Postura

Postural drainage
l
Postural Drainage
drainag
– A passive technique in which the patient is placed in position that allow gravity to assist with the
drainage of secretions from the bronchopulmonary tree.
– Assumption of one or more body positions that allow gravity to assist with draining secretions from
each lung segment
– Positions can be modified to address precaution or relative contraindication
– Positioning requires adjustable bed, pillows, blanket rolls
– Priority given to treating most affected lung segment first (largest & most profound consolidation)
– Encourage deep breathing and coughing
o Breathe/Cough, Breathe/Cough, Breathe/Cough
 PRECAUTIONS AND RELATIVE CONTRAINDICATIONS FOR PERCUSSION & VIBRATION
– Never put someone in trendelenburg & leave the room

1. what
patients benefit from Postural drainage
– cystic fibrosis
– bronchiectasis
2. How long typically does a patient stay in when getting a treatment with postural drainage ?
– 5-10min
3. If postural technique is used in conjunction with another technique like vibration, how long should the
treatment be?
– 3-5 min
4. Precautions and contraindication to PT?
– trendelenburg postion (needs to be modified due to increases in intracranial pressure)
 – decrease in atrial )2 saturation
– end stage lung disease
– avoid head down position in infants
5. a rhythmical force is applied with a caregivers cupped hands against the thorax, over the involved lung
segments, trapping air between the pt's thorax and the caregivers hands
– percussion
6. What is the goal of percussion?
– To loosen bronchial secretions from the airways
7. When is percussion performed during the breathing process?
– inspiration and expiration
8. Patient with pulmonary disease which combination of treatments is a mainstay?
– postural drainage with percussion
9. How many steady rhythmic manual percussions be delivered?
– 100 to 480 times per min
10. In infants is it appropriate to use cusped hands on their thorax?
– No- use four fingers
11. Which patients would percussion be contraindicated in?
– postoperative pt's
– -osteoporosis
– -coagulopathy
12. Purpose of postural drainage?
– To empty the bronchi of accumulated secretions. Position to promote a downward drainage of
a bronchial branch and the lung segment it supplies.
13. Drainage is most efficient from (smaller/larger) bronchi?
– Smaller bronchi to larger bronchi. Drain every involved lung segment
14. Goal of postural drainage:
– Goal is to get the patient to cough during or after each position.
15. How can postural drainage be helped? how?
– Vibrating or Shaking
– Manually (use stretched arms and co-contracting)
– Mechanically (vest)
– Pummeling (Clapping chest wall, cupped hands, perpendicular to chest wall)
16. What are 4 other ways to help postural drainage?
 – Actively coughing drained secretions
– Suctioning
– Developing a proper breathing patter
– Inhalation treatment (Nebulizers, Bronchodilators)
17. How often should you do postural drainage for CF patients?
– For CF patients at least once each 24 hr. period.
– 2x/day: Before breakfast, Before bed (1 hr after eating)
18. How long should you hold each position?
– Hold each position for a minimum of 3-minutes
– If large amounts of drainage from a particular area occur, maintain the position for a longer
period.
– Important for proper drainage
19. How should you identify specific lung segments?
– auscultation
20. After each position?
– Encourage coughing after each position. Allow rest after coughing.
21. Mechanical devices:
– Mechanical devices are replacing clapping and vibration.
– Vibration Vest
– Hand Held Percussion (Electric percussor)
22. Precautions with positioning in supine trendelenburg: (3)
– Trandelenburg not indicated for patients with:
 Pulmonary edema
 CHF
 HTN
23. Precautions with supine positioning and abdomen problems: (5)
– Obesity
– Abdominal distention
– Hernias
– Nausea or recent meal
– SOB may increase
24. Precautions with side-lying positioning: (5)
– Musculoskeletal problems:
 – arthritis
– osteoporosis
– recent rib fx
– shoulder bursitis or just plain uncomfortable
25. What are other precautions with positioning? (3)
– Blood clotting disorders (low platelet, increased coag time)
– Musculoskeletal precautions
– Pathological fractures (osteoporosis)
26. What patients need suction?
– Used for patients with a tracheotomy who cannot clear their own secretions through coughing.
27. What technique to use for suction:
– Use sterile technique to prevent infections when handling catheter
28. Precautions of suctioning:
– Precautions to prevent injury of esophagus or respiratory tract. Have the clinic train you in
their protocol
29. Which phase of breathing is vibration and shaking performed?
– expiration
30. What is the frequency of the shaking
– 2 Hz
31. At the peak of inspiration, apply a slow rhythmic bouncing pressure to the chest wall until the end of
expiration. How long should this be?
– 2 times per second
32. The goal with these patients is to teach them to relax the neck and chest accessory muscles and use
more diaphragmatic breathing (abdominal and lateral costal breathing) to reduce the work of breathing
in combination with relaxed pursed-lips breathing and prolonged exhalation.
– Patients with primary lung disease tend to overuse their accessory muscles and greatly increase
the work of breathing secondary to shortness of breath or coughing.
33. What specific patient population would you administer PLB too?
– COPD
34. What are the four stages of cough
– 1) Adequate Inspiration
– 2) Glottal Closure
– 3) Building intra-abdominal pressure
 – 4) Glottal opening and expulsion
35. How do you manually mobilized the thorax?
– Use of towel rolls or pillows to mechanically open up the anterior or lateral chest wall
– Use of upper extremity patterns to facilitate the opening of individual rib segments
– Counter-rotation of the trunk
– Use of ventilatory-movement strategies to facilitate opening of the entire thorax
– Specific rib mobilization to free up an individual segment
– Myofascial release techniques to free up restrictive connective tissue on and around the thorax
– Soft-tissue release techniques to lengthen individual tight muscles
36. Which type of treatment would be used to asthma patients?
– Autogenic Drainage and active cycle breathing
37. An "anti-dyspnea" technique based on quiet expirations in a relaxed state and without use of postural
drainage positions
– autogenic Drainage
38. What are the three stages of autogenic Drainage ?
– The first phase starts with a normal inspiration : Unstick
– Second phase is followed by a breath hold to ensure equal filling of lung segments by collateral
filling : Collect
– Third phase then a deep exhalation is made into the expira- tory reserve volume range. :
Evacuate
39. Breakdown of the elastic tissue in the bronchial walls, causing severe dilation; Inflamed mucosa and
copious purulent secretions are present in this condition
– Bronchiectasis
40. Caused by collapse of alveolar segments, often by retained pulmonary secretions
– Atelectasis
41. Patients with neurological or metastatic diseases or general debilitation will develop this
– Respiratory muscle weakness
42. Patients that unable to manage secretions independently are in need of airway clearance techniques.
What do these patients typically have to be on to stay alive?
– Mechanical ventilation
43. Infants born without surfactant in lungs --> results in atelectasis
– Neonatal respiratory distress syndrome
44. Presence of hyperactive airways and mucus plugging
 – Asthma
45. Genetic disease of exocrine gland. Copious, thick secretions and mucus plugs block the peripheral and
central airways
– Cystic Fibrosis
46. What are the three ventilatory phases in active cycle breathing technique
– breathing control
– thoracic expansion
– forced expiratory technique
47. Know as self drainage. This consists of 3 main phases ?
– Autogenic Drainage
o Unsticking phase
o Collecting phase
o Evacuating phase
48. What are the five airway clearance techniques
– Postural Drainage
– Vibration
– Shaking
– Active Cycle of Breathing
– Autogenic Drainage

