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

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

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

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

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

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

7. Hand Position

8. Research has shown that a 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.

9. Left Lung Atelectasis - Postmortem

10. Hemothorax On X-Ray

11. Left Lung Atlectasis On X-Ray

12. 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.

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

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

15. Postural Position :
High Long Sitting
Angled degrees backward in reclined sitting

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

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

19. Postural Position :
degrees reclined long sitting

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

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

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

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

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

27. Percussion & Auscultation :
Over the scapula

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

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

31. Percussion & Auscultation :
Over the scapula

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

33. Postural Position :
Prone flat

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

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

37. Postural Position :
Prone with head below horizon

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

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

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

42. Postural Position :
Supine flat

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

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

46. Postural Position :
Supine & inclined with head below horizon

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

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

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

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

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

54. 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

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

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

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

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

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

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

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

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

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

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