POSTURAL DRAINAGE-1.pptx..................

Postural drainage

1. POSTURAL DRAINAGE VARSHA ASST. LECTURER LMCP

2. ANATOMY OF THE LUNGS Bronchial tree including, fissures lobes Segments

3. Postural drainage Postural drainage involves the use of gravity and mechanical energy to help mobilise the secretions. The various body positions are intended to drain secretions from each of the patient’s lung segments into the central airways, where they can be removed by cough or suctioning

4. This drainage is accomplished by placing the segmental bronchus to be drained in a more vertical position, permitting gravity to assist in the process. Positions are to be held for a minimum of 3-15minutes. Most effective in conditions characterized by excessive sputum production Patients in critical care, including patients on mechanical ventilation, PD should be performed every 4-6 hours as indicated.

5. indications Poor oxygenation associated with position Potential for the presence of atelectasis Retained secretions in the presence of artificial airway Presence of foreign bodies in the airway.

6. CONTRAINDICATIONS 1. ALL POSITIONS ARE CONTRAINDICATED FOR: Unstable head and neck injury Active haemorrhage with hemodynamic instability ICP greater than 20mmHg

7. Recent spinal surgery or acute spinal injury Active haemoptysis Empyema Broncho pleural fistula Pulmonary oedema with CHF Aged, confused, or anxious patients Pulmonary embolism

8. Rib fracture Surgical wound or healing tissue Large pleural effusion

9. 2. TRENDELENBURG POSITION CONTRAINDICATED FOR: Recent haemoptysis ICP greater than 20mmHg Uncontrolled hypertension

10. Distended abdomen Neurosurgery, aneurysms, eye surgery Uncontrolled airway at risk for aspiration – recent meal E sophageal surgery

11. 3. EXTERNAL MANIPULATION OF THE THORAX: Subcutaneous emphysema Recent epidural spinal infusion or spinal anaesthesia Recently placed pacemaker Lung contusion Osteomyelitis of the ribs

12. Recent skin grafts or flaps on the thorax Burns, open wounds, skin infections on the thorax Suspected pulmonary TB Bronchospasm osteoporosis

13. HAZARDS & COMPLICATIONS Hypoxemia Increased ICP Acute hypotension during procedure Pulmonary haemorrhage

14. Pain or injury to muscles ribs or spine Vomiting Aspiration Bronchospasm arrhythmias

15. POSTURAL DRAINAGE POSITIONS

16. UPPER LOBE 1 . APICAL SEGMENT LEFT LUNG RIGHT LUNG POSITION : LONG SITTING WITH PILLOWS UNDER THE KNEES PROGRESSION : SITTING ON A CHAIR,FORWARD LEANING ON THE PILLOW.

17. 2. ANTERIOR SEGMENT LEFT UPPER LOBE POSITION : SAME AS FOR APICAL SEGMENT. RIGHT UPPER LOBE POSITION : SUPINE WITH ONE PILLOW UNDER THE HEAD AND THE KNEES.

18. 3. POSTERIOR SEGMENT LEFT UPPER LOBE POSITION : PRONE POSITION WITH HEAD END ELEVATED (same as apical, but prone) AND QUARTER TURN TO THE RIGHT,WITH LEFT SIDE RAISED WITH 2 PILLOWS. RIGHT UPPER LOBE POSITION : PRONE WITH QUARTER TURN TO THE LEFT WITH RIGHT SIDE UP. PILLOWS UNDER THE RIGHT SIDE OF THE CHEST TO RAISE IT UP.

19. 4. LEFT LINGULA SUPERIOR INFERIOR POSITION : SUPINE WITH QUARTER TURN TO THE RIGHT. LEFT SIDE RAISED UP WITH PILLOWS UNDER THE LEFT SHOULDER. TRENDLENBERG POSITION WITH FOOT END RAISED BY 15 DEGREE (12 INCHES).

20. 5.RIGHT MIDDLE LOBE MEDIAL LATERAL POSITION : EXACTLY OPPOSITE TO LINGULA. SUPINE WITH QUARTER TURN TO THE LEFT,RIGHT SIDE RAISED UP WITH PILLOWS. TRENDLENBERG POSITION MAINTAINED.

21. LOWER LOBE 6. APICAL LEFT LOWER LOBE RIGHT LOWER LOBE POSITION : PRONE WITHOUT ANY TILTING. PILLOWS UNDER THE ABDOMEN AND ANKLE.

22. 7. LEFT ANTERIOR SEGMENT POSITION : SUPINE WITH TRENDLENBERG POSITION. PILLOWS UNDER THE KNEES AND HEAD.

23. 8. POSTERIOR BASAL LEFT LOWER LOBE RIGHT LOWER LOBE POSITION : SAME AS APICAL PRONE WITH TRENDLENBERG UPTO 18 INCHES.

24. 9. LEFT LATERAL & RIGHT MEDIAL POSITION : SIDE LYING ON THE RIGHT SIDE WITH LEFT SIDE UP TRENDLENBERG POSITION. PILLOW TO BE PLACED BETWEEN THE KNEES

25. 10. RIGHT LATERAL POSITION : EXACT OPPOSITE TO LEFT LATERAL. SIDELYING WITH RIGHT SIDE UP. TRENDLENBERG POSITION

26. PERCUSSION Can be given in postural drainage position. Fingers should be adducted and hands cupped. No direct application to the skin, a cloth should be placed over the skin on which percussion can be given. If erythema is present then the technique is incorrect – there is no sufficient air trapping between the cup and the skin. Given at a rate of 100-480/min Can be given in both expiratory and inspiratory phase.

27. VIBRATION AND SHAKING Vibration : 1. gently and high frequency force 2. given during expiration- from the peak of inspiration to full expiration. Shaking : low frequency, like a compression force AIM : REMOVING SECRETIONS TO THE LARGER AIRWAYS.

28. Lobes & segments of the lungs