Postural Drainage Positions For COPD Patients

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Lung Anatomy

Lungs
External Anatomy of the Lungs. Artwork by Carolyn Russell

Postural drainage is an airway clearance technique that, along with chest percussion and vibration, helps patients with respiratory illnesses such as COPD clear mucus from their lungs.

The following diagrams show a variety of postural drainage positions that are meant to facilitate drainage from each specific segment of the lung. In each picture, the shaded black dots demonstrate the place where your caregiver should apply chest percussion (a clapping movement that is performed with cupped hands) and vibration (a vibrating movement done with flat hands).

The lungs consist of five lobes, three on the right side and two on the left side of the chest cavity. Each lobe is further divided into segments. The goal of postural drainage and chest percussion is to help drain mucus from each of these lobes into the larger airways of the lungs so it can be coughed up more readily.

The diagrams included in this gallery portray a series of postural drainage positions to help COPD patients drain each segment of the lungs. To be most effective, postural drainage, which is performed by a caregiver, should be accompanied by chest physiotherapy, which includes chest percussion and vibration, deep breathing and coughing.

Once a patient assumes the correct postural drainage position, the caregiver performs chest percussion and vibration to the desired location on the chest wall (this location is clearly marked by a shaded area in each of the 10 positions). Chest physiotherapy is generally performed for three to five minutes on each segment. During this time, the patient is encouraged to take a slow, deep breath followed by a vigorous cough in an attempt to clear the airways of mucus. This technique should be repeated several times during the chest physiotherapy session.

It is important to note that some postural drainage positions may cause an increase of heartburn and acid reflux and/or vomiting, particularly those positions where the head is lower than the stomach. Not only can this cause discomfort and possible wheezing, but vomiting may lead to a lung infection which may cause further lung damage. If you experience these symptoms during postural drainage, talk to your doctor about alternative methods of clearing your airways and read A Complete Guide to Airway Clearance Techniques.

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Chest Percussion

Hand Position for Chest Percussion
Hand Position for Chest Percussion. Artwork by Carolyn Russell

Chest percussion involves using a cupped hand and alternately clapping with both hands on the patient's chest wall. This should be performed over the lung segment that is to be drained. Your hand should not be flat, but cupped at all times, as if you were holding liquid in it.

The percussion technique should be vigorous and rhythmical, but it should not involve pain. If the patient does complain of pain, this means that your hand may not be cupped properly and needs to be softened or readjusted. When done properly, you should hear a hollow sound with each percussion.

Chest percussion should be done over the ribs, with careful attention to avoiding percussing over the spine, breastbone, or lower back to prevent damage to internal organs. Percussion may, or may not, be accompanied by vibration.

Mechanical percussive devices are also available as an alternative to manual chest percussion.

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Vibration

Hand Position for Vibration
Correct Hand Position for Vibration. Artwork by Carolyn Russell

Vibration is an airway clearance technique that, coupled with chest percussion, is applied during postural drainage to help COPD patients clear mucus from the airways. Vibration helps to gently shake mucus and secretions into the large airways, making them easier to cough up.

During vibration, a caregiver should place a flat hand firmly against the chest wall, atop the appropriate lung segment to be drained. Then, they will stiffen the arm and shoulder, apply light pressure and create a shaking movement, similar to that of a vibrator.

It is important for a patient to breathe in deeply during vibration therapy, and exhale slowly and completely. Taking a deep breath and then exhaling slowly and forcefully without straining will hopefully stimulate a productive cough.

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Position #1

Upper Lobe Apical Segments
Upper Lobe Apical Segments. Artwork By Carolyn Russell

To drain mucus from the upper lobe apical segments, the patient sits in a comfortable position on a bed or flat surface and leans on a pillow against the headboard of the bed or the caregiver. The caregiver percusses and vibrates over the muscular area between the collarbone and very top of the shoulder blades (shaded areas of the diagram) on both sides for 3 to 5 minutes. Encourage the patient to take a deep breath and cough during percussion in order to help clear the airways. Do not percuss over bare skin.

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Position #2

Upper Lobe Posterior Segments
Upper Lobe Posterior Segments. Artwork by Carolyn Russell

In this position, the patient sits comfortably in a chair or the side of the bed and leans over, arms dangling, against a pillow. The caregiver uses chest percussion and vibration with both hands over the upper back on both the right and left sides.

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Position #3

Upper Lobe Anterior Segments
Upper Lobe Anterior Segments. Artwork by Carolyn Russell

In this position, the patient lies flat on the bed or table with a pillow for comfort under his or her head and legs. The caregiver percusses and vibrates the right and left sides of the front of the chest, between the collar bone and nipple.

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Position #4

Lingula Postural Drainage
Lingula. Artwork by Carolyn Russell

The patient lies with their head down toward the foot of the bed on the right side, hips, and legs up on pillows. The body should be rotated about a quarter-turn towards the back. A pillow can also be placed behind the patient and their legs slightly bent with another pillow between the knees. The caregiver percusses and vibrates just outside the nipple area.

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Position #5

Postural Drainage of the Middle Lobe
Postural Drainage of the Middle Lobe. Artwork by Carolyn Russell

For the middle lobe position, the patient lies head-down on his or her left side, a quarter-turn toward the back with the right arm up and out of the way. The legs and hips should be elevated as high as possible. A pillow may be placed in back of the patient and between slightly bent legs. The caregiver percusses and vibrates just outside the right nipple area.

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Position #6

Postural Drainage of the Anterior Basal Segments
Postural Drainage of the Anterior Basal Segments. Artwork by Carolyn Russell

In this position, the patient lies on his or her right side with his or her head facing the foot of the bed and a pillow behind his back. The hips and legs should be elevated as high as possible on pillows. The knees should be slightly bent and a pillow should be placed between them for comfort.

The caregiver performs chest percussion and vibration over the lower ribs on the left side, as shown in the shaded part of the diagram. This should then be repeated on the opposite side, with percussion and vibration over the lower ribs on the right side of the chest.

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Position #7

Postural Drainage of the Posterior Basal Segments
Postural Drainage of the Posterior Basal Segments. Artwork by Carolyn Russell

For this postural drainage position, the patient lies on his or her stomach, with the hips and legs elevated by pillows. The caregiver performs chest percussion and vibration at the lower part of the back, over the left and right sides of the spine, careful to avoid the spine and lower ribs.

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Position #8 and #9

Postural Drainage of the Lower Lobes Lateral Basal Segments
Postural Drainage of the Lower Lobes Lateral Basal Segments. Artwork by Carolyn Russell

For these positions, the patient lies on his right side, leaning forward about one-quarter of a turn with hips and legs elevated on pillows. The top leg may be flexed over a pillow for support and comfort.

The caregiver percusses and vibrates over the uppermost portion of the lower part of the left ribs, as shown in the shaded area. This should then be repeated on the opposite side, with percussion and vibration over the uppermost portion of the right side of the lower ribs.

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Position #10

Postural Drainage of the Lower Lobes Superior Segments
Postural Drainage of the Lower Lobes Superior Segments. Artwork by Carolyn Russell

For this position, the patient lies on his or her stomach on a ​flat bed or table. Two pillows should be placed under the hips. The caregiver performs chest percussion and vibration over the bottom part of the shoulder blades, on both the right and left sides of the spine, avoiding direct percussion or vibration over the spine itself.

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