postural

postural drainage a technique in which the patient assumes one or more positions that will facilitate the drainage of secretions from the bronchial airways. The procedure uses gravity to move secretions toward the trachea, where they can be coughed up more easily. Choice of position is based on radiologic studies and auscultatory evidence of pooled secretions. Variations of the most effective position are adapted to the patient's general physical condition, tolerance, and pulmonary status.

External manipulation of the thorax includes percussion (or “clapping,”) and vibration, often done in conjunction with postural drainage; they may be done either manually or with mechanical devices. Percussion involves rhythmic striking of the chest wall over the area being drained. The manual method is done with hands cupped, fingers flexed, and thumbs held tightly against index fingers. If done properly, a hollow sound is heard and there is no discomfort to the patient.

Vibration is done immediately after percussion and is directed to the same area. While the patient performs a prolonged exhalation through pursed lips, the therapist presses the flat of the hands or the mechanical device against the thorax in a downward movement toward the midline of the body. This is repeated four or five times. While neither percussion nor vibration is a difficult technique to master, anyone attempting to assist the patient in this manner should have instruction and practice beforehand. The purpose of both activities is to dislodge plugs of mucus, allowing air to penetrate behind them and thus aid in their removal.

The American Association for Respiratory Care has published clinical guidelines, which are available on their web site at http://www.aarc.org. These indicate that bronchospasm is sometimes a complication of external manipulation of the thorax.