P o s t u r a l dr a i n a g e p o s i t i o n
 R LOWER LOBE - LATERAL SEGMENT
– Patient lies on the left side in a 45 degree head-down position. Percussion is applied over the lower
lateral aspect of the right rib cage.
 L LOWER LOBE - LATERAL SEGMENT
– Patient lies on the right side in a 45 degree head down position. Percussion is applied over the lower
lateral aspect of the left rib cage
 R/L LOBES - POSTERIOR SEGMENTS
– Patient lies prone with a pillow under the abdomen in a 45 degree head-down position. Percussion is
applied bilaterally over the lower portion of the ribs
 R/L LOWER LOBES - ANTERIOR SEGMENTS
– Patient lies supine, pillows under knees, in a 45 degree head-down position. Percussion is applied
bilaterally over the lower portion of the ribs
 R/L LOWER LOBES - SUPERIOR SEGMENTS
– Patient lies prone with a pillow under the abdomen to flatten the back. Percussion is applied
bilaterally, directly below the scapulae
 R MIDDLE LOBE
– Patient lies one-quarter turn from supine on the left side, supported with pillows behind the back, and
in a 30 degree head-down position. Percussion is applied under the R breast
 L LINGULA LOBE
– Patient lies one-quarter turn from supine on the right side, supported with pillows and in a 30 degree
head-down position. Percussion is applied just under the L breast
 R/L UPPER LOBES - ANTERIOR APICAL SEGMENTS
– Percussion is applied directly under the clavicle
 R/L UPPER LOBES - POSTERIOR APICAL SEGMENTS
– Percussion is applied above the scapulae. Your fingers curve over the top of the shoulders
 L UPPER LOBE - POSTERIOR SEGMENT
– Patient lies one-quarter turn from prone and rests on the right side. Head and shoulders are elevated 45
degrees or approximately 18 inches if pillows are used. Percussion is applied directly over the left
scapula
 R UPPER LOBE - POSTERIOR SEGMENT
– Patient lies flat and one-quarter turn from prone on the left side. Percussion is applied directly over the
right scapula
 R/L UPPER LOBE - ANTERIOR SEGMENTS
– Percussion is applied bilaterally, directly over the nipple or just above the breast