Today our topic of discussion is Postural Drainage.
Postural Drainage
POSTURAL DRAINAGE
Definition
Drainage of secretion from lung segments by gravity utilizing specific positioning techniques (Fig. 29.4).
Purpose
- To drain lung secretion before and after surgery
- To aid for easy breathing in bronchial or lobar pneumonia, lung abscess
- To treat patient with, e.g. bronchiectasis, chronic bronchitis and cystic fibrosis
- To assist patient who are unable to cough and bring out sputum, viz. unconscious, debilitated, quadriplegic patient.
Equipment
- Pillows: 3-4
- Sputum cup
- Tissue paper
- Sputum measuring glass.
General Instructions
- Perform postural drainage for patient on empty stomach before meals
- Avoid postural drainage for patient with hemoptysis.
Procedure
- Explain purpose an procedure to patient
- Locate affected lung with help of X-rays, auscultation and percussion
- Administer bronchodilators before procedure
- Give steam inhalation to patient after obtaining doctor’s written order
Postural drainage techniques:
Upper lobes
- Upper segments: Place patient in high Fowler’s position in chair or bed.
- Anterior segments: Place patient in semi-Fowler’s position in chair or bed.
- Posterior segments: Place patient in Fowler’s position in chair or bed, provide a cardiac table
- Lateral segments: Place patient in lateral position elevated to about 45, first to one side and then to other side. When out of bed ask patient to lean on arm, resting on chair or table for support.
Right middle lobes
- Anterior segment (Right side): Place patient flat on left side with a pillow under chest. Right shoulder and body are kept forward.
- Posterior segment: Place patient in prone with chest and abdomen elevated.
Lower lobes
- Anterior segments: Place patient in supine Trendelenburg with hips elevated with pillows, so that hips are higher than shoulders.
- Posterior segments: Place patient prone, Trendelenburg or hips elevated with pillows so that hips are higher than shoulders.
- Lateral segments: Place patient in right side lying Trendelenburg for left lung and left side lying Trendelenburg for right lung or hips elevated with pillows to keep hips higher than shoulders.
- Perform chest percussions and vibrations on areas to be drained
- Encourage patient to cough out secretions and collect in sputum container
- Do suctioning if coughing is not possible
- Make patient comfortable and ask to rest flat for ten to fifteen minutes before allowing sitting or getting out of bed
- Dispose sputum container in infectious waste container. Replace articles
- Document, time, amount and color of sputum drained, response of patient to therapy.
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