Postural Drainage Techniques and Precautions/Contraindications

Percussion Precautions:

1) bronchospasms 2) seizures 3) osteoporosis 4) rib fx 5) bony metastases 6) recent pacemaker placement 7) anxiety 8) psychiatric conditions

Percussion relative contraindications:

1) hemoptysis 2) untreated pneumothorax 3) low platelets 4) impaired integument

Relative contraindications of postural drainage:

1) increased ICP 2) unstable hemodynamically 3) diaphragmatic hernia 4) recent head trauma 5) recent eye surgery 6) recent spinal injury/fusion

Postural Drainage Precautions: Trendelenberg

1) massive obesity 2) massive ascites 3) pulmonary edema 4) pleural effusion 5) hemoptysis 6) GERD

How do you evaluate the effectiveness of an airway clearance technique?

1) subjective 2) amount of sputum 2) lung auscultation

Upper lobe: Apical segments

bed or drainage table flat pt leans back on pillow at 30 degrees: angle against therapist therapist claps with markedly cupped hand over area between clavicle and top of scap on each side

Upper Lobe: posterior segment

bed or drainage table flat pt leans over folded pillow at 30 degrees PT stands behind and claps over upper back on both sides

Upper lobe: anterior segments

bed or drainage table flat pt lies on back with pillow under knees: therapist between clavicle and nipple line on each side

Lower Lobes: superior segments

bed or table flat pt lies on abdomen with 2 pillows under hips clap over middle of back at tip of scapula on either side of the spine

Lower lobes: anterior basal segments

foot of table elevated 20 inches. Pt lies on side, head down, pillow under knees position hands over lower ribs

Lower lobes posterior basal segments:

foot of table elevated to 20 inches pt lies on abs, head down, pillow under hips clap over lower ribs close to the spine on each side

Left upper lobe: Lingular segment

foot of table or bed elevated 16 inches. Pt lies head down on R side with 1/4 turn backwards pillow may be placed behind from shoulder to hip, knees flexed therapist claps over nipple area

Right middle lobe:

foot of table or bed elevated 16 inches: Pt lies with head down on the L side and rotates 1/4 turn back pillow may be placed behind from shoulder to hip and knees should be flexed therapist claps over R nipple area