Percussion can be used while you are in a postural drainage position to dislodge and mobilize secretions from the air sacs into larger airways so they can be coughed up or suctioned. This is accomplished by forcefully tapping over the affected areas of the chest. Indications for percussion are:

• Presence of thick or excessive mucus
• Inability to raise mucus with assisted cough.

Reasons to avoid percussion include:

• Chest pain
• Fractured ribs
• Irregular pulse, or
• Tendency to bleed (taking Heparin or Coumadin or if pulmonary embolus exists).

Following is the procedure for percussion:

• Lie in a postural draining position, i.e. with your chest elevated above your head, so affected area is elevated. Lie on the left side if the right side is to be percussed, or, lie on the right side if the left side is to be percussed.
• Place towel over the area to be percussed.
• Hand should be cupped, with the tip of the thumb at the side of the middle joint of the index finger. Fingers should be straight and held closed. Assistant should remove all jewelry.

   

• With hand in this cupped position, forcefully tap the rib cage over the affected area, using a smooth rhythm and keeping the arms and shoulders relaxed. (The motion is similar to playing a bongo drum).

• Percuss for 1-2 minutes. Always avoid percussing over the spinal column and the kidneys.

• Use suction or assisted cough, following each position.

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