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P. T. CARDIO NOTES FOR BPT IV YR by M.E.P.

POSTURAL DRAINAGE
{-Introduction & it's Technique
-Anatomy of Tracheobronchial Tree
-Postural drainage positions for each lobe
[-Upper Lobe-Apical, Posterior, &Anterior]BOTH
[-Middle Lobe-Lateral,& Medial Segments]onlyRIGHT
[-Middle Lobe/Lingular -Superior &Inferior Segments]LEFT
[-Lower Lobe -Apical, Anterior basal, Posterior basal,
Medial basal, &Lateral basal ]BOTH
-Indications (9)
-Criteria for Discontinuation (4)
-Contraindications Absolute (13) & Relative (13)
-Modified postural drainage
-Home program }

POSTURAL DRAINAGE INTRODUCTION &IT'S


TECHNIQUE :-
1.Postural drainage consists of positioning the patient to
allow gravity to assist the drainage of secretions from
specific areas of the lungs.
2.The length of time spent in each position, and the total
treatment time will depend on the quantity of secretions in
each area and the number of areas that have to be
drained. 3.It may be necessary to spend an average of I5
to 20 minutes in each position for adequate drainage
4.The worst areas should be drained first.
5.Postural drainage should never be carried out
immediately before or after a meal.

ANATOMY OF TRACHEO BRONCHIAL TREE :-


The Positions of lungs for postural drainage are based on
the tracheobronchial tree
Each segment of cach lobe is drained using the positions
which indicates the specific area of the chest wall where
percussion or vibration is applied.
The divisions of the bronchial tree and their respective
segments. This knowledge is essential to enable the
patient to be placed in the correct position for drainage.

POSTURAL DRAINAGE POSITIONS ;-


Upper lobe
APICAL SEGMENTS
The patient should sit upright, with slight variations
according to the position of the lesion which may
necessitate leaning slightly backward, forward or side
POSTERIOR SEGMENT
a) Right
The patient should lie on his left side and then turn 45° on
to his face, resting against a pillow with another supporting
his head.
The patient should place his left arm comfortably behind
his back with his right arm resting on the supporting pillow;
the right knee should be flexed.
b) Left
The patient should lie on his right side turned 45 Degrees
on to his face with three pillows arranged to raise the
shoulder 3ocm (12in) from the bed.
The patient should place his right arm behind his back with
his left arm resting on the supporting pillows; both the
knees should be slightly bent.
ANTERIOR SEGMENTS
The patient should lie flat on his back with his arms relaxed
to his side; the knees should be slightly flexed over a
pillow.
MIDDLE LOBE LATERAL SEGMENT: MEDIAL
SEGMENT
The patient should lie on his back with his body quarter
turned to the left maintained by a pillow under the right
side from shoulder to hip and the arms relaxed by his side;
the foot of the bed should be raised 35cm (14in) from the
ground. The chest is tilted to an angle of I5°
Lingula
SUPERIOR SEGMENT: INFERIOR SEGMENT
The patient should lie on his back with his body quarter
turned to the right maintained by a pillow under the left
side from shoulder to hip and the arms relaxed by his side;
the foot of the bed should be raised 35cm (14in) from the
ground. The chest is tilted to an angle of I5°.
Lower lobe
APICAL SEGMENTS
The patient should lie prone with the head turned to one
side, his arms relaxed in a comfortable position by the side
of the head and a pillow under his hips.
ANTERIOR BASAL SEGMENTS
The patient should lie flat on his back with the buttocks
resting on a pillow and the knees bent; the foot of the bed
should be raised 46cm (18in) from the ground. The chest
is tilted to an angle of 20°.
POSTERIOR BASAL SEGMENTS
The patient should lie prone with his head turned to one
side, his arms in a comfortable position by the side of the
head and a pillow under his hips. The foot of the bed
should be raised 46cm (18in) from the ground. The chest
is tilted to an angle of 20°.
MEDIAL BASAL (CARDIAC) SEGMENT
The patient should lie on his right side with a pillow under
the hips and the foot of the bed should be raised 46cm
(18in) from the ground. The chest is tilted to an angle of
20°.
LATERAL BASAL SEGMENT
The patient should lie on the opposite side with a pillow
under the hips and the foot of the bed should be raised
46cm (18in) from the ground. The chest is tilted to an
angle of 20°.

Manual Techniques Used with Postural Drainage Therapy


In addition to the use of body positioning, deep breathing.
Exercises and an effective cough to facilitate airway
clearance, a variety of manual techniques are used in
conjunction with postural drainage to maximize the
effectiveness of the treatment.

