POSTURAL DRAINAGE

POSTURAL DRAINAGE (Bronchial drainage), another intervention for airway clearance, is way of mobilizing secretions in one or more lungs segments towards the central airways by placing the individual in various positions so gravity assists within the drainage process. Postural drainage therapy includes the use of manual techniques, for example percussion, shaking, and vibration, along with voluntary coughing.

Contraindication of postural drainage

intracranial pressure (ICP) > 20 mm Hg

neck and head injury until stabilized (A)

active hemorrhage with hemodynamic instability (A)

recent spinal surgery (eg, laminectomy) or acute spinal injury

acute spinal injury or active hemoptysis

empyema

bronchopleural fistula

pulmonary edema related to congestive heart failure

arge pleural effusions

pulmonary embolism

aged,confused, or anxious patients who don't tolerate position changes

rib fracture, without or with flail chest

surgical wound or healing tissue

 Hemorrhage (severe hemoptysis)

•           Copious levels of blood in the sputum.

•           NOTE: This really is different from lightly blood-streaked sputum.

 Untreated acute conditions

•           Severe pulmonary edema.

•           Congestive heart failure.

•           Large pleural effusion.

•           Pulmonary embolism.

•           Pneumothorax.

 Cardiovascular instability

•           Cardiac arrhythmia.

•           Severe hypertension or hypotension.

•           Recent myocardial infarction.

use therapy..

To empty the middle and lower servings of your lungs, you ought to be positioned with your chest above your face. Possible techniques to accomplish this position are:

 If your hospital bed can be obtained, put in Trendelenburg position (head less than feet)

Place 3-5 wood blocks, which are 2 inches by 4 inches, inside a stack that is 5 inches high, underneath the foot of a regular bed. Blocks must have indentations or a 1 inch rim on the top so that the bed doesn't slip

Stack 18-20 inches of pillow under hips.

 Put on a tilt table, with head less than feet.

 Lower head and chest within the side of the bed.

 To empty the upper portions of your lungs, you ought to be in a sitting position at in regards to a 45 degree angle.

 When you're in the proper postural drainage position, improve your position per the next sequence:

 Turn sideways

Lay on stomach

Lay on back

Stay in each position approximately 5 to 10 minutes. Use suction or assisted cough before changing position to insure elimination of any secretions drained during that position. Postural draining is generally taught by your physiotherapist.

 Inspiratory Muscle Trainer is really a device to assist in building inspiratory muscle strength. The unit should be used daily in your daily routine to help keep lungs healthy.

1. Percussion

•           This way is used to further mobilize secretions by mechanically dislodging viscous or adherent mucus in the lungs.

•           Percussion is performed with cupped hands within the lung segment being drained. The therapist’s cupped hands alternately strike the patient’s chest wall inside a rhythmic fashion. The therapist need to keep shoulders, elbows, and wrists loose and mobile throughout the maneuver. Mechanical percussion is definitely an alternative to manual percussion techniques.

•           Percussion is continued for a few minutes or until the patient must alter position to cough.

•           This procedure shouldn't be painful or uncomfortable. To avoid irritation to sensitive skin, possess the patient wear a light-weight gown or shirt. Avoid percussion over breast growth in women and over bony prominences.

•           Relative contraindications just before implementing, percussion inside a postural drainage program, the therapist must compare the possibility benefits with the possible risks towards the patient. In most instances, steer clear of the use of percussion.

o          Over fractures, spinal fusion, or osteoporosis.

o          Over tumor area.

o          If someone has a pulmonary embolus.

o          If someone has a condition in which hemorrhage could easily occur, for example in the presence of the low platelet count, or maybe a patient is receiving anticoagulation therapy.

o          If someone has unstable angina.

o          If someone has chest wall pain, for instance, after thoracic surgery.

2. Vibration

•           The way is used in conjunction with percussion in postural drainage. It's applied only during expiration because the patient is breathing to move the secretions towards the larger airways.

•           Vibration is used by placing both of your hands directly on the skin and also over the chest wall (a treadmill hand on top of another) and gently compressing and rapidly vibrating the chest area wall as the patient breathes out .

•           Pressure is used in the same direction as that where the chest is moving.

•           The vibrating action is achieved through the therapist’s isometrically contracting (tensing) the muscles from the upper extremities from shoulders to hands.

3. Shaking

•           Shaking is really a more vigorous type of vibration applied during exhalation utilizing an intermittent bouncing maneuver along with wide movements from the therapist’s hands.

•           The therapist’s thumb are locked together and also the open hands are put directly on the patient’s skin and fingers are wrapped round the chest wall. The therapist simultaneously compresses and slakes the chest area wall.