Indications and contraindication for postural drainage positions

Contraindications to external manipulation of the thorax in addition to contraindications to postural drainage 9. behind 10. Hen

9. Coagulopathy 10. Complaint of chest wall pain

Contraindications to external manipulation of the thorax in addition to contraindications to postural drainage 5 beehive 6 stick 7 heaven 8 gate

5 Bronchospasm 6 lung contusions 7 Osteomyelitis of the ribs 8 Osteoporosis

Contraindications to external manipulation of the thorax in addition to contraindications to postural drainage 1 bun 2 shoe 3 tree 4 door

1.Subcutaneous emphysema 2 Recent epidural spinal in*fu*sion or spinal anesthesia 3 Recent skin grafts or flaps on the thorax 4 Recently placed pacemaker

All positions are contraindicated for the following: Blood (2)

Active hemorrhage with hemodynamic instability Active hemoptysis

All positions are Contraindications for postural drainage: Lungs (5)

Bronchopleural fistula Empyema Large pleural effusions Pulmonary embolism Pulmonary edema associated with heart failure

Additional contraindications for percussion of a neonate (3)

Intolerance to treatment as indicated by low O2sat Rib fractures Hemoptysis

All positions are contraindicated for the following: Head spine (2)

Intracranial pressure *>20 mmHg* Unstable head and neck injury Recent spinal surgery or acute spinal injury

All positions are contraindicated for the following: (2) Misc

Older, confused, or anxious patients Rib fracture, with or without flail chest

All positions are contraindicated for the following: (surgery) 2

Recent spinal surgery or acute spinal injury Surgical wound or healing tissue

4 Indications

absent cough Excessive plumery secretion inactive cough impaired mucocillary secretion

trendelenburg position

• Patients in whom ICP is to be avoided • Uncontrolled HTN • Distended abdomen • Esophageal surgery • Recent hemoptysis related to recent lung carcinoma • Uncontrolled airway at risk for aspiration

Trendelenburg position is contraindicated for the following in neonates:

• Untreated tension pneumothorax • Recent tracheoesophageal fistula repair • Recent eye or intracranial surgery • Intraventricular hemorrhage (grades III and IV) • Acute heart failure or cor pulmonal