Airway Clearance / Postural Drainage

Goals

• Prevent accumulation of secretions in patients at risk for pulmonary complications– i.e.) chronic bronchitis, CF, prolonged bedrest, painful

incisions, and pts. vent dependent

• Remove accumulated secretions from lungs in patients with pulmonary complications– i.e.) PNA, atelectasis, COPD, very weak/elderly, and

pts. with artificial airways

Considerations for Treatment

• Positioning• Scheduling of Rx• Know ALL

Precautions and Contraindications

• Monitor & Document Necessary Vitals & Breath Sounds

Relative Contraindications to PD

• Severe hemoptysis• Severe pulmonary edema• CHF• Large pleural effusion• PE• Aortic Aneurysm• PTX• Cardiac arrhythmia• Severe hypertension or hypotension• Recent MI• Unstable angina• S/p recent neurosurgery (head-down position may cause intracranial

pressure)-modify position*These pts. will need positional modifications to ensure pt. safety if used*

Treatment Prescription

• How much?• How often?• Where?• When to discharge?

• Modify positions prn

Remember The Anatomy!

Activity #1

• Practice placing your partner in each of the postural drainage positions– Be sure to explain to your partner what you

are doing and why you are doing it!

Percussion

• Know additional contraindications

• Lumbrical position

• “It is not the force but the cupping that is effective”

• Perform 2-5 minutes per lung segment

Vibration

• Performed after percussion or in lieu of

• During exhalation• Repeat 6-8 trials• Finish with huffing or

coughing

Shaking

• “Bounce” ribcage on exhalation

• Simultaneously compress and shake

• Repeat 6-8 trials after percussion

Rib Springing

• More vigorous shaking• Apply 3-4 quick “springs”

with exhalation, assist lower ribcage with exhalation, resist 1/3 inhalation, release and ribs “spring” upward with deeper inhale

• Useful for atelectasis or airway obstruction

Activity #2

• Perform the following for the R middle lobe or lingula:– Percussion (3 minutes)– Vibration (6-8 cycles)– Shaking (6-8 cycles)– Rib Springing (6-8 cycles)

• Perform percussion for at least 3 minutes• Perform one-hand and two-handed techniques• Be sure to explain to your partner what you are

doing and why you are doing it!

Activity #3

• Pick a card and perform the position and technique indicated

• Remember to:– Auscultate the indicated lung segment before and after

treatment application

– Explain to your partner what you are doing and why you are doing it!

• Write a note for this session in SOAP format

References• Kisner, C. Colby, L. Therapeutic Exercise: Foundations and

Techniques. 5th edition. pgs. 870-873. 2007.• Watchie, J. Cardiovascular and Pulmonary Physical Therapy: A

Clinical Manual. 2nd edition. pgs. 328-336. 2010.• http://images.all-freedownload.com/images/graphicmedium/stethoscop

e_98771.jpg• http://image.shutterstock.com/display_pic_with_logo/54820/54820,12

63862109,54/stock-photo-filling-out-a-medical-prescription-with-gold-pen-44871028.jpg

• http://iupucbio2.iupui.edu/anatomy/images/Chapt24/FG24_10a.jpg• http://0.tqn.com/d/copd/1/0/k/2/-/-/Cupped_hand.jpg• http://0.tqn.com/d/copd/1/0/m/2/-/-/Flat_Hand.jpg• http://upload.wikimedia.org/wikipedia/commons/thumb/8/88/

Gray112.png/250px-Gray112.png• http://calcentrist.org/shaking%20money.jpg