Pulmonary Hygiene Postural Drainage & Percussion Frequently Known As “Pulmonary Toilet”

Postural Drainage & Percussion Postural Drainage : Positioning the patient so that retained secretions in the bronchopulmonary tree can drain by gravity out of the lungs.

Percussion : A rhythmic percussion on the thoracic wall to loosen secretions and assist the mucociliary elevator to rid the lungs of retained secretions

Percussion…How Is Done ? It is performed with a cupped hand and with most of the motion coming from the hand and wrist

A cyclic tapotement over the thoracic wall makes a popping sound Very little movement comes from the elbow and shoulder

Both hands participate - the right hand is constantly in motion setting a regular rhythm while the left hand is the dissonant rhythm hand

Hand Position

Research has shown that a 30-45 minute PD & P session can clear the lung fields of secretions. An x-ray of the lungs pre and post treatment demonstrates a dramatically improved lung.

Left Lung Atelectasis - Postmortem

Hemothorax On X-Ray

Left Lung Atlectasis On X-Ray

Positioning The Patient Positioning the patient is important to allow the bronchi of each bronchopulmonary segment to be vertical so that the fluid inside the bronchus will move toward the mainstem bronchi and out of the lung.

Positioning The Patient The Sitting Positions : Apical Segments of Right & Left upper Lobes Anterior Segment of the Left Upper Lobe

The Apical Segment Of The Right & Left Upper Lobes The bronchial feed into these segments are : forward upward lateral

Postural Position : High Long Sitting Angled 30-45 degrees backward in reclined sitting

Percussion & Auscultation : Over the trapezius between the clavicle anteriorly and the scapula posteriorly

Left Anterior BP Segment Of The Left Upper Lobe The bronchial feed into this segment is : obliquely upward forward

Postural Position : 45 - 60 degrees reclined long sitting

Percussion & Auscultation : Over the Pectoralis Major muscle on the left side

Positioning The Patient The Near-Prone & Prone Positions Posterior BP Segment Of The Left &The Right Upper Lobe

Superior or Apical BP Segment Of The Right And the Left Lower Lobes Posterior Basilar BP Segment Of The Right & Left Lower Lobes

Posterior BP Segment Of The Left Upper Lobe The bronchial feed into this segment is : Posterior Obliquely Upward

Postural Position : Prone onto right side with left shoulders pillowed & rotated up off of the bed

Percussion & Auscultation : Over the scapula

Posterior BP Segment Of The Right Upper Lobe The bronchial feed into this segment is : Posterior Obliquely upward

Postural Position : Prone onto left side with right shoulders pillowed & rotated up off of the bed

Percussion & Auscultation : Over the scapula

Superior or Apical BP Segment Of The Right & Left Lower Lobes The bronchial feed into these segments is : Posterior

Postural Position : Prone flat

Percussion & Auscultation : Over the thorax just at the inferior angle of the scapula

Posterior Basilar BP Segment Of The Right & Left Lower Lobes The bronchial feed into these segments is : Posterior Obliquely downward

Postural Position : Prone with head below horizon

Percussion & Auscultation : Over the posterior thorax just above the inferior border of the thoracic cage

Positioning The Patient Supine Positions : Anterior BP Segment Of The Right Upper Lobe Anterior Basilar BP Segments Of The Right & Left Lower Lobes

Anterior BP Segment Of The Right Upper Lobe The bronchial feed into this segment is : Forward

Postural Position : Supine flat

Percussion & Auscultation : Over the Pectoralis Major muscle on the right side

Anterior Basilar BP Segments Of The Right & Left Lower Lobes The bronchial feed into these segments is : Forward Obliquely Downward

Postural Position : Supine & inclined with head below horizon

Percussion & Auscultation : Over the thoracic wall on the anterior surface just above the inferior border of the thorax

Positioning The Patient The Right Side-Lying Positions The Lingula Of The Left Upper Lobe Lateral Basilar BP Segment Of The Left Lower Lobes

The Lingula Of The Left Upper Lobe The bronchial feed into these segments is : Lateral Obliquely Downward

Postural Position : Right side-lying inclined with head below horizon Left shoulder rotated down toward the bed

Percussion & Auscultation : Over the thoracic wall on the left lateral surface over the nipple and the thorax in the mid-axillary line

Lateral Basilar BP Segment Of The Left Lower Lobes & Right Cardiac BP Segment Of The Right Lower Lobes The bronchial feed into these segments is : Left Side = Lateral Right Side = Medial Obliquely Downward

Postural Position : Right side-lying inclined with head below horizon

Percussion & Auscultation : Over the thoracic wall on the left lateral surface in the mid-axillary line

The Cardiac or Medial Basilar BP Segment Of The Right Lower Lobes Cannot Be Auscultated Nor Percussed

Positioning The Patient The Left Side-Lying Positions The Right Middle Lobes Lateral Basilar BP Segment Of The Right Lower Lobes

The Right Middle Lobes The bronchial feed into these segments are : Lateral Forward Obliquely Downward

Postural Position : Left side-lying inclined with head below horizon and the right shoulders rotated down towards the bed

Percussion & Auscultation : Over the thoracic wall on the right thoracic wall over the nipple extending into the mid-axillary line

Lateral Basilar BP Segment Of The Right Lower Lobes The bronchial feed into this segment is : Lateral Obliquely Downward

Postural Position : Left side-lying inclined with head below horizon

Percussion & Auscultation : Over the right thoracic wall in the mid-axillary line at the inferior border of the thorax