INDICATIONS OF POSTURAL DRAINAGE


1.To Prevent Accumulation of Secretions in Patients at
Risk for Pulmonary Complications
2.To Patients with pulmonary diseases that are associated
with increased production or viscosity of mucus, such as
chronic bronchitis and cystic fibrosis
3.For Patients who are on prolonged bed rest
4.For Patients who have received general anesthesia and
who may have painful incisions that restrict deep breathing
and coughing postoperatively
5.For Any patient who is on a ventilator if he or she is
stable
enough to tolerate the treatment
6.To Remove Accumulated Secretions from the Lungs
7.For Patients with acute or chronic lung disease, such as
pneumonia, atelectasis, acute lung infections, COPD
8.For Patients who are generally very weak or are elderly
9.For Patients with artificial airways

CRITERIA FOR DISCONTINUING POSTURAL


DRAINAGE
1.If the chest radiograph is relatively clear
2.If the patient is a febrile for 24 to 48 hours auscultation
3.If normal or near-normal breath sounds are heard with
4.If the patient is on a regular home program

CONTRAINDICATIONS TO POSTURAL DRAINAGE


I. Head injuries including cerebral vascular accidents
because intracranial pressure would be increased.
2. Severe hypertension as venous return is increased with
tipping and this can overload the heart.
3. Following oesophagectomy there can be undue stress
on the anastomosis and tipping may cause regurgitation.
4. Severe haemoptysis, when all forms of physiotherapy
should be discontinued until there has been discussion
with the doctors.
5. Aortic aneurysms which would be put under tension if
the patient is tipped.
6. Pulmonary oedema which collects in the dependent
areas postural drainage would cause extreme dyspnoea
and probably, worsen the situation.
7.Surgical emphysema which might attack toward the face
if the patient is tipped and might result in dyspnoea.
8. Tension pneumothorax without an intercostal drain.This
condition should not require physiotherapy, but must never
be tipped as the cardiac embarrassment may lead to a
cardiac arrest
9. Cardiac arrhythmias which can be worsened by postural
drain age; in some positions the myocardial oxygen
demand would be greater and so its sensitivity to abnormal
rhythms is increased.
10. Hiatus hernias should not be tipped as the patient may
regurgitate gastric juices.
I1. The filling cycle of peritoneal dialysis. The descent of
the
diaphragm is impeded during this phase and tipping may
cause more respiratory distress.
12. Facial oedema from burns will be increased with
tipping.
13. Eye operations where there may be some associated
oedema which could be increased with tipping.
RELATIVE CONTRAINDICATIONS FOR POSTURAL
DRAINAGE
1.Severe hemoptysis
2.Untreated acute conditions
3.Severe pulmonary edema
4.Congestive heart failure
5.Large pleural effusion
6.Pulmonary embolism
7.Pneumothorax
8.Cardiovascular instability
9.Cardiac arrhythmia
10.Severe hypertension ar hypotension
11.Recent myocardial infarction
12.Unstable angina
13.Recent neurosurgery
(Head-down positioning may cause increased intracranial
pressure; if PD is required, modified positions can be
used)

MODIFIED POSTURAL DRAINAGE


Some patients who require postural drainage canno
assume or cannot tolerate the positions optimal for
postural drainage.
For example, a patient with congestive heart fail-
ure may exhibit indications of orthopnea (shortness of
breath while lying flat).
After neurosurgery a patient may not be allowed to
assume a head-down (Trendelenburg) position because
this position causes increased intracranial pressure.
After thoracic Surgery a patient may have chest
tubes and monitoring wires that limit positioning. Under
these circumstances and others, positioning during
postural drainage must be modified.
The positions in which postural drainage is undertaken are
modified consistent with the patient's medical or surgical
problems. This compromise, although not ideal, is better
than not administering postural drainage at all.
HOME PROGRAM OF POSTURAL DRAINAGE
Postural drainage may have to be carried out on a regular
basis at home for patients with chronic lung disease.
Patients need to be shown how to position themselves
using inexpensive aids. An adult may place pillows over a
hard wedge or stacks of newspapers to achieve the
desired head-down positions in bed.A patient also can lean
the chest over the edge of a bed, resting with the arms on
a chair or stool. A child can be positioned on an ironing
board
propped up against a sofa or heavy chair. A family
member
often must be taught proper positioning. percussion or
shaking techniques, and precautions to assist the patient.
REFERENCES :-
CASH TEXT BOOK OF CARDIOPULMONARY FOR
PHYSIOTHERAPISTS 4TH EDITION
CAROLYN KISNER THERAPEUTIC EXERCISE SIXTH
EDITION
&TEXT BOOK OF CARDIOPULMONARY BY ELIZABETH
DEAN