2. Postural drainage
Introduction
• Postural drainage is the positioning of a
patient with an involved lung segment such
that gravity has a maximal effect of facilitating
the drainage of bronco-pulmonary secretions
from the tracheobronchial tree.
• It is based on the concept of gravity-assisted
mobilization of secretions and transport it for
removal.
3. • The lungs consist of five lobes, three on the
right side and two on the left side of the chest
cavity. Each lobe is further divided into
segments.
• It uses a combination of chest percussion (a
clapping movement performed with cupped
hands) and vibration (a vibrating movement
done with flat hands).
4. • Postural drainage is generally performed for
three to five minutes on each segment. During
this time, the person being treated should
take slow, deep breaths followed by a vigorous
coughing to help clear mucus.
5. Purpose
• To help loosen the mucous by shaking it loose.
• To help drain mucus from each of the lobes
into the larger airways so it can be coughed up
more readily.
6. Chest percussion
• Chest percussion involves using a cupped
hand and alternately clapping both hands on
the person's chest wall. Your hand should not
be flat but cupped at all times as if you were
holding liquid in it.
• Chest percussion should be done over the
ribs, taking care to avoid the spine,
breastbone, or lower back where you can
potentially injure internal organs.
7.
8. Vibration therapy
• Vibration therapy is used along with chest percussion
helps to gently shake mucus and secretions into the
large airway passages.
• During vibration, the caregiver should place a flat hand
firmly at top the lung segment to be drained. Then,
stiffening the arm and shoulder, he or she should apply
light pressure and create a rapid, shaking movement,
similar to that of a vibrator.
• It is important for the person being treated to inhale
deeply and exhale slowly but forcefully. This should be
done without straining to stimulate a productive
cough.
9.
10. Assessment
• The following should be assessed and reported to
establish a need for postural drainage:-
• A recent radiograph or bronchogram if available,
is a useful adjunct in isolating the affected areas.
• Pulmonary Function Test
• excessive sputum production
• effectiveness of cough
• history of pulmonary problems treated
successfully with PDT (e.g., bronchiectasis, cystic
fibrosis, Lung Abscess)
11. • decreased breath sounds or crackles or
rhonchi suggesting secretions in the airway
• change in vital signs
• abnormal chest x-ray consistent with
atelectasis, mucus plugging, or infiltrates
• deterioration in arterial blood gas values or
oxygen saturation
12. Procedure
The patient is tilted or propped at an angle
required and chest percussion is performed to
loosen the secretions.
Frames, tilt tables, and pillows may be used to
support patients in these positions.
A foot end elevation of 14-18 inches is requires
for the drainage of middle and lower lobes.
Each position consists of placing the target lung
segment(s) superior to the carina. Positions
should generally be held for 3 to 15 minutes
13. In critical care patients, including those on
mechanical ventilation, Postural Drainage
should be performed from every 4 to every 6
hours as indicated.
PDT order should be re-evaluated at least
every 48 hours based on assessments from
individual treatments.
14.
15. • To drain mucus from the upper lobe apical
segment, have the person sit in a comfortable
position on a bed or flat surface, leaning
against a pillow on the headboard or the
caregiver for support.
• The caregiver will then percuss and vibrate the
muscular area between the collarbone and
very top of the shoulder blades on both sides
for around three to five minutes.
• Encourage the person to take deep breaths
and to cough during the percussion.
16.
17. • The person will next sit comfortably in a chair
or on the side of the bed and lean over a
pillow with his or her arms dangling.
• As before, percuss and vibrate with both
hands over the upper back on both the right
and left sides.
18.
19. • In this position, the person will lie flat on a
bed or table with a pillow situated
comfortably under the head and legs.
• The caregiver will then percuss and vibrate
the right and left sides of the front portion of
the chest between the collarbone and nipple.
20.
21. • The person will then lie on the right side, face
down toward the foot of the bed, with the
hips and legs propped on pillows. The body
should be rotated about a quarter-turn
towards the back.
• A pillow can also be placed behind the
person. The legs should be slightly bent with
another pillow placed between the knees. The
caregiver will then percuss and vibrate just
outside the nipple area.
22.
23. • For the middle lobe position, the person will
lie face-down on his or her left side, a quarter-
turn toward the back with the right arm up
and out of the way. The legs and hips should
be elevated as high as possible.
• A pillow may be placed on the back and
between slightly bent legs. The caregiver will
percuss and vibrate just outside the right
nipple area.
24.
25. • In this position, the person will lie on the right
side, face down facing the foot of the bed,
with a pillow propped behind the back.
• The hips and legs should be elevated as high
as possible on pillows. The knees should be
slightly bent with a pillow placed in between.
• The caregiver will percuss and vibrate over the
lower ribs on the left side and repeat the right
side.
26.
27. • For this position, the person will lie on his or
her stomach with hips and legs elevated on
pillows.
• The caregiver will percuss and vibrate the
lower part of the back over the left and right
sides of the spine, taking care to avoid the
spine and lower ribs.
28.
29. • For these positions, the person will lie on the
right side, leaning forward about one-quarter
of a turn with hips and legs elevated on
pillows. The top leg may be flexed over a
pillow for support and comfort.
• The caregiver will percuss and vibrate the
uppermost portion of the lower part of the
left ribs, repeating on the right side.
30.
31. • For this final position, the patient will lie flat
his or her stomach on a bed or table. Two
pillows should be placed under the hips.
• The caregiver will percuss and vibrate the
bottom part of the shoulder blades on both
the right and left sides of the spine, taking
care to avoid the spine itself.
