Definition
Postural drainage is the gravitational clearance of secretions from specific bronchial segments by using one or more of ten different positions Each position.
Each position drains a specific corresponding section of the tracheobronchial tree, either from the upper, middle of lower
Lung field into the traches. Coughing or suctioning can then remove secretions from the trachea,
Areas are selected for drainage based on:
- Knowledge of patient’s condition and disease process.
- Physical assessment of the chest.
- Chest X-ray examination results
Contraindications
- Increased intracranial pressure (ICP).
- Unstable head or neck injury.
- Active haemorrhage with hemodynamic instability.
- Recent spinal surgery or injury.
- Empyema
- Bronchopleural fistula.
- Rib fractures or flail chest
- Lung tumour
- Diseases of chest wall.
- Haemorrhage in respiratory tract.
- Painful chest conditions
- Tuberculosis.
- Osteoporosis.
Articles
- A comfortable surface, that can be slanted such as hospital beds in Trendelenburg position or tilt table and chair for draining upper lobe areas.
- One to four pillows, depending on patient’s posture and comfort.
- A glass with water.
- Tissues and paper bag.
- Sputum cup
Positions for Draining Different Areas of Lungs
1. Left and right upper lobe anterior apical bronchi: Have patient sit in chair leaning back. Percuss with cupped hands and vibrate with heels of hands at shoulders and with fingers over collarbone. Both sides can be done at the same time. Note body posture and arm position of nurse. Nurse’s back is kept straight, and elbows and knees are slightly flexed.
2. Left and right upper lobes posterior apical bronchi: Have patient sit in chair leaning forward on pillow or cardiac table. Percuss and vibrate with hands on either side of the upper spine, can do both sides at the same time.
3. Right and left anterior upper lobe bronchi: Have patient lie flat on back with small pillow under knees. Percuss and vibrate just below clavicle on either side of sternum.
4. Left upper lube lingular bronchus. Have patient lie on right side with arm over head in Trendelenburg position with foot of bed raised 30 cm. Place pillow behind back and roll patient one-fourth on to pillow. Percuss and vibrate lateral to left nipple below axilla.
5. Right middle lobe bronchus: Have patient lie on left side, raise foot of bed to 30 cm. Place pillow behind back and roll patient one fourth turned on to pillow. Percuss and vibrate area of right nipple below axilla.
6. Left and right anterior lower lobe bronchi. Have patient lie on back in Trendelenburg position, with foot of bed elevated 45-50 cm. Have knees bent on pillow. Percuss and vibrate over lower anterior ribs on both sides.
7. Hight lower lobe lateral bronchus Have patient lie on left side in Trendelenburg position with foot of bed raised to 45-50 cm. Percuss and vibrate right side of the chest below scapula posterior to midaxillary line.
8.Left lower lateral bronchus: Have patient lie on right side in Trendelenburg position with foot of bed raised to 45-50 cm. Percuss and vibrate left side of the chest below scapula posterior to midaxillary line.
9. Right and left lower lobe superior bronchi: Have patient lie flat on stomach with pillow under stomach. percuss and vibrate below scapulae on either side oof spine.
10.Left and right posterior basal bronchus: Have patient lie on stomach in Trendelenburg position with foot of bed elevated 40-50cm. Percuss and vibrate over posterior ribs on either side of spine.
Procedure
| Nursing action | Rationale |
| Before procedure 1. Identify patient and check physician’s order for specific instruction for postural drainage. 2. Assess for possible impairment of airway clearance. 3. Identify signs and symptoms that indicate need to perform postural drainage with such as change in x-ray film consistent with atelectasis, pneumonia, bronchiectasis, infective coughing with thick wheezing, crackling, and gurgling. 4.Identify which bronchial segments needs to be drained by reviewing chest x-ray reports. Auscultate over all lung fields for wheezes, crackles and gurgles, palate over all lung fields for crepitus, fremitus, and chest expansion. During procedure 5.Wash hands 6.Select congested areas to be drained based on assessment of all lung felids, clinical data, and chest X-ray data. 7.Place patient in position to drain congested area. Area selected may vary from patient to patient. Help patient assume position as needed. Teach patient correct posture and arm and leg positioning, place pillows for support and comfort. 8. Have patient maintain posture for 10-15 minutes. 9. During 10-15 minutes of drainage in each posture, perform chest percussion and vibration over areas being drained. 10. After 10-15 minutes of drainage in first posture, have patient it up and cough. Save expectorated secretions in clear container. If patient cannot cough suctioning to be performed. 11. Have patient rest briefly if necessary. 12. Have patient take sips of water. 13. Repeat procedure until all congested areas selected have been drained. Each treatment should not exceed 20-30 minutes After procedure 14. Wash hands 15. Record in nurse’s notes baseline e and post therapy assessment of chest. frequency and duration of treatment, postures used, and bronchial segments drained, cough effectiveness, need for suctioning, color, amount and consistency of sputum, hemoptysis or other unexpected outcome, and patient’s tolerance and reactions. | Performs correct procedure for the right patient Certain circumstances, disease process, and conditions place patient at risk for impaired airway clearance X-film data and signs and symptoms indicate accumulation of pulmonary secretion Area of lung congestion and postures for drainage will vary depending on disease process, patient condition and patient problem. Area most in need of and responsive to postural drainage usually can be easily identified by presence of early inspiration crackles and gurgles. Reduces transmission of microorganisms To be effective, treatment must be Individualized to treat specific areas involved. Specific positions are selected to drain each area involved. In adults, draining each area takes time. These maneuvers provide mechanical forces that aid in mobilization of airway secretions. Secretions mobilized into central airways should be removed by coughing or suctioning before placing patient into next drainage position. Coughing is most effective when patient li sitting up and leaning forward. Short rest periods between postures can prevent fatigue and help patient for better tolerance to therapy. Keeping mouth moist aids in expectoration of secretions. Reduces transmission of microorganisms Helps to evaluate outcomes and need for changes in therapy. |
Special Considerations
- Provide Inhalation using bronchodilators 20 minutes before postural drainage for patients at risk of bronchospasm.
- In severe haemoptysis, stop therapy, remain calm, and stay with patient. Request assistance and keep patient comfortable, warm, and quiet.
- Best times for treatment are:
- In the morning before breakfast, when patient can clear secretions that accumulate overnight.
- One hour before bedtime, so lungs are clear before sleeping and patient has time after treatment to cough up any mobilized secretions.
- Patient’s condition is acute, frequent treatments are tolerated best.
- If patient is receiving inhaled bronchodilators or aerosol therapy, postural drainage should be done after 20 minutes.
- The procedure should be discontinued if tachycardia, palpitation, dyspnoea or chest pain occur. These symptoms may indicate hypoxemia.
- Do not perform postural drainage immediately after taking food.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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