A patient s guide. Postural drainage. A patient s guide
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1 Postural drainage A patient s guide 1
2 What is postural drainage? Postural drainage is a sputum clearance method using gravity to aid the removal of sputum from the deeper parts of your lungs. It is most effective for people who produce a moderate to large amount of sputum (half a pot per day). The technique is usually used in conjunction with the Active Cycle of Breathing Techniques (ACBT), there is a leaflet available on request, and it can also be used with manual techniques (chest percussion/ shaking). Your physiotherapist will discuss the leaflet with you, ensuring you are aware there are alternative chest clearance techniques. They will also advise you that the risks are included in the when should you not use postural drainage. When should you NOT use postural drainage? You should not do postural drainage as part of your physiotherapy regime if you have or develop any of the following: Gastro-oesophageal reflux (acid reflux/acid stomach) Nausea Significant increase in breathlessness Current haemoptysis (fresh blood in your sputum) Recent rib, spine or muscle injury Bronchospasm (wheeze) Do not do postural drainage for at least an hour after eating a large meal. Discuss with your physiotherapist about alternative chest clearance and postural drainage techniques. 1
3 When should you do your treatment? You should aim to do your physiotherapy sessions(s) at a convenient time for you, balancing this with when you are at your most productive of sputum Start so that you are draining the most affected area of your lungs first. For you this is: You should aim to stay in each position for at least 10 minutes for most effective treatment What do you need to do before starting postural drainage? Wear comfortable clothing Allow enough time to complete your physiotherapy treatment. This can be from 10 minutes up to half an hour Remember to take your prescribed inhalers at the appropriate time, eg: DNase 1 hour before physiotherapy Bronchodilators (Salbutamol/Atrovent) 10 mins before physiotherapy Nebulized antibiotics (Colomycin/TOBI) Within 30 mins after physiotherapy Nebulized steroids (Becotide) Within 30 mins after physiotherapy 2
4 What positions should you use? On the following pages are a few of the most commonly used postural drainage positions, with a short explanation of how to assume these positions at home. Your postural drainage position will have a tick in the box. Upright sitting This position helps to drain the upper part of your lungs (uppers). Sit in a comfortable upright position. You can lean slightly forwards to affect the back of your lungs or lean backwards to affect the front of your lungs. 3
5 Supine (lying on your back). This position helps to drain the front and upper parts of your lungs (anterior uppers). Lie on your back with the bed flat; your knees and head can be supported by a pillow if required. Right side lying with 1/4 turn This is a modified postural drainage position which helps to drain the middle (lingula) area of the left lung. Lie on your right side with a pillow long ways down your back, and under your left shoulder and hip. Roll back onto the pillow, so your body is at an angle. Left side lying with 1/4 turn This is a modified postural drainage position which helps to drain the middle lobe of the right lung. Lie on your left side with a pillow long ways down your back and under your right shoulder and hip. Roll back onto the pillow, so your body is at an angle. 4
6 Right side lying with tip This position helps to drain the left base of the lung (medial basal). Lie on your right side with your hips supported by at least three pillows. Left side lying with tip This position helps to drain the right base of the lung (lateral basal). Lie on you left side with your hips supported by at least three pillows. Prone (lying on your front) This position helps to drain the back parts of the base of the lungs (posterior bases). Lie on your front with the bed flat. If you have a lot of sputum you may find it useful to place two or three firm pillows underneath your hips to tip your chest downwards. 5
7 Physiotherapy notes If you have any problems or questions regarding the information in this leaflet, please speak to your physiotherapist on the ward, or contact the Physiotherapy Department by telephone extension
8 Papworth Hospital NHS Foundation Trust Papworth Everard Cambridge CB23 3RE Tel: Fax: For more information about Papworth Hospital please visit our website A member of Cambridge University Health Partners Papworth Hospital is a smokefree site Large print copies and alternative languages can be made available on request. Author ID: Physiotherapy Department: Physiotherapy Stickered: June 2015 Review date: June 2018 Version: 3 Leaflet number: PI 54 Papworth Hospital NHS Foundation Trust
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