How to Perform Postural Drainage for People With COPD

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Understand the Anatomy of the Lungs

External Anatomy of the Lungs, diagram
Artwork by Carolyn Russell

Postural drainage is an airway clearance technique that helps people with COPD clear mucus from their lungs.

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 is to help drain mucus from each of these lobes into the larger airways so it can be coughed up more readily.

It uses a combination of chest percussion (a clapping movement performed with cupped hands) and vibration (a vibrating movement done with flat hands).

Postural drainage is generally performed for three to five minutes on each segment. During this time, the person being treated should take slow, deep breaths followed by a vigorous coughing to help clear mucus. 

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How to Cup Your Hands for 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 both hands on the person's chest wall. 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 should not involve pain. If there is pain, your hand is probably not cupped properly and needs to be softened or adjusted. When done properly, you should hear a hollow sound with each percussion.

Chest percussion should be done over the ribs, taking care to avoid the spine, breastbone, or lower back where you can potentially injure internal organs. 

Do not percuss over bare skin.

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How to Perform Vibration

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

Vibration therapy is used along with chest percussion helps to gently shake mucus and secretions into the large airway passages.

During vibration, the caregiver should place a flat hand firmly atop the lung segment to be drained. Then, stiffening the arm and shoulder, he or she should apply light pressure and create a rapid, shaking movement, similar to that of a vibrator.

It is important for the person being treat to inhale deeply and exhale slowly but forcefully. This should be done without straining to 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 segment, have the person sit in a comfortable position on a bed or flat surface, leaning against a pillow on the headboard or the caregiver for support. 

The caregiver will then percuss and vibrate the muscular area between the collarbone and very top of the shoulder blades on both sides for around three to five minutes. Encourage the person to take deep breaths and to cough during the percussion. 

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Position #2

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

The person will next sit comfortably in a chair or on the side of the bed and lean over a pillow with his or her arms dangling. As before, percuss and vibrate 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 person will lie flat on a bed or table with a pillow situated comfortably under the head and legs. The caregiver will then percuss and vibrate the right and left sides of the front portion of the chest between the collar bone and nipple.

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Position #4

Lingula Postural Drainage
Lingula. Artwork by Carolyn Russell

The person will then lie on the right side, face down toward the foot of the bed, with the hips and legs propped on pillows. The body should be rotated about a quarter-turn towards the back.

A pillow can also be placed behind the person.  The legs should be slightly bent with another pillow placed between the knees. The caregiver will then percuss and vibrate 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 person will lie face-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 on the back and between slightly bent legs. The caregiver will percuss and vibrate 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 person will lie on right side, face down facing the foot of the bed, with a pillow propped behind the back. The hips and legs should be elevated as high as possible on pillows. The knees should be slightly bent with a pillow placed in between.

The caregiver will percuss and vibrate over the lower ribs on the left side and repeat the right side.

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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 position, the person will lie on his or her stomach with hips and legs elevated on pillows. The caregiver will percuss and vibrate the lower part of the back over the left and right sides of the spine, taking care to avoid the spine and lower ribs.

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Position #8

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 person will lie on the 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 will percuss and vibrate the uppermost portion of the lower part of the left ribs, repeating on the right side.

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Position #9

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

For this final position, the patient will lie flat his or her stomach on a bed or table. Two pillows should be placed under the hips.

The caregiver will percuss and vibrate the bottom part of the shoulder blades on both the right and left sides of the spine, taking care to avoid the spine itself.

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Be Aware of Side Effects of Postural Drainage

It is important to note that some positions may cause an increase of heartburn and acid reflux and/or vomiting, particularly when the head is lower than the stomach. Not only can this cause discomfort and wheezing, it can lead to a lung infection if there is any vomiting.

If you experience any of these symptoms, speak with your doctor about alternative methods of clearing airways.

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