Postural drainage

Deblina Roy
M.Sc. Nursing 1st year
K.G.M.U Institute of Nursing

 define postural drainage
 describe the various lobes of the
lungs
 discuss the components of postural
drainage
 describe the settings of the
postural drainage
 enumerate the indications and
contra indications of postural
drainage
 describe the steps of the
procedure
 describe the hazards ,limitations
 discuss the nursing care for the
procedure.

 Postural drainage therapy is
designed to improve the
mobilization of bronchial
secretions and the matching of
ventilation and perfusion, and to
normalize functional residual
capacity based on the effects of
gravity and external manipulation
of the thorax. This includes
turning, postural drainage,
percussion, vibration, and cough.

Turning
Postural drainage
External manipulation
of the thorax
1. Percussion
2. Vibration
Components of
postural drainage
therapy

Critical care
 In-patient acute care
 Extended care and
skilled nursing facility
care
 Home care
 Outpatient/ambulator
y care
 Pulmonary diagnostic
(bronchoscopy)
laboratory
Postural drainage
therapy
SETTING:

Turning:
1. Inability or reluctance
of patient to change
body position. (eg,
mechanical ventilation,
neuromuscular disease,
drug-induced paralysis)
2. poor oxygenation
associated with
position (eg, unilateral
lung disease)
3. potential for or
presence of atelectasis
4. presence of artificial
airway.

Postural drainage:
1. evidence or suggestion of
difficulty with secretion
clearance
2. difficulty clearing secretions
with expectorated sputum
production greater than 25-
30 mL/day (adult)
3. evidence or suggestion of
retained secretions in the
presence of an artificial
airway
4. presence of atelectasis
caused by or suspected of
being caused by mucus
plugging
5. diagnosis of diseases such
as cystic fibrosis,
bronchiectasis, or cavitating
lung disease
6. presence of foreign body in
airway

External
Manipulation of the
Thorax
1. sputum volume
or consistency
suggesting a
need for
additional
manipulation

 Positioning
 All positions are contraindicated for
 intracranial pressure (ICP) > 20 mm
Hg(59,60)
 head and neck injury until stabilized (A)
 active hemorrhage with hemodynamic
instability (A)
 recent spinal surgery (eg, laminectomy)
or acute spinal injury
 acute spinal injury or active hemoptysis
 empyema
 bronchopleural fistula
 pulmonary edema associated with
congestive heart failure
 large pleural effusions
 pulmonary embolism
 aged, confused, or anxious patients who
do not tolerate position changes
 rib fracture, with or without flail chest
 surgical wound or healing tissue

 Trendelenburg position is
contraindicated for
 intracranial pressure (ICP) > 20 mm
Hg
 patients in whom increased
intracranial pressure is to be avoided
(eg, neurosurgery, aneurysms, eye
surgery)
 uncontrolled hypertension
 distended abdomen
 esophageal surgery
 recent gross hemoptysis related to
recent lung carcinoma treated
surgically or with radiation therapy
 uncontrolled airway at risk for
aspiration (tube feeding or recent
meal)

 Reverse Trendelenburg is
contraindicated in the presence of
hypotension or vasoactive
medication

 based more on tradition and
anecdotal report than on scientific
evidence
 Airway clearance may be less than
optimal in patients with ineffective
cough.
 Optimal positioning is difficult in
critically ill patients.

 bed or table that can be adjusted
for a range of positions from
Trendelen-burg to Reverse
Trendelenburg position
 pillows for supporting patient
 light towel for covering area of
chest during percussion
 tissues and/or basin for collecting
expectorated sputum
 suction equipment for patients
unable to clear secretion
 gloves, goggles, gown, and mask as
indicated for caregiver protection
 optional: hand-held and
mechanical percussor or vibrator
 oxygen delivery device
 recent chest x-ray, if available
 stethoscope for auscultation

 excessive sputum production
 effectiveness of cough
 history of pulmonary problems
treated successfully with PDT (eg,
bronchiectasis, cystic fibrosis, lung
abscess)
 decreased breath sounds or
crackles or rhonchi suggesting
secretions in the airway
 change in vital signs
 Abnormal chest x-ray consistent
with atelectasis, mucus plugging,
or infiltrates
 deterioration in arterial blood gas
values or oxygen saturation

Turning
Postural
drainage
therapy

Assessment
Diagnosis
Goal
Planning
Intervension
evaluation

 Potter PA. Perry AC. Fundamentals
of nursing 7th ed.
Elsevir,Mosby.New york:2012 Pp-
265-78
 Pryor JA, Webber BA. An
evaluation of the forced expiration
technique as an adjunct to postural
drainage. Physiotherapy
1979;65(10):305-307.
 Bateman JRM, Newman SP, Daunt
KM, Pavis D, Clarke SW. Regional
lung clearance of excessive
bronchial secretions during chest
physiotherapy in patients with
stable chronic airways obstruction.
Lancet 1979;1:294-297.
 Postural drainage Wikipedia free
encyclopedia . available from
http:// postural drainage

Postural drainage

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