POSTURAL DRAINAGE

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.
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
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
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.
 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.
Lung lobes & segments
Position for chest
physiotherapy
Manual techniques
Percussion
 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.
 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.

 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.
 Not tolerated by many post-operatively without
adequate pain control.

 Associated with fall in oxygen saturation.

 Relative C/I –
 Osteoporosis
 Coagulopathy
Vibration & Shaking
 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.

 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