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Postural Drainage Egan pg. 928-933
32

Power Point Postural Drainage

Sep 05, 2014

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Tabby Mendence
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Page 1: Power Point Postural Drainage

Postural Drainage

Eganpg. 928-933

Page 2: Power Point Postural Drainage

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.

Page 3: Power Point Postural Drainage

Postural DrainageA 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

Page 4: Power Point Postural Drainage

Goal

To move secretions so they can be coughed out of lungs

Page 5: Power Point Postural Drainage

Positions

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

Carina

Page 6: Power Point Postural Drainage

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

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

Also see

JB Review

pages 310-314

Page 8: Power Point Postural Drainage

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

Page 9: Power Point Postural Drainage

Percussion

A cupped hand claps on the thorax over the target segment

Mechanical devices are available that do the same thing

Page 10: Power Point Postural Drainage

VibrationRapid 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

Page 11: Power Point Postural Drainage

Assess patient

Benefit

vs.

Risk

Page 12: Power Point Postural Drainage

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

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May need to modify positions

Assess patient

Head down position may be harmful to patients with …

unstable cardiovascular status hypertension cerebrovascular disorders dyspnea

Page 28: Power Point Postural Drainage

To avoid gastroesophageal reflux and aspiration

Treatment times at least 1.5 hours after meals

or tube feeding

Page 29: Power Point Postural Drainage

Consider pulse oximetry during treatment

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

Page 30: Power Point Postural Drainage

When positioning patient watch out for:

I.V. tubing

Monitoring equipment

Patient oxygen equipment

Page 31: Power Point Postural Drainage

Postural drainage…Outcome assessment

How has the patient responded to the therapy?

Change in sputum productionChange in breath soundsChange in dyspnea levelChange in vital signsChange in chest radiograph/ABG

resultsChange in ventilator variables

Page 32: Power Point Postural Drainage

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:For example:11/27/1111/27/1109000900PD with percussion to right PD with percussion to right middle lobe. Patient middle lobe. Patient tolerated for 10 minutes tolerated for 10 minutes without problem.without problem.Cough and deep breathing Cough and deep breathing done. Productive cough of done. Productive cough of 10 ml. thick yellow sputum10 ml. thick yellow sputum j. Kelly R.R.Tj. Kelly R.R.T