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.

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.
References in periodicals archive ?
In a follow-up study, 21 patients with acute lobar atelectasis were randomly allocated to one of 3 treatment groups involving postural drainage but not vibration and were then compared with the two previous groups described above.[67] After one treatment and again after 6 hours, patients who received postural drainage or modified postural drainage alone or with vibration, with the involved lung uppermost, had significantly greater resolution of their atelectasis than those receiving routine care or only 1 treatment.
Another study examined the effects between postural drainage and percussion by measuring arterial blood gases after each step of their protocol in 22 patients with acute lung disease, although 13 of the subjects had an underlying chronic lung disease.[9] The authors reported a significant decline in arterial oxygenation after 10 minutes of chest percussion in the group which produced no sputum or small amounts of sputum.
Between attacks a graduated scheme of forced expiration and breathing control was prescribed to continue to remove mucus along with exercises that focussed on changing posture and thoracic mobility as well as postural drainage. The publicity around the management of asthma currently advocated by the profession (PNZ 2012) is focussed on breathing correctly, staying active, control of coughing and clearing mucus; perhaps a less dogmatic regime but yet it still retains an emphasis on the key themes of breathing control, clearance of mucous and exercise in order to maintain the individual's well-being.
Pryor JA and Webber BA (1979): An evaluation of the forced expiration technique as an adjunct to postural drainage. Physiotherapy 65:304-307
At the completion of initial training, all nurses were able to meet mastery criteria in all skill domains except respiratory assessment (1 of 6 did not achieve mastery), tracheostomy tube change (1 of 6 did not achieve mastery), percussion and postural drainage (3 of 6 did not achieve mastery), respiratory treatments(2 of 6 did not achieve mastery), ventilator tubing change (1 of 6 did not achieve mastery), and managing water in the tracheostomy tube as part of tracheostomy emergencies (1 of 6 did not achieve mastery).
None of the trainees met mastery criteria prior to training in the skill domains of percussion and postural drainage, ventilator alarms, or bonding the tracheostomy swivel.
In the 0-4 year olds 60% performed modified postural drainage (13/25 bronchiectasis; 5/5 CF) (see Table 2).
A 2002 survey of UK BX clinics (predominantly adult) showed the majority used active cycle of breathing technique (91.5%) and/or postural drainage (75.6%) (O'Neill et al 2002).
Eaton T, Young P, Zeng I, Kolbe J (2007) A randomized evaluation of the acute efficacy, acceptability and tolerability of Flutter and active cycle of breathing with and without postural drainage in non-cystic fibrosis bronchiectasis.
This device provides a gentler form of therapy than the traditional "clapping" method of postural drainage therapy, allowing it to be used on patients who cannot be treated by clapping.
The main treatments at this time were SVN, Postural drainage and percussion (P&PD), and Ultra Sonic Nebulizers (USN).