POSTURAL DRAINAGE

Definition: Postural drainage is positioning the patient so that the force of gravity helps the lungs
drain secretions from specific segments into the major bronchi and trachea where they can
be removed by coughing (Ellis, et. Al 1996 p. 174).

Purposes:
1. To drain the loosened secretions out of the patient’s lungs.
2. To prevent loosened secretions from repooling or draining into healthy lung segments.
(Swearing & Howard, 1996 p.370).

Underlying Principles:
1. The force of gravity help drain long secretions (Monahan, et. al. 1994, p. 443).
2. Because of branching structure of the lungs a variety of positions must be used to drain all the
lung segments adequately. However, not all positions are necessary for every patient (Ellis, et.
al. 1996 p. 174).
3. The patient is made as comfortable as possible.

Equipment:
 Sputum cup
 Tissue or mouth wipes

STEPS RATIONALE
ASSESSMENT
1. Check the chart for a physician’s order, which
is needed to perform postural drainage.

2. Identify the specific segments of the lungs to

be drained. This may be found in the chest x-
ray result.

3. Wash your hands. For infection control.

4. Auscultate the patient’s lung fields for To provide a baseline for post-treatment
crepitus, fremitus, and monitor the rate and assessment. Diminished, absent or bronchial
depth of respirations. Note the presence and breath sounds are indicative of obstructed airways
location of retained secretions. and reduced airflow caused by retained secretions.

5. Palpate the bilateral thoracic expansion and Percuss over a thin layer of clothing or a towel to
percusss the areas of dullness. avoid traumatizing the skin.

6. Observe for thick, sticky, tenacious and

discolored secretions that are difficult to
cough up.

7. Assess vital signs.

8. Consider the contraindications to therapy and Procedure is contraindicated for head injuries,
to Trendelenburg’s position and other posture increased intracranial pressure, recent severe
that can cause severe hypotension, severe myocardial failure, lung hemorrhage and certain
hypoxemia or severe shortness of breath. surgical procedure, pain or traction.

9. 9. Assist the patient maintain the position for This allows time for secretions to drain from the
10-15 minutes then perform percussion, smaller to larger branches to the bronchi.
vibration and shaking over the area drained.
10. Have the patient sit-up and cough forcefully. The maneuvers provide mechanical forces that
If unable to do so, suction the loosened promote mobilization of secretions. Secretions
secretions. mobilized into the central airways can be expelled
through coughing or suctioning.
11. Have the patient sip water. Keep the mouth moist.

12. Have the patient rest briefly. Rest periods between positions promote comfort
since entire procedure can be tiring.
13. Help the patient assume the next position.
Repeat the same steps (3 to 7) until the end of
the procedure.

14. Make the patient comfortable and offer mouth Promotes rest after a tiring procedure. Mouth care
care. provides oral hydration and hygiene.

15. Wash hands.

EVALUATION
1. Evaluate, look for the following outcomes: Provided for comparison to determine the
 Lung sounds improved if not clear effectiveness of the procedure and the need for
 Amount of sputum expectorated or modifications.
suctioned
 Color, consistency of sputum
 Ease in breathing
 Vital signs
 Patient’s response to procedure
 Absence of untoward effects or
complications such as severe dyspnea,
bronchospasm, hypoxemia and
hypercapnea.

2. Evaluate the patients understanding of the To increase the patient’s readiness to perform the
procedure. procedure at home. Readiness will enhance
compliance.
RECORDING AND REPORTING
1. Record in nurse’s notes: The nurse’s documentation communicates with
 Positions used for postural drainage the other members of the health team about the
 Secretions produced procedure and the patient’s response.
 Any changes in respiratory status

2. Report promptly any untoward results or For prompt medical intervention.

complications.

UNEXPECTED OUTCOMES AND RELATED INTERVENTIONS

 Patient experiences severe dyspnea with bronchospasm, hypoxemia, and hypercarbia
(hypercapnia).
 Identify patients at risk for this unexpected outcome:
1. Those with status asthmaticus
2. Those with severe exacerbation of bronchitis debilitated and tired and whose
blood gas levels are consistent with severe hypoxemia and hypercarbia.
 Chest therapy may have to be discontinued or modified for these patients. They
may tolerate only 3 to 5 minutes of drainage per hour.
 Bronchodilator inhalation should be scheduled 20 minutes before postural drainage.
  Hemoptysis occurs
 These may be caused by infection, erosion of blood vessels, or other causes.
 In severe hemoptysis, stop therapy, call physician, remain calm, stay with patient,
request assistance, and keep patient comfortable, calm, warm, and quiet.
 No secretions are obtained.
 Continue therapy for several days to 1 week. There may be a lack of secretions, or
secretions may be too thick to mobilize.
 Secretions are not always mobilized and coughed up after each posture. If, after two
or three coughs, nothing is expectorated, proceed with next posture. Often
secretions are coughed up to 30 to 60 minutes after postural drainage.
 Improve hydration.
 There is no improvement in chest assessment: adventitious sounds are present, dyspnea occurs,
there is poor chest excursion.
 Increase frequency of therapy
 Consult physician for potential sputum culture and initiation of antibiotics
 Teach coughing exercises.
 Patient’s vital signs and oxygen saturation decline.
 Notify physician.
 Continue to monitor patient’s vital signs and oxygen saturation
 Modify type and frequency of postural drainage.
 Patient unable to demonstrate or explain postural drainage.
 Provide further instruction.

