Postural drainage

contains details about postural drainage like definition, indication, contraindications & positions.

1. POSTURAL DRAINAGE

2. Definition Postural drainage (bronchial drainage), is an intervention for airway clearance by mobilizing secretions in one or more lung segments to the central airway by placing the patient in various positions so gravity assists in the drainage process. It is effective in cystic fibrosis, bronchiectasis, & other pulmonary diseases.

3. Goals & indications Prevent accumulation of secretions in patients at risk of pulmonary complications :- Diseases with increased production or viscosity of mucus Prolonged bed rest Who has received general anaesthesia Painful incision causing restricted deep breathing & coughing Patients on ventilator Remove accumulated secretions from the lung :- Acute or chronic lung disease Generally weak or elderly people Patients with artificial airways

4. Contraindications Severe hemoptysis Untreated acute conditions Severe pulmonary edema Congestive heart failure Large pleural effusion Pulmonary embolism pneumothorax Cardiovascular instability Cardiac arrhythmias Severe hypertension or hypotension Recent MI Unstable angina Recent neurosurgery Head down position may cause increased ICP – use modified positions

5. Preparation All the patients do not require postural drainage for all the lung segments. So the procedure must be based on the clinical findings . In postural drainage, the person is tilted or propped at an angle to help drain secretions from the lungs. The lower lobes require drainage most frequently because the upper lobes drain by gravity . Before postural drainage, the client may be given a bronchodilator medication or nebulization therapy to loosen secretions.

6. Postural drainage treatments are scheduled two or three times daily, depending on the degree of lung congestion. The best times include before breakfast, before lunch, in the late afternoon, and before bedtime . It is best to avoid hours shortly after meals because postural drainage at these times can be tiring and can induce vomiting.

7. Lung lobes & segments

8. Position for chest physiotherapy

9. Manual techniques

10. Percussion

11. Chest clapping Rhythmical force is applied with the cupped hands against the thorax, over the involved lung segment, trapping air between patient’s thorax & caregiver’s hands. Aim – dislodging or loosening bronchial secretions from airways. Performed during both inspiratory & expiratory phase of breathing. Used during PD & also during ACBT to increase its effectiveness.

12. Mechanism – transmission of wave of energy through chest wall to lungs – wave loosens secretions from bronchial wall – moves them proximally – removal of secretions. Handheld percussor can also be used. Pediatrics – use padded rubber nipple, pediatric face mask, padded medicine cups, bell of stethoscope. Use towel or patient’s gown to cover skin.

13. Sound of percussion should be hollow. Even & steady rhythm – 100 – 480 times/min. Force should be equal B/L & to the patient’s comfort. Infants – use 4 fingers cupped, 3 fingers with middle finger tented or thenar & hypothenar surface of hand. Should not be done on bony prominences, breast tissue – discomfort & reduce effectiveness of treatment.

14. Not tolerated by many post-operatively without adequate pain control. Associated with fall in oxygen saturation. Relative C/I – Osteoporosis Coagulopathy

15. Vibration & Shaking

16. Opposite ends of spectrum. Vibration – Gentle high frequency force Delivered through sustained co-contraction of caregiver’s UE to apply vibratory force. Shaking – Vigorous Similar to vibration but is a bouncing maneuver, also referred as rib springing – supplying concurrent compressive force to chest wall. Performed only during expiration.

17. Enhances mucociliary transport from periphery to central airways. Produces increased chest wall displacement & stretch of respiratory muscles may produce increased inspiratory effort & lung volumes. Mechanical vibrators can also be used. Infants – padded electric tooth brush. Advantages – Better tolerated than percussion Allows to assess pattern & depth of respiration