Preparation for postural drainage I. Obtain All Patient Information: 1-Where is the lung area to be emphasized? This information may be obtained from a thorough chest evaluation, the patient's chart, conferring with the physician, and looking at the patient's x-rays. 2-What is the patient's general medical condition? Vital signs, especially relatively stable pulse and blood pressure, arrhythmias, , ability to tolerate treatment, any acute or chronic medical Condition that may pertain to treatment and positioning precautions should all be taken into account.

Preparation for Postural Drainage 3-When is the best treatment time? One should consider meals or tube feedings: generally, a treatment should not be given immediately after a meal, rather 1½-2 hours after the ingestion. 4-How can I best treat the patient? Which positions are indicated? What will the patient tolerate? Are position modifications necessary? What coordination with nursing and respiratory therapy is appropriate?

Preparation for Postural Drainage II. Prepare the Patient: 1-Loosen any tight or binding clothing, especially around the neck or waist. 2-Explain the treatment to the patient, simply but completely. 3-Seek to develop a relaxed atmosphere and rapport with the patient.

Preparation for Postural Drainage 4-Observe any tubes and connections attached to the patient, such as IVs, ECG monitor, artificial airway, ventilator, Foley catheter, arterial lines, central venous pressure lines, aortic balloon, etc. determine how each of the connections will move as the patient is positioned. 5- Adjust any tubes that would not move properly before positioning patient.

Preparation for Postural Drainage 6-Make sure there are enough personnel to position patient with as little stress to both patient and staff as possible. 7-With a critically ill patient, check the pulse and blood pressure to establish baselines before treatment begins. 8-Have the patient either cough or be suctioned prior to positioning if he tends to have a large amount of secretions. This should be repeated before changing positions if more than one position is to be utilized.

Treatment: 1-The therapist should be positioned in front of the patient during postural drainage in order to observe any changes quickly. Care should be taken not the have the patient cough directly at the therapist, with proper covering of his mouth, utilizing tissue, and other precautions. 2-Position patient in proper postural drainage position or modify position as indicated. Modified positions are utilized if there is a precaution or relative contraindication to the ideal position.

Treatment 3-Position should be maintained at least 5-10 minutes if tolerated, and may be maintained longer if a large amount of secretion is present or if secretions are thick. (Note: If secretions seem thick and difficult to mobilize, an ultrasonic nebulizer (USN) should be considered. 4-The patient should also be encouraged to drink more fluids unless this is contraindicated). If several positions are used, it is best to limit the total treatment time to 30 – 40 minutes as this may become extremely fatiguing to the patient.

Treatment 5-One may treat certain lung areas in the morning and others in the afternoon rather than doing everything in one treatment. If this is done, the most important areas should be treated in the morning. 6- Generally, percussion, vibration and breathing exercises will be included in the treatment if there are no specific contraindications.

Treatment 7- Intermittent positive pressure breathing (IPPB) may be included with patients who have a decreased vital capacity, muscle weakness, increased airway resistance or increased work of breathing. 8- The patient should sit up slowly after the treatment to take some deep breaths and cough. 9- The therapist may determine to have the patient stay in the postural drainage position for a prolonged time.

Equipment 1- Bed or table that can be adjusted for a range of positions. 2- Pillows for supporting patient. 3- Light towel for covering area of chest during percussion 4- Tissues for collecting expectorated sputum 5- Suction equipment for patients unable to clear secretion

Equipment 6-Gloves, goggles, gown, and mask as indicated for caregiver protection 7-Optional: hand-held and mechanical percussor or vibrator 8- Oxygen delivery device. 9- Recent chest x-ray, if available. 10- Stethoscope for auscultation.