Postural drainage; It is an airway cleaning technique that helps clear mucus from the lungs in chronic chest diseases such as cystic fibrosis and COPD. Postural drainage based on the action of gravity to drain secretions (sputum) from one or more lung segments into the central airways by huffing or coughing techniques.
Anatomy of the Lungs
Learning more about the respiratory system and its relationship to other organs in the body can help you understand why postural drainage treatments are effective.The lungs consist of five lobes, three on the right side and two on the left side of the chest cavity. Each lobe is further divided into segments. The left and right upper lobes each consist of three parts: upper (apical), posterior and anterior. Lob segments consist of a network which include airways, air sacs and blood vessels. These sacs allow the exchange of oxygen and carbon dioxide between the blood and air. It is these segments that are emptied during postural drainage. In brief, the purpose of postural drainage is to facilitate the removal of mucus by moving it into larger airways.
Postural Drainage Techniques
Postural drainage involves a combination of techniques such as more than one positions, percussion, vibration, deep breathing, and coughing to empty the lungs. Positioning the patient is important because gravity is used to postural drainage for drain the secretion.The person lies or sits in various positions so that the portion of the lung to be infused is as high as possible.That part of the lung is emptied using percussion, vibration and gravity.
What are the benefits of postural drainage?
- Elimination of secretions, minimizes the risk of developing a chest infection.
- It can also help improve respiratory function.
- It can be use with manual physiotherapy techniques.
- It requires very little active attendance of the patient.
- Postural drainage is less invasive than manual respiratory physiotherapy techniques.
In percussion, the hand is positioned as if holding water, but with the palm facing down.
The percussion should be strong and rhythmic, but ıt should not involve any pain. Each percussion should also have a hollow sound.Most of the movement is in the wrist with the relaxation of the arm and and that makes percussion less tiring. If there is pain during the application, your hand position is probably wrong, you need to correct it again.
Vibration application is applied with a straightened hand position.
In vibration, the hand is firmly placed on the segment suitable for the lung area to do applied.Then, by stiffen the arm and shoulder, applying a light pressure and should creating a fast, staggering movement similar to that of a vibrator.
It is important for the person getting treatment to breathe deeply and exhale slowly but strongly. This should be do without difficulty to stimulate a productive cough.
Postural Drainage Timing
Usually, each treatment session can take 20 to 40 minutes. 3-5 minutes are ideal for each position. Drainage is best done before meals or one-and-a-half to two hours after eating, to decrease the chance of vomiting. It is proposed early in the morning and before bedtime.If the person is more congested or sick, it may be necessary to increase the length and frequency of drainage per day. Your therapist will usually help you know which positions, how often and for how long drainage should be do.
What the therapist should pay attention to during the application?
The therapist should not bend over forward when performing percussion, but stay in an upright position to protect her back.
Positions in Postural Drainage
Positioning during drainage is important for the extraction of the secretion by taking advantage of the gravitational effect as described above. Pillows can be used for the patient’s comfort.If the person is easily tired, the order of positions can be changed, but it is necessary to apply to all segments that need to be done.
The Upper Lobe
-Apical segment :The patient bends back 30 degrees. Vibration and percussion between the clavicle and the upper scapula.
-Front Segment :The patient lies on her back with a pillow under the knees, which facilitates relaxation of the abdominal muscles and breathing. Vibration and percussion, any side between the clavicle and nipple of a male patient. It may not be possible in a female patient.
-Rear Segment: The patient bends forward 30 degrees to the back of the chair (or bed). Vibration and percussion on the upper part of the back.
Right Middle and Left Lingual
-Right side – medial segments : The patient turns a quarter of a lap from the back position and a pillow can be placed between the bent knees. The foot of the bed is lift up 15 degrees. Vibration and percussion is from under the right breast area, over the axillary line.
-Upper left and lower Lingual segments: The patient turns a quarter of a lap from the back position and a pillow can be placed between the bent knees. The foot of the bed is lift up 15 degrees. Vibration and percussion is from under the right breast area, over the axillary line.
-Apical Basal Segment:The patient lies face down on the bed with a pillow under the hips.The bed is in a horizontal position. Vibration and percussion can be performed in the middle of the back, under the scapula, on whatever side.
-Anterior Basal Segment: The foot of the bed is lift up 30 degrees. Vibration and percussion, armpits from under the lower ribs.
-Lateral Basal Segment: The patient extends up the fourth round from the downward position on the opposite side, where it should be drained. The foot of the bed is lift up 30 degrees. Vibration and percussion can be performed on the posterolateral areas of the lower part.
–Posterior Basal Segment : The patient lies face down on the bed with a pillow between the hips. The foot of the bed is lift up 30 degrees. Vibration and percussion can be done over the suitable area (back).