2. Definition
Postural drainage (bronchial drainage), is an
intervention for airway clearance by mobilizing
secretions in one or more lung segments to
the central airway by placing the patient in
various positions so gravity assists in the
drainage process.
It is effective in cystic fibrosis, bronchiectasis,
& other pulmonary diseases.
3. Goals & indications
Prevent accumulation of secretions in patients at risk of
pulmonary complications :-
Diseases with increased production or viscosity of
mucus
Prolonged bed rest
Who has received general anaesthesia
Painful incision causing restricted deep breathing &
coughing
Patients on ventilator
Remove accumulated secretions from the lung :-
Acute or chronic lung disease
Generally weak or elderly people
Patients with artificial airways
4. Contraindications
Severe hemoptysis
Untreated acute conditions
Severe pulmonary edema
Congestive heart failure
Large pleural effusion
Pulmonary embolism
pneumothorax
Cardiovascular instability
Cardiac arrhythmias
Severe hypertension or hypotension
Recent MI
Unstable angina
Recent neurosurgery
Head down position may cause increased ICP – use modified
positions
5. Preparation
All the patients do not require postural drainage
for all the lung segments. So the procedure must
be based on the clinical findings.
In postural drainage, the person is tilted or
propped at an angle to help drain secretions from
the lungs.
The lower lobes require drainage most frequently
because the upper lobes drain by gravity.
Before postural drainage, the client may be given
a bronchodilator medication or nebulization
therapy to loosen secretions.
6. Postural drainage treatments are scheduled
two or three times daily, depending on the
degree of lung congestion.
The best times include before breakfast,
before lunch, in the late afternoon, and before
bedtime.
It is best to avoid hours shortly after meals
because postural drainage at these times can
be tiring and can induce vomiting.
24. Chest clapping
Rhythmical force is applied with the cupped hands
against the thorax, over the involved lung
segment, trapping air between patient’s thorax &
caregiver’s hands.
Aim – dislodging or loosening bronchial secretions
from airways.
Performed during both inspiratory & expiratory
phase of breathing.
Used during PD & also during ACBT to increase
its effectiveness.
25. Mechanism – transmission of wave of energy
through chest wall to lungs – wave loosens
secretions from bronchial wall – moves them
proximally – removal of secretions.
Handheld percussor can also be used.
Pediatrics – use padded rubber nipple, pediatric
face mask, padded medicine cups, bell of
stethoscope.
Use towel or patient’s gown to cover skin.
26. Sound of percussion should be hollow.
Even & steady rhythm – 100 – 480 times/min.
Force should be equal B/L & to the patient’s comfort.
Infants – use 4 fingers cupped, 3 fingers with middle
finger tented or thenar & hypothenar surface of hand.
Should not be done on bony prominences, breast
tissue – discomfort & reduce effectiveness of treatment.
27. Not tolerated by many post-operatively without
adequate pain control.
Associated with fall in oxygen saturation.
Relative C/I –
Osteoporosis
Coagulopathy
29. Opposite ends of spectrum.
Vibration –
Gentle high frequency force
Delivered through sustained co-contraction of
caregiver’s UE to apply vibratory force.
Shaking –
Vigorous
Similar to vibration but is a bouncing maneuver, also
referred as rib springing – supplying concurrent
compressive force to chest wall.
Performed only during expiration.
30. Enhances mucociliary transport from periphery to
central airways.
Produces increased chest wall displacement & stretch
of respiratory muscles may produce increased
inspiratory effort & lung volumes.
Mechanical vibrators can also be used.
Infants – padded electric tooth brush.
Advantages –
Better tolerated than percussion
Allows to assess pattern & depth of respiration
