postural drainage & manual techniques

Question 1

how to perform

Answer 1

introduction, contraindications, informed consent, provide tissues/pot for cleared secretions to be placed in, Position patient appropriately using pillows
provide towel/blanket for comfort, carry out desired treatment communicating regularly to your patient, monitor for adverse reactions

percussion - rhythmical cupping
vibrations - high frequency
shaking - low frequency

Question 2

positioning

Answer 2

Apical - sitting upright
posterior right - on left, 45° towards prone, x1 pillow under head
posterior left - on right, 45° towards prone, x3 pillows to lift shoulders 30cm
anterior - spine, knees slightly flexed with x1 pillow

lingula - supine, body 1/4 to right (x1 pillow under left), chest down 15° (foot of bed up 35cm)
medial + lateral - supine, body 1/4 to left, chest down 15°

superior - prone, head to side
medial basal - on right, chest down 20° (bed up 46cm)
anterior basal - supine, knees slightly flexed, chest down 20°
lateral basal - opposite side, chest down 20°
posterior basal - prone, pillow under hips, chest down 20°

Question 3

contraindications

Answer 3

MSK: head/neck trauma, surgery to eyes/spine/throat
CR: aspiration/recently eaten
CV: hypertension
N: headaches
Recent thoracic/abdominal/spinal surgery, raised intracranial pressure, illness, CV instability, healing tissue

Question 4

rational

Answer 4

The effect of gravity can assist secretions to move towards larger airways to aid clearance.

Question 5

physiological effects

Answer 5

clearance of secretions, more efficient cilia
improved ventilation - gas exchange
maintain lung expansion - compliant, can function optimally without mucus accumulation

Question 6

structures effected

Answer 6

right lung:
UL: apical, posterior, anterior segment
ML: lateral, medial
LL: superior, medial + lateral + posterior basal

left:
UL: apical posterior + anterior, superior + inferior lingula
LL: superior, anterior + lateral + posterior basal

Question 7

principles

Answer 7

Patients should be positioned with the area to be drained uppermost (upwards) to allow secretions to be moved with gravity to the larger airways.
- segmental drainage
- deep breathing for chest expansion
- duration/frequency dependent on symptoms
- P positioned safely, comfortably
- educate P on purpose + technique