeat the process below lying on both sides
 Physiotherapy in the position(s) chosen
o Ensure … has a top on or a blanket/towel over her skin to protect it.
o Pat …’s chest for 2-3 minutes using a cupped hand
o The pats should sound dull not “slappy”
o Repeat these pats in each position chosen
 Suction
o Following percussion (if …’s cough is not effective) suction using a size …..
catheter
o The catheter should only go down as far as it takes to instigate a cough to a
maximum of …..cms
o Use a suction pressure of 120mmhg. If secretions are thick/sticky/difficult to
remove, the pressure can be increased to a maximum of 200mmhg if required.
 Re-examine chest
o Re examine …’s chest to see if her expansion has improved/ secretions have
been removed/ signs of deterioration have improved. If not you may need to
repeat the above process if … is not too tired; or rest and repeat later.
IF YOU ARE CONCERNED THAT …’S CHEST IS GETTING
WORSE PLEASE RING ME AND/OR SEEK MEDICAL ADVICE.
IF YOU ARE UNABLE TO CLEAR SECRETIONS AND/OR UNABLE
TO MAINTAIN OXYGEN SATURATIONS PLEASE RING ME
AND/OR SEEK MEDICAL ADVICE.
Indications of Worsening Respiratory Status
Sweating
Becoming pale / blue
Increasing respiratory rate
Decreasing oxygen saturations
Increasing work of breathing shown by pulling in under/between the ribs, tracheal tug,
nasal flaring
Children’s Community Respiratory Physiotherapy
Increasing quantity and thickness of secretions
Darkening colour of secretions i.e. yellow / green
Chest feels “rattly” when this is not normal for them or more “rattly” than normal
Decreased activity / sleeping more
Decreased strength of cough
Wet sounding cough when previously dry
Increased frequency of cough
Reduced speech volume or wet sounding voice if this is unusual for them
Stringing less words together in a sentence before they have to take a breath
Temperature
How to examine …’s chest
PALPATION
Place one hand either side of the chest. Initially at the top and then under the armpits
If expansion is less on
one side then that is
usually the side with
the problem.
If secretions are felt
more on one side then
that is the side with
the problem.
If you have any questions about your chest physiotherapy programme, please contact
your respiratory physiotherapist
M………… on 07………….
Children’s Community Respiratory Physiotherapy
Service Evaluation of the Children’s Community Respiratory
Physiotherapy Service
Dear Parent or Carer,
We are looking at the children’s community respiratory physiotherapy service to see if parents
and carers find it useful. We would be extremely grateful if you could please answer the
following questions. Your answers will help us to improve the service.
It helps us to know the name of your child so that we don’t keep asking the same person, but
we do assure you that your comments will not adversely affect the way we treat your child and
all information that you give us will be kept anonymous.
1. How satisfied are you with the service you have received?
Very
satisfied
Satisfied
Neither satisfied
nor dissatisfied
Dissatisfied
Very
Dissatisfied
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Do you have any comments on your satisfaction/ dissatisfaction with the service?
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2. Are you able to tell us two ways in which the service has particularly helped you
and your child?
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Children’s Community Respiratory Physiotherapy
3. Have you had to call out the rapid response physiotherapist?
Yes □
No □
Not sure □
If yes, was the service ‘timely’ and ‘helpful’?
Completely Somewhat
Not sure
Not
very
Not at
all
Timely?
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Helpful?
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Do you have any comments on these aspects of the service?
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4. Have there been any problems for you or your child as a result of the service?
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Name of your child
Date
Thank you for taking the time to complete this questionnaire
Please return to: Dr HG in the enclosed envelope.