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  303 Postural Drainage And Percussion 303 / Page 1 of 4 RCS SFGH Reviewed 8/92, 9/93, 8/98, 1/10, 6/12 Revised 02/02, 7/04, 10/07   Description Postural drainage and percussion of the chest has been used for years to help remove retained secretions from the lungs. These techniques aid the patient in clearing their own secretions. Increased secretions and the need for postural drainage and percussion can be seen in patients with chronic inflammation of the airways such as bronchiectasis, emphysema, and cystic fibrosis. Retained secretions are also found in the general hospital population that includes post operative, elderly, and long-term bedridden patients. The procedures involve therapist/patient contact with no equipment used, just human contact, encouragement, and instruction. Postural drainage is a procedure whereby the patient is placed in such a position as to best use the effects of gravity to drain the lungs of secretions. Percussion incorporates postural drainage with clapping or vibrating the exterior chest wall to loosen retained secretions. Both techniques are passive on the part of the patient, and may take considerable time to produce results. The best results are obtained when the patient can cooperate with coughing to increase effectiveness. Physician Order Postural drainage and percussion Q _____ hour to (affected part of lung). Contraindications 1.   Postural drainage is contraindicated when gravitational effects may adversely affect  patient status eg. increased intra-cranial pressure in patients with unstable ICP. 2.   Percussion and vibration is contraindicated for the following conditions. a.   Post operative patients in the area of the surgical procedure or any area likely to hemorrhage or wound dehissance).  b.    Neurotrauma patients with elevated ICP. c.   Flail Chest d.   Tuberculosis patients. e.   Over the area of a carcinoma. f.   Psychiatric patients (special consult from Psych service advisable). Equipment ã   Tissue and/or sputum cup. ã   Yankuer ã   Suction Catheters ã   Working suction apparatus.  303 Postural Drainage And Percussion 303 / Page 2 of 4 RCS SFGH Reviewed 8/92, 9/93, 8/98, 1/10, 6/12 Revised 02/02, 7/04, 10/07   Procedure 1.   Adults a.   Postural drainage - Position the patient (as indicated in appendix) to drain the affected area of the lung. Have patient maintain position for a half hour.  b.   Percussion i.   Place patient in most effective position for drainage. ii.   Clap over the affected area with the hands slightly cupped, employing brisk relaxed wrist motion. Do not percuss over the spine or anterior chest or other  boney prominences. Percuss for about 30 seconds and follow with vibration. iii.   Vibration is a vibrating motion applied through one or more hands, in combination with pressure over the area to be drained. Apply only during exhalation, prolonging it as long as possible. Apply for 3 to 7 successive  breaths. 2.   Young Children And Infants a.   A majority of young children who require postural drainage and percussion have involvement of the right lung; particularly the upper and middle lobes.  b.   Very young children and infants may be handled more effectively if held. If the therapist is seated and the child is held in lap, all positions can be approximated. c.   Infants should be wrapped in a blanket with arms inside and the blanket off the shoulders. d.   Duration is for 10 to 15 minutes depending upon tolerance. Note: The procedure should be avoided immediately after medications have been given nor less than one hour after meals. Patient Assessment / Reassessment The patient’s response to therapy should be assessed and reassessed. Patient assessment and reassessment should be performed according to the general RCS policy (see Section IV - Patient Assessment / Reassessment in the RCS Policy Manual). The need to continue therapy should be reassessed every 24 hours. Specific criteria for assessment and reassessment should include: ã   Changes in breathsounds ã   Changes in expectorated sputum ã   Patient’s tolerance to therapy ã   Development of the following complications  303 Postural Drainage And Percussion 303 / Page 3 of 4 RCS SFGH Reviewed 8/92, 9/93, 8/98, 1/10, 6/12 Revised 02/02, 7/04, 10/07   Complications ã   Postural drainage  has few dangers. They are limited to gravitational effects on the  patient's cardiovascular system. If side affects are noted, eg. nausea, dizziness, or fainting, return the patient to his/her previous position and notify the nurse and physician. ã   Percussion and vibration may elicit some limited cardiovascular reactions. Monitor  patient and discontinue procedure if side effects are noted. If blood is noted, notify  physician and responsible nurse immediately.  303 Postural Drainage And Percussion 303 / Page 4 of 4 RCS SFGH Reviewed 8/92, 9/93, 8/98, 1/10, 6/12 Revised 02/02, 7/04, 10/07   Appendix - Postural Drainage Lobe Position Upper Lobe ã   Apical Bronchus Sitting upright, with slight variations i.e., slightly leaning  backwards, forwards or sideways. Usually only necessary for infants or recumbent patients. ã   Posterior Bronchus - Right Lying on left side horizontally turned 45° onto face, resting against a pillow (with another pillow supporting the head). ã   Posterior Bronchus - Left Lying on right side turned 45° on to face, with 3 pillows arranged to lift shoulders 12 from bed. ã   Anterior Bronchus Lying flat on back with knees slightly flexed. Middle Lobe ã   Lateral Bronchus ã   Medial Bronchus Lying flat on back, body 1/4 turned to left maintained by a  pillow under right side from shoulder to hip. Foot of bed raised 14 . Lingula ã   Superior Bronchus ã   Inferior Bronchus Lying flat on back, body 1/4 turned to right maintained by a  pillow under left side from shoulder to hip. Foot of bed raised 14 . Lower Lobe ã   Apical Bronchus Lying flat on face, pillow under the hips. ã   Medial basal (cardiac) Lying on right side with a pillow under the hips, foot of bed raised 18 . ã   Anterior basal bronchus Lying flat on back, buttocks resting on a pillow and knees  bent, foot of bed raised 18 . ã   Lateral basal bronchus Lying on opposite side, foot of bed raised 18 , pillow under hips. ã   Posterior basal bronchus Lying flat on face with a pillow under the hips, foot of bed raised 18 . D4wwsw
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