WHAT IS POSTURAL DRAINAGE ?
B ) HOW WOULD YOU PREPARE A PATIENT FOR POSTURAL DRAINAGE ?
C ) IN WHAT CONDITIONS DOES THIS HELP ?
A 5 INTRODUCTION / DEFINITION
1 Postural drainage is getting in positions that make it easier for mucus to drain.
2 In this , The patient’s body is positioned so that the trachea is inclined downward and below the affected chest area
3 It is done at least three times daily for up to 30 minutes.
4 It can be done in the night to reduce coughing at night (although PD should be avoided after meals) or in the morning to clear accumulated secretions during the night.
5 The most affected area is drained first to prevent infected secretions spilling into healthy lung.
6 Drainage time varies but each position requires 10 minutes.
7 If an entire hemithorax is involved, each lobe has to drained individual but a maximum of three position per session is considered sufficient.
8 The treatment is often used in conjunction with a technique for loosening secretions in the chest cavity called chest percussion.
9 Chest percussion is performed by clapping the back or chest with a cupped hand - also called chest physiotherapy
10 Postural drainage may be followed by breathing exercises to help expel loosened secretions from the airway.
11 Vibration thru hand positioning - flattened hand can also be used to remove secretions
12 other methods / techniques -
A ) Deep breathing moves the loosened mucus and may lead to coughing.
B ) Breathing with the diaphragm, belly breathing or lower chest breathing is used to help the person take deeper breaths and get the air into the lower lungs.
C ) The belly moves outward when the person breathes in and sinks in when he or she breathes out
IN DETAIL
1 Postural drainage is an airway clearance technique that helps people with COPD clear mucus from their lungs.
OR
POSTURAL DRAINAGE IS THE GRAVITATIONAL CLEARANCE OF SECRETIONS FROM SPECIFIC BRONCHIAL SEGMENTS BY USING ONE OR MORE DIFFERENT POSITIONS
2 The lungs consist of five lobes, three on the right side and two on the left side of the chest cavity.
3 Each lobe is further divided into segments.
4 The goal of postural drainage is to help drain mucus from each of these lobes into the larger airways so it can be coughed up more readily.
5 It uses a combination of chest percussion (a clapping movement performed with cupped hands) and vibration (a vibrating movement done with flat hands).
6 Postural drainage is generally performed for three to five minutes on each segment.
7 vv imp During this time, the person being treated should take slow, deep breaths followed by a vigorous coughing to help clear mucus.
B ) PATIENT POSITIONING - HOW WILL YOU PREPARE A PATIENT FOR POSTURAL DRAINAGE
INTRODUCTION
1 Use specific positions so the force of gravity ( vv imp ) can assist in the removal of bronchial secretions from affected lung segments to central airways by means of coughing and suctioning.
-
The patient is positioned so that the diseased area is in a near vertical position, and gravity is used to assist the drainage of specific segment.
-
The positions assumed are determined by the location, severity, and duration of mucous obstruction
-
The exercises are performed two to three times a day, before meals and bedtime.
5 Each position is done for 3-15 minutes.
6 The procedure should be discontinued if tachycardia, palpitations, dyspnea, or chest occurs as These symptoms may indicate hypoxemia. Discontinue if hemoptysis occurs
7 Bronchodilators, mucolytics agents, water, or saline may be nebulised and inhaled before postural drainage and chest percussion to reduce bronchospasm, decrease thickness of mucus and sputum, and combat edema of the bronchial walls, there by enhancing secretion removal
8 Perform secretion removal procedures before eating.
9 Make sure patient is comfortable before the procedure starts and as comfortable as possible he or she assumes each position
10 Auscultate the chest to determine the areas of needed drainage
11 Encourage the patient to deep breathe and cough after spending the allotted time in each position.
12 Encourage diaphragmatic breathing through out postural drainage: this helps widen airways so secretions can be drained.
POSITIONING
I - 1 To drain the middle and lower portions of your lungs, you should be positioned with your chest above your head.
2 Possible techniques to achieve this position are -
A ) If a hospital bed is available, put in Trendelenburg position (head lower than feet).
B ) Place 3-5 wood blocks, that are 2 inches by 4 inches, in a stack that is 5 inches high, under the foot of a regular bed.
C ) Blocks should have indentations or a 1 inch rim on top so that the bed does not slip.
D ) Stack 18-20 inches of pillow under hips.
E ) Place on a tilt table, with head lower than feet.Lower head and chest over the side of the bed.
II - To drain the upper portions of your lungs, you should be in a sitting position at about a 45 degree angle.
C ) CONDITIONS IN WHICH IT IS USEFUL / INDICATIONS
A ) Turning inability or reluctance of patient to change body position. (eg, mechanical ventilation )
B ) neuromuscular disease
C ) drug-induced paralysis
D ) poor oxygenation associated with position(eg, unilateral lung disease)
E ) potential for or presence of atelectasis
F ) presence of artificial airway
G ) cystic fibrosis
H ) bronchiectasis
I ) lung abscess
J ) pneumonia
CONTRAINDICATIONS
1 intracranial pressure (ICP) > 20 mm Hg
2 head and neck injury until stabilized
3 active hemorrhage with hemodynamic instability (A)
4 recent spinal surgery (eg, laminectomy) or acute spinal injury
5 acute spinal injury or active hemoptysis
6 empyema
7 bronchopleural fistula
8 pulmonary edema associated with congestive heart failure
9 large pleural effusions
10 pulmonary embolism
11 aged, confused, or anxious patients who do not tolerate position changes
12 rib fracture, with or without flail chest
13 surgical wound or healing tissue
1.2 Trendelenburg position is contraindicated for -
1 intracranial pressure (ICP) > 20 mm Hg
2 patients in whom increased intracranial pressure is to be avoided (eg, neurosurgery, aneurysms, eye surgery)
3 uncontrolled hypertension
4 distended abdomen
5 esophageal surgery
6 recent gross hemoptysis related to recent lung carcinoma treated surgically or with radiation therapy
7 uncontrolled airway at risk for aspiration (tube feeding or recent meal)
8 Reverse Trendelenburg is contraindicated in the presence of hypotension or vasoactive medication
1.3 External Manipulation of the Thorax
In addition to contraindications previously listed -
1subcutaneous emphysema
2 recent epidural spinal infusion or spinal anesthesia
3 recent skin grafts, or flaps, on the thorax
4 burns, open wounds, and skin infections of the thorax
5 recently placed transvenous pacemaker or subcutaneous pacemaker (particularly if mechanical devices are to be used)
6 suspected pulmonary tuberculosis
7 lung contusion
8 bronchospasm
9 osteomyelitis of the ribs
10 osteoporosis
11 coagulopathy
12 complaint of chest-wall pain
COMPLICATIONS
1 Hypoxemia
2 Increased Intracranial Pressure
3 Acute Hypotension during Procedure
4 Pulmonary Hemorrhage
5 Pain or Injury to Muscles, Ribs, or Spine
6 Vomiting and Aspiration
7Bronchospasm
8 Dysrhythmias