postural drainage

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drainage

 [drān´ij]
systematic withdrawal of fluids and discharges from a wound, sore, or cavity.
capillary drainage that effected by strands of hair, surgical gut, spun glass, or other material of small caliber which acts by capillary attraction.
closed drainage airtight or water-tight drainage of a cavity so that air or contaminants cannot enter; for example, drainage of an empyema cavity carried out by means of an intercostal drainage tube passing into an airtight receiving vessel.
open drainage drainage of a cavity through an opening in the chest wall into which one or more drainage tubes are inserted, the opening not being sealed against the entrance of outside air.
percutaneous drainage drainage of an abscess or collection of fluid by means of a catheter inserted through the skin and positioned under the guidance of computed tomography or ultrasonography.
postural drainage see postural drainage.
tidal drainage drainage of the urinary bladder by an apparatus that alternately fills the bladder to a predetermined pressure and empties it by a combination of siphonage and gravity flow.

postural

 [pos´chur-al]
pertaining to posture or position.
postural drainage a technique in which the patient assumes one or more positions that will facilitate the drainage of secretions from the bronchial airways. The procedure uses gravity to move secretions toward the trachea, where they can be coughed up more easily. Choice of position is based on radiologic studies and auscultatory evidence of pooled secretions. Variations of the most effective position are adapted to the patient's general physical condition, tolerance, and pulmonary status.

External manipulation of the thorax includes percussion (or “clapping,”) and vibration, often done in conjunction with postural drainage; they may be done either manually or with mechanical devices. Percussion involves rhythmic striking of the chest wall over the area being drained. The manual method is done with hands cupped, fingers flexed, and thumbs held tightly against index fingers. If done properly, a hollow sound is heard and there is no discomfort to the patient.

Vibration is done immediately after percussion and is directed to the same area. While the patient performs a prolonged exhalation through pursed lips, the therapist presses the flat of the hands or the mechanical device against the thorax in a downward movement toward the midline of the body. This is repeated four or five times. While neither percussion nor vibration is a difficult technique to master, anyone attempting to assist the patient in this manner should have instruction and practice beforehand. The purpose of both activities is to dislodge plugs of mucus, allowing air to penetrate behind them and thus aid in their removal.

The American Association for Respiratory Care has published clinical guidelines, which are available on their web site at http://www.aarc.org. These indicate that bronchospasm is sometimes a complication of external manipulation of the thorax.

pos·tur·al drain·age

drainage used in bronchiectasis and lung abscess. The patient's body is positioned such that the trachea is inclined downward and below the affected chest area.

postural drainage

the use of positioning to drain secretions from specific segments of the bronchi and the lungs into the trachea. Coughing usually expels secretions from the trachea. Also called bronchial drainage.
method Positions that promote drainage from the affected parts of the lungs are selected. Pillows and raised sections of the hospital bed are used to support or elevate parts of the body. The procedure is begun with the patient level, and the head is gradually lowered to a full Trendelenburg position. Inhalation through the nose and exhalation through the mouth are encouraged. Simultaneously the nurse or other health care provider may use cupping and vibration over the affected area of the lungs to dislodge and mobilize secretions. The person is then helped to a position conducive to coughing and is asked to breathe deeply at least three times and to cough at least twice. See also cupping and vibrating.
interventions A patient who is dyspneic or who has hemoptysis or signs of cerebral hemorrhage, increased intracerebral pressure, or lung abscess is not placed in a head-down position without caution and a specific medical order. Suction is kept available in all cases in which the patient may not be able to expel the secretions that have drained into the trachea. The patient's tolerance for the procedure and the position is carefully observed. Fatigue is prevented.
outcome criteria Effectiveness of the procedure depends on positioning that allows drainage by gravity and on liquefaction, ciliary action, and effective breathing. As the secretions are cleared, the patient becomes better able to breathe, is more comfortable, and may move about more freely; thus the respiratory passages may remain freer of obstructing secretions and resume their expected function. Also called bronchial drainage.

pos·tur·al drain·age

(pos'chŭr-ăl drān'ăj)
Procedure to remove excess liquid from the respiratory tract in bronchiectasis and lung abscess. The patient's body is positioned so that the trachea is inclined downward and below the affected chest area.
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POSTURAL DRAINAGE OF LUNGS: posterior apical segments of the right and left upper lobes
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POSTURAL DRAINAGE OF LUNGS: anterior apical segments of the right and left upper lobes
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POSTURAL DRAINAGE OF LUNGS: anterior apical segments of the right and left upper lobes
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POSTURAL DRAINAGE OF LUNGS: anterior segments of the right and left upper lobes
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POSTURAL DRAINAGE OF LUNGS: posterior segment of the left upper lobe
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POSTURAL DRAINAGE OF LUNGS: posterior segment of the right upper lobes
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POSTURAL DRAINAGE OF LUNGS: left lingula
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POSTURAL DRAINAGE OF LUNGS: right middle lobe
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POSTURAL DRAINAGE OF LUNGS: anterior basal segments of the right and left lung
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POSTURAL DRAINAGE OF LUNGS: posterior basal segments of the right and left lung
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POSTURAL DRAINAGE OF LUNGS: left lateral segment of the lower lobes
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POSTURAL DRAINAGE OF LUNGS: superior segment of the right and left lower lobes

postural drainage

A passive airway clearance technique in which patients are positioned so that gravity will assist the removal of secretions from specific lobes of the lung, bronchi, or lung cavities. It can be used for patients with pneumonia, chronic bronchitis, cystic fibrosis, bronchiectasis, inhaled foreign bodies, before surgery for lobectomy, or in any patient having difficulty with retained secretions. A side effect of the treatment in some patients is gastroesophageal reflux. See: illustration

Patient care

Physical tolerance to the procedure is evaluated. The respiratory therapist teaches and assists the patient in the procedure, as ordered, by positioning the patient for effective drainage of the affected lung region(s). The patient is encouraged to remove secretions with an effective cough. To decrease the risk of aspiration, the patient should not perform the procedure after meals. Chest vibration and percussion are often performed at the same time to assist movement of retained secretions in the lung.

See also: drainage

postural drainage

A method of disposing of sputum or other secretions by positioning the body so that gravity helps to carry them into a position from which they can be coughed out or otherwise drained away. Chest postural drainage may be assisted by gentle thumps with a cupped hand.

Postural drainage

This technique uses the force of gravity to assist in effectively draining secretions from the lungs and into the central airway where they can either be coughed up or suctioned out. The patient is placed in a head or chest down position and is kept in this position for up to 15 minutes. Critical care patients and those depending on mechanical ventilation receive postural drainage therapy four to six times daily. Percussion and vibration may be performed in conjunction with postural drainage.