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Chest physiotherapy- CPT – postural drainage

POSTURAL  DRAINAGE.

Postural drainage is the procedure to drain pulmonary secretions by gravity into the major bronchi or trachea and is accomplished by sequential repositioning of the patient. Usually, secretions drain best with the patient positioned so that the bronchi are perpendicular to the floor. E.g Lower and middle lobe bronchi empty best with the patient in the head-down position and upper lobe bronchi, in the head-up position.

POSITION OF PATIENTS  FOR  POSTURAL  DRAINAGE

Lower Lobes: Posterior Basal Segments (fig 1)

Provide prone position to the patient with head lowered by elevating the foot of the bed 30 degrees. Position pillows under his chest and abdomen. Percuss his lower ribs on both sides of his spine.

 Fig 1:  position for draining Posterior Basal Segments

 

Lower Lobes: Lateral Basal Segments (fig 2)

 

Elevate the foot of the bed 30 degrees. Instruct the patient to lie on his abdomen with his head lowered and his upper leg flexed over a pillow for support. Then have him rotate a quarter turn upward. Percuss his lower ribs on the uppermost portion of his lateral chest wall.

 Fig 2 position for draining Lateral Basal Segments

 

Lower Lobes: Anterior Basal Segments (fig 3)

 

Elevate the foot of the bed 30 degrees. Instruct the patient to lie on his side with his head lowered. Then place pillows as shown. Percuss with a slightly cupped hand over his lower ribs just beneath the axilla. If an acutely ill patient has trouble breathing in this position, adjust the bed to an angle he can tolerate. Then begin percussion.

Fig 3 : Position for draining Anterior Basal Segments

 

Lower Lobes: Superior Segments (fig 4)

 

With the bed flat, have the patient lie on his abdomen. Place two pillows under his hips. Percuss on both sides of his spine at the lower tip of his scapulae.

Fig 4: Position for draining Superior Segments

 

Right Middle Lobe: Medial and Lateral Segments (fig 5)

 

Elevate the foot of the bed 15 degrees. Have the patient lie on his left side with his head down and his knees flexed. Then have him rotate a quarter turn backward. Place a pillow beneath him. Percuss with your hand moderately cupped under the right nipple. For a woman, cup your hand so that its heel is under the armpit and your fingers extend forward beneath the breast.

 Fig 5: Position for draining Medial and Lateral Segments

 

Left Upper Lobe: Superior and Inferior Segments, Lingular Portion (fig 6)

 

Elevate the foot of the bed 15 degrees. Have the patient lie on his right side with his head down and knees flexed. Then have him rotate a quarter turn backward. Place a pillow behind him, from shoulders to hips. Percuss with your hand moderately cupped over his left nipple. For a woman, cup your hand so that its heel is beneath the armpit and your fingers extend forward beneath the breast.

Fig 6: Position for draining Superior and Inferior Segments, Lingular Portion

 

Upper Lobes: Anterior Segments (fig 7)

 

Make sure the bed is flat. Have the patient lie on his back with a pillow folded under his knees. Then have him rotate slightly away from the side being drained. Percuss between his clavicle and nipple.

Fig 7: Position for draining Anterior Segments

Upper Lobes: Apical Segments (fig 8)

 

Keep the bed flat. Have the patient lean back at a 30-degree angle against you and a pillow. Percuss with a cupped hand between his clavicles and the top of each scapula.

fig 8: Position for draining Apical Segments

 

Upper Lobes: Posterior Segments (fig 9)

 

Keep the bed flat. Have the patient lean over a pillow at a 30-degree angle. Percuss and clap his upper back on each side.

Fig 9 position for draining posterior segments

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