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1. POSTURAL DRAINAGE
Rahul AP.
BPT,MPT, MIAP (CRD&ICU Management )
Assi Proff: LIAHS –Kannur,Kerala

2. Definitions
 PD or bronchial drainage is a means of
mobilizing secretions in one or more lung
segments to the central airways by placing
the patients in various positions so that the
gravity assist in the drainage process
 It include the manual techniques such as
percussion, shaking, vibration and voluntary
coughing

3.  When secretions are moved to the larger
airways, they are then cleared by coughing
or Endotracheal suctioning.

4. Positions
 Positions are based on the anatomy of the lungs
and the tracheobronchial tree.
The patient may be positioned on a
Postural drainage table that can be elevated at
one end eg;Tilt table
A small child can be positioned on the physio’s
lap.

5. Bronchopulmonary segments

7. Goals
To Prevent accumulation of secretions in
patients who are at risk for pulmonary
complications
This may include:
Patients with pulmonary diseases that are
associated with increased production or
viscosity of mucus, such as chronic bronchitis
and cystic fibrosis.
Patients who are on prolonged bed rest.

8. Post surgical patients who have received
general anesthesia and who may have painful
incisions that restrict deep breathing and
coughing postoperatively.
Any patient who is on a ventilator if they are
stable enough to tolerate the treatment.

9. To Remove secretions already accumulated in
the lungs of
 Patients with acute or chronic lung disease, such
as pneumonia, Atelectasis, acute lung infections,
and COPD.
 Patients who are generally very weak or are
elderly.

10. INDICATIONS
 Cystic fibrosis
 Bronchiectasis
 Atelectasis
 Lung abscess
 Pneumonias
 Acute lung disease
 COPD –emphysema, chronic bronchitis
 For patients with a high spinal cord lesion/ spinal
cord injury, myopathies etc.
 After surgeries (thoracic or abdominal surgery)

11.  On prolonged bed rest
 Patient received general anesthesia and have
painful incision that restrict deep breathing and
coughing postoperatively
 Who is on ventilator (if stable enough to tolerate
PD)
 Patient who is generally weak or old

12. CONTRAINDICATIONS
 Increased ICP
 Unstable head or neck injury
 Active hemorrhage
 Hemoptysis
 Recent spinal injury
 Empyema
 Bronchoplueral fistula
 Flail chest
 Uncontrolled hypertension
 Rib or vertebral fractures
 Tuberculosis

13.  Pulmonary embolism.
 aged, confused, or anxious patients who don't
tolerate position changes

14. PREPARATIONS
 Loosen the dress
 Sputum cup
 Pillows
 Explain the Rx and teach the patient deep
breathing and cough

15. PROCEDURE
 Determine segments
 Vital signs
 Position the patient
 Stand in front of pt
 Maintain position
 Apply manual techniques
 Do coughing or suctioning

16. MANUAL TECHNIQUES

17. Percussion
 This is used to mobilize secretions by
mechanically dislodging viscous or adherent
mucus from the lungs
 It is done by the cupped hand over the lung
segments being drained
 Here the PTs cupped hand alternatively strikes
the patients chest wall in a rhythmic fashion to
help loosen thick secretions
 The PT should try to keep his shoulder elbow
and wrist loose and mobile during the maneuver
 The procedure should not be painful

18. Chest Percussion

19.  To prevent irritation patient wear a light gown or
shirt
Contraindication to percussion
 Over #
 Osteoporotic bone
 Spinal fusion
 Over tumor area
 Pulmonary embolus
 Condition in which hemorrhage could easily occur
(low platelet count ,anticoagulation therapy)
 Patient with unstable angina
 Case of chest wall pain (after any surgery CABG
or trauma

20. Vibration
 This is done in conjunction with percussion
 It is applied only during expiration
 It is applied by placing both hands directly over
the chest wall or one hand on top of other and
gently compressing
 The therapist stiffen his arm and shoulder and
apply light pressure and rapidly vibrating the
chest wall as the patient breaths out

