Postural drainage

Apical Post
segment segment
upper lobe upper lobe

Ant
segment Apical segment lower
upper lobe lobe

Ant
segment Lower segment lower
lower lobe lobe

Lateral segment lower

lobe
Definitions
• Postural drainage, also known as bronchial drainage, is a passive
technique in which the patient is placed in positions that allow gravity
to assist with the drainage of secretions from the bronchopulmonary
tree.
• PD is accomplished by positioning the patient so that the angle of the
lung segment to be drained allows gravity to have its greatest effect
• Positioning the patient to assist the flow of bronchial secretions from
the airways has been a standard treatment for some time in patients
with retained secretions.
• PD has been shown to be effective in mobilizing secretions in patients
with cystic fibrosis, bronchiectasis,10 and other pulmonary diseases.
• Other treatments, such as percussion, vibration, and the active cycle
of breathing technique (ACBT), may be used while the patient is in
postural drainage positions.
 Preparation for Postural Drainage
• For the hospitalized patient, electric beds allow patients to be positioned more easily.
• Air therapy beds, most often used in the intensive care unit (ICU), are valuable aids for positioning,
especially in patients who are large or unresponsive.
• In the ICU, it is imperative to be familiar with the multiple lines, tubes, and other devices attached to
the patient. Allow enough slack from each device to position a patient for postural drainage.
• Ensure there are enough staff members to position the patient with as little stress to both patient and
staff as possible.
• For treatment in the clinic, have foam wedges or pillows available for positioning.
• For home treatment, aids in positioning might include pillows, sofa cushions, or a bean-bag chair.
• Nebulized bronchodilators or mucolytics before PD may facilitate the mobilization of sputum.
• For the patient with an adequate cough to expectorate secretions, have tissues or a specimen cup
available.
• Have suctioning equipment ready to remove secretions from an artificial airway or the patient’s oral or
nasal cavity after the treatment.
 Treatment for postural drainage
• After determining the lobe of the lung to be treated by auscultation and chest x-ray, position the patient in
the appropriate position, supporting the patient comfortably in the position indicated (see Figure 21-2).
• If postural drainage is used exclusively, each position should be maintained for 5 to 10 minutes, if
tolerated, or longer when focusing on a specific lobe.
• If postural drainage is used in conjunction with another technique, the time in each position may be
decreased. For example, if percussion and vibration are performed while the patient is in each PD position,
3 to 5 minutes is sufficient.
• It is not always necessary to treat each affected lung segment during every treatment;
• The patient should be encouraged to take deep breaths and cough after each position, if possible, and
again after the treatment is completed.
• Having the patient sit upright or lean forward optimizes this effort by allowing the use of the abdominals
for a stronger cough.
• Mobilization of secretions may not be apparent immediately after the treatment, but this may occur up to 1
hour later. The patient should be thus informed and reminded to clear secretions at a later time.
Advantages and disadvantages of PD
• Postural drainage is relatively easy to learn; the patient and/or
caregiver must be familiar with the appropriate positioning for the
affected lung fields.
• Treatment in the hospital may be coordinated with other patient
activities, such as positioning for skin pressure relief, bathing, or
positioning for a test or procedure.
• Home treatment can be coordinated with activities such as reading or
watching television.
 Advantages and disadvantages of PD
• For many patients, optimal PD positions will be contraindicated for a variety of reasons
and modified positions should be used.
• Adherence to PD may be a challenge because of the length of the treatment; this is
especially challenging in the pediatric population, who will require considerable distraction
to maintain a desired position for the appropriate length of time.
• Children who are able to role-play the treatment—for instance, with a doll or stuffed toy—
may better understand what is expected and be more cooperative with therapy.
• The cost of the equipment required for PD is minimal.
• The cost of a caregiver’s time to provide the treatment, however, especially in the case of a
chronic disease, may be substantial.
• A family member should be taught the procedure, if possible, to decrease the cost and
provide flexibility in scheduling.
Contraindication of PD
Upper lobe Middle lobe

Lower lobe