Postural Drainage and Chest Physiotherapy Procedure

Chest Physiotherapy and Postural Drainage are two common types of Airway Clearance Therapy that are performed by Respiratory Therapists. We’re going to break down the concepts of each here in this study guide, including the Postural Drainage Positions.

Postural Drainage

So if you’re ready, let’s go ahead and dive right in.

What is Airway Clearance Therapy?

Airway Clearance Therapy uses noninvasive techniques to help mobilize and remove secretions in order to improve gas exchange.

There are several that fall into this type of therapy but this guide is specifically focused on Postural Drainage and Chest Physiotherapy.

What is Chest Physiotherapy?

It is a form of Airway Clearance Therapy that is generally performed by a Respiratory Therapist with the goal of clearing mucus from the airways and lungs. It involves striking the lungs manually with your hands, with a cuff, or with an automatic percussor.

The rhythmic strikes and vibrations help loosen secretions from the airways. Then you can help propel them forward by placing the patient in various postural drainage positions using gravity.

What is Postural Drainage?

It is a form of Airway Clearance Therapy that involves placing the patient’s body in various positions in order to drain secretions from the lung segments into the central airways using gravity. From there, the secretions can be removed via cough or suctioning.

Postural Drainage Positions:

The following tables break down every Postural Drainage Position that is needed in order to drain each specific lobe or segment of the lungs.

Upper Lobes
Posterior Segment	Patient leans forward 30 degrees over the back of a chair (or in bed). Vibration and percussion can be performed over the upper portion of the back on either side, if ordered.
Apical Segment	Patient leans backward 30 degrees. Vibration and percussion can be performed between the clavicle and the top of the scapula on either side, if ordered.
Anterior Segment	Patient lies supine with a pillow under the knees, which enables the abdominal muscles to relax and makes breathing easier. Vibration and percussion can be performed between the clavicle and nipple of a male patient on either side, if ordered. It may not be possible in a female patient.

Right Middle and Left Lingual

Right Lateral and Medial Segments

Same position is used to drain both lobes.
Patient lies one-fourth turn up from the back-down position and a pillow may be placed between flexed knees.
The foot of the bed is elevated 15 degrees (14 inches).
Vibration and percussion can be performed below the right nipple area in a male patient, if ordered. It may not be possible in a female patient.

Left Superior and Inferior Lingual Segments

Same position is used to drain both lobes.
Patient lies one-fourth turn up from the back-down position and a pillow may be placed between flexed knees.
The foot of the bed is elevated 15 degrees (14 inches).
Vibration and percussion can be performed below the left nipple area in a male patient, if ordered. It may not be possible in a female patient.

Lower Lobes
Posterior Basal Segment	Patient lies face down on the bed with the pillow between hips. The foot of the bed is elevated 30 degrees (18 inches). Vibration and percussion can be performed over the appropriate lobe, if ordered.
Lateral Basal Segment	Patient lies one-fourth turn up from the face-down position on the opposite side of that which is needed to be drained. The foot of the bed is elevated 30 degrees (18 inches). Vibration and percussion can be performed over the posterolateral areas of the lower ribs, if ordered.
Anterior Basal Segment	Patient lies straight up on their opposite side of that which is needed to be drained. The foot of the bed is elevated 30 degrees (18 inches). Vibration and percussion can be performed over the lower ribs below the axilla, if ordered.
Superior Segment	Patient lies face down on the bed with a pillow beneath the hips. The bed is in the flat position. Vibration and percussion can be performed in the middle of the back below the scapula on whichever side is needed, if ordered.

Postural Drainage Positions Image:

Hopefully you can use this illustration to help make learning the Postural Drainage Positions much easier.

Postural Drainage Indications:

Postural Drainage should only be recommended for certain patients under certain conditions. Here are some examples:

To mobilize retained secretions so that they can be suctioned or expectorated
Cystic Fibrosis
Atelectasis
Bronchiectasis
Foreign body obstruction

Postural Drainage Contraindications:

There are certain situations in which Postural Drainage would not be recommended. Here are some examples:

Head, neck, or spinal injury
Hemodynamic instability
Increased intracranial pressure
Hemoptysis
Bronchopleural fistula
Pulmonary edema as a result of CHF
Pleural effusion
Flail Chest

Is Postural Drainage Used to Treat Cystic Fibrosis?

Yes, Postural Drainage is an effective method that is used to treat patients with Cystic Fibrosis.

With that said, other forms of Airway Clearance Therapy can be used as well and no one method has been proven to be more effective than others. It all depends on the patient’s preference. In general, you should select the method that will be most tolerated by the patient.

What is the Chest Physiotherapy Vest?

Using “The Vest” is also a common type of Airway Clearance Therapy for Cystic Fibrosis patients. It involves the use of an inflatable vest that produces vibrations at a very fast frequency which helps to loosen up secretions in the airways of the lungs.

After wearing the vest for a period of time, usually 5 minutes, the therapy is paused so that the patient can attempt to cough and remove mucus from the lungs.