Postural Drainage Egan pg.

928-933

Learning Objectives
Be able to

Describe the potential benefits of Postural drainage, Percussion and Vibration Describe the proper procedure for each. List contraindications. Use the Clinical Practice Guidelines to find indications, contraindications, etc.

Postural Drainage
A method used in Bronchial Hygiene

Also known as Chest Physiotherapy

Consists of:
Positioning

patient so that gravity drains different areas of the lungs Sometimes Percussion and Vibration are used Patient encouraged to deep breath and cough

Goal
To move secretions so they can be coughed out of lungs

Positions
Body is positioned so target segment of the lung is superior to the carina.
Carina

Body positioned so that this segment of the lung is superior to the carina

Each position is held for 3-15 minutes, depending on the situation

Also see JB Review

pages 310-314

Which positions are chosen?

Conditions such as Cystic Fibrosis may require PD in all positions.
If atelectasis is located in one segment than that segment receives PD Positions are chosen as tolerated by the patient

Percussion
A cupped hand claps on the thorax over the target segment Mechanical devices are available that do the same thing

Vibration
Rapid motion on the thorax with the goal of loosening mucus

Can be done with hands while patient exhales

Also a variety of mechanical devices available

Assess patient
Benefit vs. Risk

Contraindications

Recent injury to spine, head, neck, thorax Active hemorrhage Hemodynamic instability Rib fracture Elderly, frail or unable to tolerate See Clinical Practice Guidelines for complete list of contraindications

May need to modify positions

Assess patient Head down position may be harmful to patients with unstable cardiovascular status hypertension cerebrovascular disorders dyspnea

To avoid gastroesophageal reflux and aspiration

Treatment times at least 1.5 hours after meals or tube feeding

Consider pulse oximetry during treatment

Take vital signs before treatment Be aware of changes during treatment Monitor vitals signs following treatment

When positioning patient watch out for:

I.V. tubing Monitoring equipment Patient oxygen equipment

Postural drainageOutcome assessment How has the patient responded to the therapy?
Change

in sputum production Change in breath sounds Change in dyspnea level Change in vital signs Change in chest radiograph/ABG results Change in ventilator variables

Documentation following procedure

The chart entry should include The positions used Time in positions Patient tolerance Indicators of effectiveness Any untoward effects observed

For example: 11/27/11 0900 PD with percussion to right middle lobe. Patient tolerated for 10 minutes without problem. Cough and deep breathing done. Productive cough of 10 ml. thick yellow sputum j. Kelly R.R.T