1. Airway Clearance / Postural Drainage

2. 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

3. Considerations for Treatment
Positioning
Scheduling of Rx
Know ALL Precautions and Contraindications
Monitor & Document Necessary Vitals & Breath Sounds

4. 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*

5. Treatment Prescription
How much?
How often?
Where?
When to discharge?
Modify positions prn

6. 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.

9. 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!

10. Percussion Know additional contraindications Lumbrical position
“It is not the force but the cupping that is effective”
Perform 2-5 minutes per lung segment

11. Vibration Performed after percussion or in lieu of During exhalation
Repeat 6-8 trials
Finish with huffing or coughing

12. Shaking “Bounce” ribcage on exhalation
Simultaneously compress and shake
Repeat 6-8 trials after percussion

13. 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

14. 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!

15. 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

16. References
Kisner, C. Colby, L. Therapeutic Exercise: Foundations and Techniques. 5th edition. pgs
Watchie, J. Cardiovascular and Pulmonary Physical Therapy: A Clinical Manual. 2nd edition. pgs