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Postural Drainage And Percussion

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Description
Postural drainage and percussion of the chest has been used for years to help remove retained
secretions from the lungs. These techniques aid the patient in clearing their own secretions.
Increased secretions and the need for postural drainage and percussion can be seen in patients
with chronic inflammation of the airways such as bronchiectasis, emphysema, and cystic
fibrosis. Retained secretions are also found in the general hospital population that includes post
operative, elderly, and long-term bedridden patients.
The procedures involve therapist/patient contact with no equipment used, just human contact,
encouragement, and instruction. Postural drainage is a procedure whereby the patient is placed
in such a position as to best use the effects of gravity to drain the lungs of secretions. Percussion
incorporates postural drainage with clapping or vibrating the exterior chest wall to loosen
retained secretions. Both techniques are passive on the part of the patient, and may take
considerable time to produce results. The best results are obtained when the patient can
cooperate with coughing to increase effectiveness.
Physician Order
Postural drainage and percussion Q _____ hour to (affected part of lung).
Contraindications
1. Postural drainage is contraindicated when gravitational effects may adversely affect
patient status eg. increased intra-cranial pressure in patients with unstable ICP.
2. Percussion and vibration is contraindicated for the following conditions.
a. Post operative patients in the area of the surgical procedure or any area likely to
hemorrhage or wound dehissance).
b. Neurotrauma patients with elevated ICP.
c. Flail Chest
d. Tuberculosis patients.
e. Over the area of a carcinoma.
f. Psychiatric patients (special consult from Psych service advisable).
Equipment

Tissue and/or sputum cup.

Yankuer

Suction Catheters

Working suction apparatus.

RCS SFGH

Reviewed 8/92, 9/93, 8/98, 1/10, 6/12

Revised 02/02, 7/04, 10/07

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Procedure
1. Adults
a. Postural drainage - Position the patient (as indicated in appendix) to drain the affected
area of the lung. Have patient maintain position for a half hour.
b. Percussion
i. Place patient in most effective position for drainage.
ii. Clap over the affected area with the hands slightly cupped, employing brisk
relaxed wrist motion. Do not percuss over the spine or anterior chest or other
boney prominences. Percuss for about 30 seconds and follow with vibration.
iii. Vibration is a vibrating motion applied through one or more hands, in
combination with pressure over the area to be drained. Apply only during
exhalation, prolonging it as long as possible. Apply for 3 to 7 successive
breaths.
2. Young Children And Infants
a. A majority of young children who require postural drainage and percussion have
involvement of the right lung; particularly the upper and middle lobes.
b. Very young children and infants may be handled more effectively if held. If the
therapist is seated and the child is held in lap, all positions can be approximated.
c. Infants should be wrapped in a blanket with arms inside and the blanket off the
shoulders.
d. Duration is for 10 to 15 minutes depending upon tolerance.
Note: The procedure should be avoided immediately after medications have been given
nor less than one hour after meals.
Patient Assessment / Reassessment
The patients response to therapy should be assessed and reassessed. Patient assessment and
reassessment should be performed according to the general RCS policy (see Section IV - Patient
Assessment / Reassessment in the RCS Policy Manual). The need to continue therapy should be
reassessed every 24 hours.
Specific criteria for assessment and reassessment should include:

Changes in breathsounds

Changes in expectorated sputum

Patients tolerance to therapy

Development of the following complications

RCS SFGH

Reviewed 8/92, 9/93, 8/98, 1/10, 6/12

Revised 02/02, 7/04, 10/07

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Complications

Postural drainage has few dangers. They are limited to gravitational effects on the
patient's cardiovascular system. If side affects are noted, eg. nausea, dizziness, or
fainting, return the patient to his/her previous position and notify the nurse and physician.

Percussion and vibration may elicit some limited cardiovascular reactions. Monitor
patient and discontinue procedure if side effects are noted. If blood is noted, notify
physician and responsible nurse immediately.

RCS SFGH

Reviewed 8/92, 9/93, 8/98, 1/10, 6/12

Revised 02/02, 7/04, 10/07

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Appendix - Postural Drainage

Lobe

Position

Upper Lobe
Sitting upright, with slight variations i.e., slightly leaning
backwards, forwards or sideways. Usually only necessary
for infants or recumbent patients.

Apical Bronchus

Posterior Bronchus - Right Lying on left side horizontally turned 45 onto face, resting
against a pillow (with another pillow supporting the head).

Posterior Bronchus - Left

Lying on right side turned 45 on to face, with 3 pillows

arranged to lift shoulders 12" from bed.

Anterior Bronchus

Lying flat on back with knees slightly flexed.

Middle Lobe

Lateral Bronchus

Medial Bronchus

Lying flat on back, body 1/4 turned to left maintained by a

pillow under right side from shoulder to hip. Foot of bed
raised 14".

Lingula

Superior Bronchus

Inferior Bronchus

Lying flat on back, body 1/4 turned to right maintained by a

pillow under left side from shoulder to hip. Foot of bed
raised 14".

Lower Lobe

Apical Bronchus

Lying flat on face, pillow under the hips.

Medial basal (cardiac)

Lying on right side with a pillow under the hips, foot of bed
raised 18".

Anterior basal bronchus

Lying flat on back, buttocks resting on a pillow and knees

bent, foot of bed raised 18".

Lateral basal bronchus

Lying on opposite side, foot of bed raised 18", pillow under

hips.

Posterior basal bronchus

Lying flat on face with a pillow under the hips, foot of bed
raised 18".

D4wwsw

RCS SFGH

Reviewed 8/92, 9/93, 8/98, 1/10, 6/12

Revised 02/02, 7/04, 10/07