TEACHING CONSIDERATIONS
 Best times for treatment are:
1. In the morning before breakfast, when patient can clear secretions that accumulate overnight
and;
2. About 1 hour before bedtime, so that lungs are clear before sleeping and patient has time
after treatment to cough up any mobilized secretions. Frequency depends on need and
patient’s tolerance and may vary from once daily to every 2 to 4 hours in an acute situation.
 If patient is receiving inhaled bronchodilators or aerosol treatment, postural drainage should be
done 20 minutes after such therapy. Plan for rest period after postural drainage.
 Do not schedule major activities (such as exercise or bath) right after therapy treatment
especially in patients with severe obstructive lung disease.
 Instruct patient’s family or primary caregiver o recognize when the patient’s respiratory status
requires breathing exercises or postural drainage.
 Encourage primary caregiver or family member to encourage the patient to participate in
physical activities that will increase respiratory efficiency.
 Teach patient and significant others how to assume postures at home. Some postures may need
to be modified to meet individual needs: for example, side-lying Trendelenburg’s position to
drain lateral lower lobes may have to be done with patient lying flat on side or in side-lying
semi-Fowler’s position if patient is very short of breath.

Patient Teaching for performing postural drainage. Teach the patient to do the following:
 Plan to perform postural drainage 2 to 4 times each day, such as before meals and bedtime.
 Self-administer inhaled medications that have been prescribed before performing postural
drainage.
 Have paper tissue and a waterproof container nearly for collecting expectorated sputum.
 Position yourself so as to drain the appropriate diseased areas of your lungs.
 Cough and expectorate the secretions that drain into the upper airway.
 Remain in each of the prescribed positions for at least 15 – 30 minutes, but no longer than 45
minutes.
 Resume a position of comfort after the usual volume of sputum has been expectorated, or if you
experience fatigue, lightheadedness, rapid pulse rate, difficulty breathing or chest pain (Timby,
1996 p. 778).
References:
 Ellis, Janice R., et. Al (1996). Modules for basic nursing skills. Philadelphia: Lippincott.
 Monahan, Frances D., et. al. (1994). Nursing care of adults. Philadelphia: W. B. Saunders
Company.
 Swearingen, Pamela L. and Howard, Cheri A. (1996). Photo atlas of nursing procedures.
California: Addison – Wesley Nursing.
 Timby, Barbara (1996). Fundamental skills & concepts in patient care. New York: Lippincott.
 Old SUCN procedure & checklist
Student: _________________________________

Instructor: _______________________________

Instructor’s Signature: ____________________ Date: _______________

PERFORMANCE CHECKLIST POSTURAL DRAINAGE

ASSESSMENT S U NP REMARKS
1. Checked the chart for physician’s order
which is needed to perform postural
drainage
2. Identified the specific segments of the lungs
to be drained. This may be found in the
chest x-ray result.
3. Washed hands
4. Auscultated the patient’s lung fields for
crepitus, fremitus, and monitors the rate
and depth of respirations. Note the
presence and location of retained
secretions.
5. Palpates the bilateral thoracic expansion and
percuss the areas of dullness.
6. Observes for thick, sticky, tenacious and
discolored secretions that are difficult to
cough up.
7. Assessed vital signs.
8. Considered he contraindications to therapy
and to Trendelenburg’s position and other
posture that can cause severe hypotension,
severe hypoxemia or severe shortness of
breath.
NURSING DIAGNOSIS
Develops appropriate nursing diagnoses based
on assessment data.
PLANNING
1. Planned how to place the patient in various
positions.
2. Scheduled treatments at appropriate time of
the day. Stop all continuous gastric tube
feeding for 30 – 45 minutes before postural
drainage. Checked for residual feeding in
the patient’s stomach; if greater than 100
ml, hold treatment.
3. Tell the patient to remove any tight or
restrictive clothing.
4. Obtains pillows and a sputum cup and
tissues for the patient to use.
5. Obtained clean gloves if the patient is
unable to manage his/her own secretions.
6. Determined length of tube to be inserted
and marked with tape or indelible ink.
IMPLEMENTATION
1. Identified the patient.
2. Explained to the patient the purpose and
method of postural drainage.
3. Positioned the patient according to the lung
area to be drained. Help the patient to
assume the position when needed. Assisted
the patient assume correct posture. Draped
the patient appropriately.
4. Assisted the patient maintain the position
for 10-15 minutes then perform percussion,
vibration and shaking over the area
drained.
5. Tells the patient sit-up and cough forcefully.
If unable to do so, suction the loosened
secretions.
6. Made the patient sip water.
7. Made the patient rest briefly.
8. Helped the patient assumed the next
position. Repeated the same steps (3 to 7)
until the end of the procedure.
9. Made the patient comfortable and offered
mouth care.
EVALUATION
1. Evaluates, looks for the following
outcomes:
 Lung sounds improved if not clear
 Amount of sputum expectorated or
suctioned
 Color, consistency of sputum
 Ease in breathing
 Vital signs
 Patient’s response to procedure
 Absence of untoward effects or
complications such as severe dyspnea,
bronchospasm, hypxemia and
hypercapnea
2. Evaluated the patients understanding of the
procedure.
RECORDING AND REPORTING
1. Recorded in nurse’s notes:
 Positions used for postural drainage
 Secretions produced
 Any changes in respiratory status
2. Reported promptly any untoward result or
complications.