Principle Positions of Postural Drainage

Question 1

Contraindications for head-down positions (“POACH CORE”)

Answer 1

-Pt intolerance
-Orthopedic limitations
-Acute head/neck trauma
-Cerebral hemorrhage or neurosurgery
-Hernia
-CV instability, acute MI, systemic hypo/hypertension, pulmonary HTN
-Orthopnea or CHF
-Recent meals (turn off tube feedings, 30 min)
-Esophageal surgery/gastric reflux/Hiatus

Question 2

L/R anterior upper segments (upper lobes)

Answer 2

-pt leans back ~30 deg against bed
-pillow under knees

Question 3

L/R posterior apical segments

Answer 3

-pt leans forward ~30 deg
-pillow under knees

Question 4

L/R anterior segments

Answer 4

-pt supine
-bed flat
-pillow under knees

Question 5

R posterior segment

Answer 5

-lying on L side with R side of body turned
-L arm behind back

Question 6

L posterior segment

Answer 6

pt prone, reverse trendelenburg, with pillow under L side

Question 7

R middle lobe

Answer 7

-pt supine
-foot of bed raised 12 in
-1/4 turn to L
-knees flexed

Question 8

L lingular

Answer 8

-looks similar to R middle lobe, just the opposite
-pt supine
-foot of bed raised 12 in
-1/4 turn to R
-knees flexed

Question 9

L/R anterior segments (lower lobes)

Answer 9

-pt supine
-foot of bed raised 18 in
-pillow under knees

Question 10

R lateral segment

Answer 10

-pt lying on L side
-foot of bed raised 18 in
-pillow under R arm

Question 11

L lateral segment

Answer 11

-pt lying on R side
-foot of bed raised 18 in
-pillow under L arm

Question 12

L/R posterior basal segments

Answer 12

-foot of bed raised 18 in
-pt prone
-pillow under hips and ankles
-arms up

Question 13

L/R superior segments

Answer 13

-pt prone
-bed flat
-pillow under hips and ankles
-arms up