Postural Drainage Egan pg. 928-933
Sep 05, 2014
Postural Drainage
Eganpg. 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 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
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
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
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 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
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