POSTURAL DRAINAGE

POSTURAL DRAINAGE
• Postural drainage is a passive technique, in
which the patient is placed in positions
that allow the bronchopulmonary tree to
be drained with the assistance of gravity.
• Positioning the patient to enable gravity to
assist the flow of bronchial secretions
from the airways has been a standard
treatment for some time in patents with
retained secretions.(Zadai-1981).
• Each lobe to be drained must be aligned so
that gravity can mobilize the secretions
from the periphery to the larger, more
central airway.
• The mechanism of bronchial drainage
considered to be a direct effect of gravity
on secretions.(Lennefors-1992).
• Postural drainage has been shown to be
effective in mobilizing secretions in
patients with cystic fibrosis(Wong, 1977:
Lorin 1971), bronchiectasis(Mazzacco,
1985).
 INDICATIONS

• Lung abscess ( usually)

• Bronchiectasis (often)
• Cystic fibrosis (sometimes).
 CONTRAINDICATIONS
All positions are contraindicated for
the following:
1. ICP more than 20 mm hg
2. Head and neck injury until stabilized,
3. Active hemorrhage with haemodynamic
instability
4. Acute spinal injury
5. Active hemoptysis
6. Empyema
 CONTRA…
7. Aged, confused or anxiety patients,
8. Rib fracture with or with out flail
chest,
9. Bronchopulmonary fistula,
10. Pulmonary edema associated with
chronic heart failure
11. Large pleural effusion
12. Pulmonary embolism,
13. Surgical wound or healing tissue.
 CONTRA…
Trendulenburg position is
contraindicated for the following
1. Patients in whom increased ICP to be
avoided,
2. Uncontrolled hypertension,
3. Distended abdomen,
4. Esophageal surgery,
5. Recent gross hemoptysis related to
recent lung carcinoma,
6. Uncontrolled airway at risk for
aspirations.
 CONTRA…

– Trendulenburg position increases ICP in

neurosurgery patients.( Humberstone,
1990).
– However if the patient develops
atelectasis, the stress of the
respiratory embarrassment may also
increase ICP in this instance, tip the
patient to clear the atelectasis and then
subsequently to a modified conservative
regimen.( Frownfelter 1987).
 A fall in arterial oxygen saturation has
been reported with the use of postural
drainage(Selsby 1990, Huerby 1976).
• Therefore oxygen saturation levels should
be monitored during treatment, most
importantly in those patients with known
low Pao2 values.
• In pediatric population some experts
recommend caution with the position used
to treat the anterior lower lobes because
of risk of gastroesophageal reflux.
 EQUIPMENT REQUIRED
• For hospitalized patients: variety of beds
that employ manual or electric devices to
position the patient.
• Air therapy beds for ICU patients.
• Pillows,
• Bed rolls.
• Home treatment:
• Pillows, slant board, foam wedge, sofa
cushions, or a bean bag chair.
 PREPARATION FOR PD
• Nebulized bronchodilators before postural
drainage (to facilitate the mobilization of
sputum)
• Adequate intake of fluids(decrease the
viscosity of secretions) not immediately
before treatment.
• Familiar with the positions, model of the
bed, in ICU, multiple lines, leads, tubes
attached to patients.
• Suction equipment to remove secretions
from artificial airways or patient oral or
nasal cavity after the treatment.
 TREATMENT WITH PD
• Timing depends on the individual but PD in
the early mornings help clear the nights
accumulated secretions, PD can hour
before sleep reduces night coughing
• Avoid after meals
• If bronchodilators prescribed taken
before fifteen minutes
• The most affected area is drained first to
prevent infected secretions spilling in to
healthy lung.
 Treatment…
• After determining the lobe of the lung to
be treated, position the patient
comfortably appropriate position, using
pillows or bed rolls.
• Ideal drainage time for each patient
position is ten minutes
• If the whole lung is affected, each lobe
require drainage, maximum 3 positions at a
session keeps it tolerable
 Treatment…
• Patient should be encouraged to take deep
breaths and cough after the treatment or
each position.
• Sitting upright or leaning forward optimize
this position.(Frownfelter 1987)
• Secretions may not be mobilized
immediately but possible half an hour to
one hour later. The patient should be
informed to clear it then.
POSTURAL DRAINAGE
POSTIONS:
 EFFECTS OF PD
• PD is effective if it provides relief of long
term benefit. It is unhelpful if patients
find it uncomfortable of unacceptably
inconvenient.
• Wong et al 1977, thin mucus is more
responsive to gravity than thick mucus, in
cystic fibrosis patients, mucus in the
large airways is responsive to gravity in
smaller airways surface forces may limit
the drainage.
• Mortensen et al(1991):Have shown that
total clearance is unchanged several hours
after treatment.
 Effects…
• Tannenbaum and Davids 1995 cost doubt
on the ability of gravity to influence thick
secretions and Lannfors 1992 found
surprisingly that dependant lung showed
greater clearance than non dependant lung.
• The rationale may be that the greater
ventilation in dependent regions
encourages movement of secretions by
mechanical squeezing
 ADVANTAGES
• Easy to learn
• Cost of equipment is minimal and
inexpensive lites may be used for home
treatment.
• Decrease the expense and flexibility in
scheduling
• Treatment in hospital can be coordinated
with other patient activities positioning
for pressure relief, bathing or positioning
for a test procedure
 DISADVANTAGES
• For may patients pd positions is
contraindicated for various reasons
• Compliance with pd may be reduced
because of the length of the
treatment, especially in pediatric
population who will require
considerable distraction to maintain a
desired position.