postural drainage

Question 1

what is postural drainage?

Answer 1

the use of gravity assisted positioning to facilitate secretion movement from specific lung segments towards larger airways

Question 2

limitations of head down positions

Answer 2

poorly tolerated by acutely ill patients and contraindicated in some patients (GERD, pregnancy, raised ICP, sinusitis)

Question 3

what is modified PD?

Answer 3

postural drainage without head down tilt

Question 4

when is PD most useful?

Answer 4

when secretions are copious, when there is segmental involvement, and when the patient tolerates positioning

Question 5

when does PD have a limited effect?

Answer 5

when there is very thick mucus without add on techniques (percussion and vibration) and when there is a poor cough

Question 6

what is PD often combined with?

Answer 6

percussion, vibration, ACBT, FET

Question 7

evidence of PD

Answer 7

grade A when combined with percussion and vibration

Question 8

contraindications for PD

Answer 8

conditions with neurological instability, conditions with cardiopulmonary instability, conditions where gravity may worsen lung injury or air leaks, and conditions where increased abdominal pressure is unsafe

Question 9

what are conditions with neurological instability that are contraindications for PD?

Answer 9

raised ICP > 20 mm HG, hydrocephalus, head and neck injuries that aren’t stabilized, recent spinal surgery, recent CVA, and cerebral aneurysm

Question 10

what are conditions with cardiopulmonary instability that are contraindications for PD?

Answer 10

arrhythmias, decreased CO, cardiogenic pulmonary edema, and pulmonary embolus

Question 11

what are conditions where gravity may worsen lung injury or air leaks that are contraindications for PD?

Answer 11

tension pneumothorax, bronchopleural fistula, or active hemoptysis

Question 12

what is a condition where increased abdominal pressure is unsafe and a contraindication for PD?

Answer 12

excessive abdominal distention

Question 13

precautions for PD

Answer 13

GERD, pregnancy, severe hypoxemia, orthopnea, severe dyspnea, and with 1 hour after eating

Question 14

PD for upper lobe apical segment (right and left)

Answer 14

bed inclined 75-90 from horizontal and patient sitting with pillow under knees

Question 15

PD for upper lobe right anterior segment

Answer 15

supine with pillow under knees

Question 16

PD for left upper lobe anterior segment

Answer 16

bed inclined 75 degrees from horizontal so the patient is half lying

Question 17

PD for right upper lobe posterior segment

Answer 17

1/4 prone (rotated 45 degrees) from left side lying with pillow under right side of chest and right leg

Question 18

PD for left upper lobe posterior segment

Answer 18

inclined 15 degrees from horizontal, 1/4 prone from right side lying (rotated 45 degrees), with pillow under left chest and left leg OR sitting leaning forward hugging pillow

Question 19

PD for right middle lobe

Answer 19

head down 15 degrees and 1/4 turned from left side lying into supine with 2 pillows behind back

Question 20

PD for left upper lingula lobe

Answer 20

head down 15 degrees and 1/4 turned from right side lying into supine with 2 pillows behind back

Question 21

PD for lower lobes anterior segment (left and right)

Answer 21

head down 20-30 degrees and supine with knees flexed (pillow under knees)

Question 22

PD for both lower lobes superior segments

Answer 22

prone with pillow under hips and head down flat

Question 23

PD for both lower lobes posterior segement

Answer 23

head down 20-30 degrees and prone with pillows under hips and knees

Question 24

PD for right lower lobe lateral segment

Answer 24

head down 20-30 degrees and left side lying with pillow in between knees

Question 25

PD for left lower lobe lateral segment

Answer 25

head down 20-30 degrees and right side lying with pillow in between knees

Question 26

how long per position?

Answer 26

about 10 minutes or however is long enough to allow secretion movement (could be 2-3 minutes when combined with percussion or vibration)

Question 27

what to do after positioning?

Answer 27

encourage huffing or coughing

Question 28

how many times per day to do PD?

Answer 28

1-3 and this depends on the volume of secretions and the patient's tolerance

Question 29

what is chest percussion?

Answer 29

rhythmic clapping of the chest wall using cupped hands and transmits mechanical energy through the chest wall to loosen secretions from bronchial walls

Question 30

for how long is chest percussion done for?

Answer 30

1-3 minutes per segment

Question 31

what frequency is chest percussion done at?

Answer 31

3-6 Hz

Question 32

when is chest percussion most useful?

Answer 32

when there are copious, tenacious secretions, when the patient is unable to perform effective ACTs, and as an adjunct during PD

Question 33

what populations does chest percussion have a limited effect in?

Answer 33

those with large adipose tissue on the chest wall

Question 34

contraindications for chest percussion and vibration

Answer 34

rib fractures, chest wall pain, osteoporosis, bleeding risk, chest wall integrity issues, and unstable cardiovascular system

Question 35

what areas of the body should chest percussion not be done over?

Answer 35

buttons, zippers, spine, sternum, and lower back

Question 36

what is vibration?

Answer 36

fine oscillatory movement and compression applied to the chest wall during expiration only and this is more controlled and less forceful than percussion

Question 37

what is the mechanism behind vibration?

Answer 37

it increases expiratory airflow and enchanes expiratory flow bias, helping to move secretions towards central airways

Question 38

what is expiratory flow bias?

Answer 38

a condition where expiratory airflow exceeds inspiratory airflow, promoting the movement of airway secretions toward the mouth

Question 39

how to do vibration?

Answer 39

firm, flat hand over the targeted segment and use rhythmic contractions and relaxations for about 1-3 minutes per segement

Question 40

is percussion or vibration better in frail patients?

Answer 40

vibration

Question 41

when to use a shorter during or percussion or vibration?

Answer 41

in acute illness or in those who fatigue easily

Question 42

when to stop or modify percussion or vibration?

Answer 42

increased dyspnea, oxygen desaturation, worsening bronchospasm, or patient discomfort/pain