POSTURAL DRAINAGE

POSTURAL DRAINAGE

▪ Chest physiotherapy consists of physical maneuvers such as

cough, chest wall percussion, vibration and shaking and
postural drainage.
▪ Postural drainage is achieved by positioning the client so
that the position of the lung segment to be drained allows
gravity to have its greatest effect.
▪ It achieves gravitational clearance of airway secretions
from specific bronchial segments by using several different
positions.
 POSTURAL DRAINAGE

▪ Each position drains a specific corresponding section of

tracheobronchial tree, wither from upper, middle, or lower
lung field into the trachea.
▪ Areas are selected for drainage based on:
▪ a) knowledge of client’s condition and disease process;
▪ b) physical assessment of the chest;
▪ c) chest x-ray examination results;
▪ d) extent of pathologic condition and lobe involvement
based on physical examination and chest x-ray findings.
 POSTURAL DRAINAGE

▪ Each position drains a specific corresponding section of

tracheobronchial tree, wither from upper, middle, or lower
lung field into the trachea.
▪ Areas are selected for drainage based on:
▪ a) knowledge of client’s condition and disease process;
▪ b) physical assessment of the chest;
▪ c) chest x-ray examination results;
▪ d) extent of pathologic condition and lobe involvement
based on physical examination and chest x-ray findings.
 ASSESSMENT
Determine presence of indications for postural drainage:
1. ineffective coughing
2. thick or sticky secretions that are difficult to cough up
3. abnormal breath sounds; increased vocal fremitus or complete loss/decrease of breath sounds
Determine presence of contraindications to procedure
1. Trendelenburg’s position
2. head injuries
3. increased intracranial pressure
4. recent MI
5. lung hemorrhage
6. certain surgical procedures
7. pain
8. traction
Nursing Diagnoses:
1. Ineffective Airway Clearance
2. Ineffective Breathing Pattern
3. Impaired Gas Exchange
 PLANNING
Prepare all the materials and supplies needed for the procedure:
1. Trendelenburg’s hospital bed or tilt table is used for client’s positioning
2. Water pitcher and glass for fluid intake
3. Chair (for draining upper lobes) for positioning
4. One to four pillows for support and comfort.
5. Tissues and paper bag for secretions
 IMPLEMENTATION
1. Identify client and explain the purpose of doing the procedure.
2. Encourage high fluid intake program if not contraindicated by other diseases
3. Plan treatments so they do not overlap with meals or tube feeding.
4. Put tissues and paper bags for secretions within reach of the client
5. Schedule the treatments at appropriate times of the day.
6. Perform handwashing
7. Select congested areas to be drained and position client appropriately:
 IMPLEMENTATION
Left and right upper lobe anterior apical bronchi
1. Have the client sit on a chair, leaning back
2. Percuss and vibrate with heel of the hands at shoulders and fingers over the collarbones
(clavicles) in front.
3. Nurse’s back is kept straight, elbows and knees are slightly flexed.
Left and right upper lobe posterior apical bronchi
1. Have the client sit on a chair, leaning forward on a pillow or table.
2. Percuss and vibrate with hands on either side of the upper spine.
Right and left anterior upper lobe bronchi
1. Have the client lie flat on his/her back with a small pillow under the knees.
2. Percuss and vibrate just below the clavicle on either side of the sternum.
Left upper lobe lingular bronchus
1. Have the client lie on the right side with the arm over the head in Trendelenburg’s position
with foot of the bed raised 30 cm (12 in)
2. Place a pillow behind the back and roll the client one-quarter turn onto the pillow.
3. Percuss and vibrate lateral to left nipple below the axilla.
Right middle lobe bronchus
1. Have the client lie on his/her left side with the foot of the bed raised 30 cm (12 in)
2. Place a pillow behind the back and roll the client one-quarter turn onto the pillow.
3. Percuss and vibrate the right nipple below the axilla
Left and right anterior lower lobe bronchi
1. Have the client lie on her back in Trendelenburg’s position with the foot of the bed
elevated 45-50 cm (18-20 in). Have knees bent on a pillow.
2. Percuss and vibrate over the lower anterior ribs on both side
Right lower lobe lateral bronchi
1. Have the client lie on her left side in Trendelenburg’s position with the foot of the bed
elevated 45-50 cm (18-20 in).
2. Percuss and vibrate on the right side of the chest below the scapula. (posterior to
midaxillary line)
 IMPLEMENTATION
Left lower lobe lateral bronchi
1. Have the client lie on her right side in Trendelenburg’s position with the foot of the bed
elevated 45-50 cm (18-20 in).
2. Percuss and vibrate over the lower anterior ribs on both side
Right and left lower lobe superior bronchi
1. Have the client lie on his/her stomach with a pillow under the abdomen.
2. Percuss and vibrate below the scapula on either side of the spine.
Left and right posterior basal bronchi
1. Have the client lie on his/her stomach in Trendelenburg’s position with foot of the bed
elevated 45-50 cm (18-20 in)
2. Percuss and vibrate over the lower posterior ribs on either side of the spine.
 IMPLEMENTATION
1. Have the client maintain posture for 10-15 minutes.
2. During the 10-15 minutes of drainage in each posture, perform chest percussion, vibration and
shaking over the area being drained.
3. After 10-15 minutes of drainage in the first posture, have the client sit up and cough.
4. Have client rest briefly between postures.
5. Have the client take sips of water.
6. Performs hand hygiene is an infection-control technique that minimizes cross-contamination.
 EVALUATION
Observe for expected outcomes:
1. Lung sounds improve or become clear
2. Sputum is more easily expectorated
3. Secretions appear more normal in color and consistency
4. Dyspnea is decreased
 VIDEO LINK

https://youtu.be/CdXP44yl6aY

https://youtu.be/KqS6n-7JL40

https://youtu.be/LJU_zVMnF3o