21.  The vibrating action is achieved by the PT
isometrically contracting the muscles of the
upper extremity from shoulder to hand
 Ask the patient to breathe in deeply and exhale
slowly and completely.
 Taking a deep breath and then exhaling slowly
and forcefully without straining will hopefully
stimulate a productive cough

23. Shaking
 It is a more vigorous form of vibration which is
applied during exhalation using an intermittent
bouncing maneuver coupled with wide movements
of the PTs hand
 The PTs thumb are locked together the open hands
are placed directly over the patients chest the
fingers are wrapped around the chest wall
 The PT simultaneously compress and shake the
chest wall

24. SEGMENTS

25. UPPER LOBE - Apical Segments
• To drain mucus from the upper lobe apical
segments, the patient sits in a comfortable
position on a bed or flat surface and leans on a
back rest.
• The PT percusses and vibrates over the muscular
area between the collar bone and very top of the
shoulder blades on both sides for 3 to 5 minutes.
• Encourage the patient to take a deep breath and
cough during percussion in order to help the
airways clearance

26. UPPER LOBE - Apical Segments

27. Posterior Segments (right)
 The patient lie on his left side and then turn
45º on to his face , resting against a pillow
with an another pillow supporting his head
 The left arm should kept comfortably behind
his back with right arm resting on a pillow,
the right knee should be flexed

28. Posterior Segments (right)

29. Posterior Segments (left)
 The patient lie on his right side and then turn
45º on to his face with 3 pillows to raise the
shoulder 30cm (12 in) from the bed.
 The right arm should kept comfortably
behind his back with left arm resting on a
pillow, both knee should be slightly flexed

30. Posterior Segments (left)

31. Upper lobe-anterior Segments
 The patient lies flat on the bed or table with a
pillow under his head and legs and arms
relaxed by his side.
 The chest PT is given to right and left sides of
the front of the chest, between the collar
bone and nipple.

32. Upper lobe-anterior Segments

33. Middle lobe (lateral and
medial segment)
 Patient lie on his back with his body quarter
turned to the left maintain by a pillow under
right side from shoulder to hip
 Arm should relaxed by his side
 Foot of the bed should be raised 35cm (14in)
from the ground
 Chest is tilted to an angle of 15º

34. Middle lobe (lateral and
medial segment)

35. Lingula (superior and
inferior segment)
 Patient lie on his back with his body quarter
turned to the right maintain by a pillow under
left side from shoulder to hip
 Arm should relaxed by his side
 Foot of the bed should be raised 35cm (14in)
from the ground
 Chest is tilted to an angle of 15º

36. Lingula (superior and
inferior segment)

37. Lower lobes(apical segment)
• Patient lie prone with the head turned to one
side
• Arm relaxed in a comfortable position by the
side
• A pillow under his hips

38. Lower lobes(apical segment)

39. Lower lobes(anterior basal
segment)
 Patient lie flat on his back with the buttocks
resting on a pillow and knees are flexed
 The foot of the bed is elevated 46cm (18 in)
from the ground
 The chest is tilted to an angle of 20º

40. Lower lobes(anterior basal
segment)

41. Lower lobes(posterior basal
segments)
 Patient lie prone with his head turned to one
side
 Arms in a comfortable position by the side
 A pillow under his hip
 The foot of the bed is elevated 46cm (18 in)
from the ground
 The chest is tilted to an angle of 20º

42. Lower lobes(posterior basal
segments)

43. Lower lobes(medial basal or
cardiac segment)
 Patient lie on his right side with a pillow
under his hips
 The foot end is raised 46cm (18in) from the
ground
 The chest is tilted to an angle of 20º

44. Lower lobes(medial basal or
cardiac segment)

45. Lower lobes(lateral basal
segment)
 Patient lie on his left side with a pillow under
his hips
 The foot end is raised 46cm (18in) from the
ground
 The chest is tilted to an angle of 20º

46. Lower lobes(lateral basal
segment)

47. Thank you…