POSTURAL DRAINAGE

Definition: Postural drainage is a technique in which different positions are assumed to

facilitate the drainage of secretions from the bronchial airways.
Gravity helps to move the secretions to the trachea to be coughed up easily.

PURPOSE:
• To maintain full expansion of lungs by taking out the secretion from the lowest part of the
lung
• To prevent collapse & consolidation

INDICATIONS:

• Preoperative patients with excessive secretions by any cause such as chronic bronchitis,
smoking etc
• Post-operative patients with excessive secretions
• Bronchial or lobar pneumonia
• Lung abscess
• Any disease process in which abnormal sputum is produced & the patient is prone to
recurrent infection
• When the patient is unable to initiate a voluntary cough or effort to expel the sputum

CONTRAINDICATIONS:

• Patient who had, increased cyanosis & exhaustion during earlier postural drainage
• Patient with increased intra cranial pressure & head injury.

POSTURAL DRAINAGE POSITION:

Lung Segment Position Recommended Purpose

Self-Percussion -- Upper Lobes  Sit upright and reach across his or her To facilitate
chest to clap on front of chest over the easy
muscular area between the collarbone and breathing.
the top of the shoulder blade. Repeat on
the opposite site, can also clap his or her
own upper back if able to reach it. 

Upper Front Chest -- Upper Sit upright. Clap on both sides of the To clear the
Lobes upper front chest over the muscular area airway and
between the collarbone and the top of the to collect
shoulder blade. the sputum.

Upper Back Chest -- Upper Have the patient sit up and lean forward Vibration
Lobes  on a pillow over the back of a sofa or soft and cupping
chair at a 30-degree angle. Stand or sit frees the
 behind your child and clap both sides of mucus from
the upper back. Take care not to clap on bronchial
patient’s backbone.  walls.

Upper Front Chest -- Upper Have the patient lie on his or her back To facilitate
Lobes  with arms to sides. Stand behind your easy
child's head. Clap both sides of patients breathing.
chest between the collarbone and nipple.

Left Side Front Chest  Have the patient lie with left side up and To drain out
raise his or her left arm overhead. Clap secreations.
over the lower ribs just below the nipple
area on the front side of left chest. Do not
clap on patients stomach.

Right Side Front Chest  Have the patient lie with right side up and To drain out
raise his or her right arm overhead. Clap secreations
over the lower chest just below the nipple and easy
area on the front side of right chest. Do breathing.
not clap patients lower ribcage. 

Lower Back Chest -- Lower Have the patient lie on his or her Vibration
Lobes  stomach. Clap both sides at the bottom of and cupping
his or her chest just above the bottom frees the
edge of the ribcage. Do not clap the lower mucus from
ribcage or over the backbone.  bronchial
walls.

Left Lower Side Back Chest -- Have the patient lie with left side up and To facilitate
Lower Lobe  roll toward you a quarter turn so you can easy
reach your child's back. Clap on the breathing.
lower left side of his or her chest just
above the bottom edge of the ribcage. 

Right Lower Side Back -- Lower Have the patient lie with right side up and To drain out
Lobe  roll toward you a quarter turn so you can secreations.
reach your child's back. Clap on the
 lower right side of his or her chest just
above the bottom edge of the ribcage. 

Preparation of Articles and their Purposes:-

Articles required Rational

 A mouth wash To wash the mouth, if the patient has
vomited
 A pillow To support the patient in different
positions
 A small hand towel To wipe the face

 A screen To maintain privacy of the patient

 A kidney tray or a sputum cup. To spit out sputum

 A chair or foot stool for proper To give comfort to the patient

height to be used to support hands.

Steps of Procedure:-

Steps Rational
- Identify the patient and check Performs correct procedure for the right patient.
physician’s order for specific
instructions for postural drainage.
- Explain the procedure and screen the To reassure the patient and to give confidence to him
patient.
-Wash the hands and dry. Reduce transmission of infection.
- Continue treatment by sequential
positioning for 10 min.
-Watch the patient repeatedly for To detect and prevent adverse effects. To give
signs of collapse, fatigue, breathing comfort and confidence to the patient.
pattern. Put him in a comfortable
position immediately.
-Carry the procedure before meals or Postural drainage may stimulate gagging and
after two hours of meal. The best time vomiting.
is early in the morning.
-the length of treatment depends on To avoid complications and fatigue.
the tolerance of the patient.
-Proper position to be provided along For adequate drainage to reassure the patient of nurses
with cupping or vibration technique. presence.
-Periodically the patient is encouraged To clear the airway and to collect the sputum.
to cough and spit out in the sputum
 cup provided.
-After procedure give a mouth wash to To clean and provide comfort to the patient. For
the patient anaesthetic sence
-Supportive measures like steam To loosen the secretions.
inhalation could be given to the
patient, if need be.
Record the effects of procedure to the To follow up for further treatment.
patient, date and time

After Care:-

• Patient should be advised to practice oral hygiene procedure to decrease the bad taste
and odor.
• Record the procedure
• Report all significant findings
• Disinfect all non disposable equipment used and store appropriately