Postural drainage and manual techniques

Question 1

Rationale behind postural drainage and manual techniques

Answer 1

The effect of gravity can assist secretions to move towards larger airways to aid clearance - patients can’t clear secretions themselves.

Chest manual techniques (percussion, vibrations and shaking) apply a force and kinetic energy to the chest wall which transmits to the airways to help to loosen, mobilise and remove retained secretions from the tracheobronchial tree.

Question 2

Physiological effects of postural drainage

Answer 2

Secretion drainage from areas of the lungs where sputum is present

Question 3

Physiological effects of percussion

Answer 3

Compresses air in airways,
turbulence
Shears and moves secretions off airway walls
Aids mucociliary escalator

Question 4

Physiological effects of vibrations & shaking

Answer 4

Air compression and turbulence
Increased expiratory airflow - Cephalad movement of secretions
Direct mechanical effect on cilial beat – 11-15Hz
Potential vagus nerve stimulation through receptors in chest wall/airways - acetylcholine release – increased cilial beat frequency

Question 5

Structures affected by these techniques

Answer 5

Specific lobes of the lungs that contain sputum

Question 6

Treating patients using postural drainage

Answer 6

Get patient to lie in certain positions for a certain period of time - sputum moves 10 mm in 1 minute. Often use manual techniques to assist drainage - percussion, vibrations & shaking

Question 7

Principles of applying percussion

Answer 7

Rhythmic ‘clapping’ on chest wall with cupped hand
Use a towel over skin
Throughout inspiration and expiration

Question 8

Principles of applying vibrations

Answer 8

Flat hand in contact with chest wall (no towel)
Beginning and during expiration only
High frequency, low amplitude

Question 9

Principles of applying shaking

Answer 9

Flat hand in contact with chest wall (no towel)
Beginning and during expiration only
lower frequency and higher amplitude

Question 10

Contraindications & precautions

Answer 10

Acute illness e.g. nausea, vomiting, dizziness
Cardiovascular instability
Raised intracranial pressure (ICP)
Recent thoracic, abdominal or spinal surgery
Burns, wounds or healing tissue

Are you feeling well in yourself?
Any recent chest or spinal surgery
Any heart or lung conditions?
Any skin conditions?

Question 11

Precautions for head down positions

Answer 11

young children and babies
Cerebral oedema
Head/neck trauma
Recent pneumonectomy, surgery to eyes, spine, oesophagus, aorta
Risk of aspiration
or recently eaten meal (due to vomiting risk)
Hypertension/aortic aneurysm
Symptomatic hiatus hernia
Headaches, epistaxis, haemoptysis

Question 12

Apical lobe: Apical segment position

Answer 12

Sitting upright

Question 13

Apical lobe: Posterior right segment position

Answer 13

Lying on the left side horizontally turned 45 degrees towards prone, resting against a pillow with another supporting the head

Question 14

Apical lobe: Posterior left segment position

Answer 14

Lying on the right side turned 45 degrees towards prone, with 3 pillows arranged to lift the shoulders 30 cm from the horizontal

Question 15

Apical lobe: Anterior segment position

Answer 15

Lying supine with the knees slightly flexed for comfort using a pillow

Question 16

Lingula lobe: superior and inferior segments position

Answer 16

Lying supine with the body a quarter turned to the right maintained by a pillow under the left side from shoulder to hip.
The chest is tilted downwards to an angle of 15 degrees (foot of bed raised 35cms)

Question 17

Middle lobe: Lateral & Medial segments position

Answer 17

Lying supine with the body a quarter turned to the left maintained by a pillow under the right side from shoulder to hip.
The chest is tilted downwards to an angle of 15 degrees (foot of bed raised 35cms).

Question 18

Lower lobe: Apical segments (both sides) position

Answer 18

Lying prone; head turned to side

Question 19

Lower lobe: Medial basal segment position

Answer 19

Lying on the right side with the chest tilted downwards to an angle of 20 degrees (foot of bed raised 46cms).

Question 20

Lower lobe: anterior basal segment position

Answer 20

Lying supine with the knees flexed for comfort with a pillow and the chest tilted downwards to an angle of 20 degrees (foot of bed raised 46cms)

Question 21

Lower lobe: Lateral basal segment position

Answer 21

Lying on the opposite side with the chest tilted downwards to an angle of 20 degrees (foot of bed raised 46cms)

Question 22

Lower lobe: Posterior basal segment (both sides) position

Answer 22

Lying prone with a pillow under the hips and the chest tilted downwards to an angle of 20 degrees (foot of bed raised 46cms).