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! Pay Special Attention to the horizontal plane of the R secondary bronchus with regard to positioning for postural drainage! Ie…R is more horizontal and will require pt to be on less of an incline to drain properly. The L secondary bronchus has more of a vertical nature upward, thereby to be drained in the more upright positioning. Look at yellow branches next to split.

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/stethoscope_98771.jpg http://image.shutterstock.com/display_pic_with_logo/54820/54820,1263862109,54/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