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Postural Drainage, Percussion & Vibration (P&PD) (3.10)

Postural Drainage, Percussion & Vibration (P&PD) (3.10) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Airway Clearance

3.10






3.10 Postural Drainage, Percussion and Vibration (P&PD)
Category: UWHC Patient Care Policy
Effective Date: January 1, 2017
Version: Revision
Manual: Respiratory Care Services
Section: Airway Clearance

I. PURPOSE
A. Postural drainage involves the use of gravity to help mobilize respiratory tract secretions from lung lobes or
segments into the central airways. This is done by placing the segmental bronchus to be drained in a vertical
position relative to gravity.
B. Percussion and vibration involves clapping with a cupped hand (preferred), or a palm cup and vibrating
over the lung segment to facilitate the bronchial secretion clearance and elimination of atelectasis caused by
mucus plugging.

II. POLICY
A. All patients will be assessed by the Respiratory Care Practitioner (RCP) to determine if the appropriate
indications for therapy are present.
B. Therapy will be provided in accordance with a provider’s order.
C. Appropriate Health Facts for You (HFFY) will be given if therapy is being planned for home usage.
D. Percussion should not be performed over bony areas, broken ribs, female breast tissue, new surgical sites or
on patients with hemoptysis.
E. Procedure should be held for at least 30 to 60 minutes after feeding, unless patient is able to tolerate a
shorter time.
F. All patients at AFCH will:
1. Have therapy before meals, school and bedtime.
2. Be encouraged not to refuse therapies.
3. Cough before proceeding to the next position.
4. Be encouraged to expectorate mucus (especially after age7 years).
5. Cystic Fibrosis patients will have therapies done QID. Inquire about the reason for therapies not
ordered at this frequency.
a. Have therapy to all six standard positions, but are not to be positioned in Trendelenburg if under
the age of 5. (This does not apply to the neuromuscular population.)
b. Alternating airway clearance techniques (ACT) may be performed per physician’s order.
c. Notify the Pediatric Pulmonary physician when modification is necessary.
6. Not be allowed to have a pacifier or bottle while performing therapy.
7. Not be suctioned without a physician's order. Nasal or oropharyngeal suctioning can be done if
secretions cannot be mobilized by other means.
G. The order of therapies should be:
1. Bronchodilator
2. Hypertonic Saline (can be given with ACT)
3. Dnase (can be given with ACT)
4. Airway Clearance Technique
5. Aerosolized Antibiotic
6. Inhaled Steroid
H. Patients considered high risk for falling require someone present during therapy.

III. EQUIPMENT
A. Palm cups
B. Mechanical percussor/vibrator
IV. PROCEDURE
A. Review and acknowledge provider’s order.
B. Review patient's chart.
C. Obtain the appropriate equipment.





D. Introduce yourself to the patient &/or family. Explain the reason for the procedure.
E. Assess the patient throughout the procedure.
F. Each position should receive a minimum of 3 to 5 minutes of percussion followed by three vibrations
during exhalation. The patient should take in a maximal inspiration and exhale through their mouth while
the RCP does the vibration.
G. If percussion is not employed, drainage position should be held for a minimum of 5 minutes.
H. Percussion/vibration should be done in one or more of the six standard positions (see HFFY #4916).
I. The various drainage positions and areas to be percussed and/or vibrated are as follows:
1. Upper lobes (posterior) - lean the body forward 30 degrees. Percuss between he clavicle and the
shoulder blade on each side of the chest.
2. Upper lobes (anterior) - lean the body back 30 degrees. Percuss between the clavicle and the nipple
on each side of the chest.
3. Lower lobes (lateral basal) - position the body with the head down 30 degrees lying on the right side.
Percuss on the left side below the underarm.
4. Lower lobes (lateral basal - position the body with the head down 30 degrees lying on the left side.
Percuss on the right side below the underarm.
5. Lower lobes (posterior basal) - position the body with the head down 30 degrees lying on the
abdomen. Percuss between the lower edges of the rib cage and the shoulder blade on each side of the
spinal cord.
6. Lower lobes (right middle lobe & left lingula) - position the body with the head down 30 degrees
lying on the back. Percuss on the front of the chest in the nipple area and just below for women.
J. Patient is instructed to cough after each position.
1. Adult patient with an inadequate cough may require nasotracheal suctioning
2. Patient on mechanical ventilator will be suctioned as needed and after the therapy.

V. REFERENCES
A. Respiratory Care Services (RCS) P&P;
1. 1:40 "Cleaning and Monitoring of Patient Care Equipment"
2. 3:42 "Tracheal Bronchial Suctioning"
3. 3:11 "PEP Therapy"
4. 3:12 "High Frequency Chest Compression (HFCC) Vest Treatment"
5. 3:14 "Intrapulmonary Percussive Ventilation (IPV)"
6. 3:15 "Flutter"
B. UWH P&P 13.15 “Fall Prevention for Inpatients”
C. HFFY #4916 Chest Physical Therapy (CPT)
D. Other
1. Cystic Fibrosis Pulmonary Guidelines: Airway Clearance Therapies,” Patrick A Flume MD, Karen A
Robinson MSc, Brian P O’Sullivan MD, Jonathan D Finder MD, Robert L Vender MD, Donna-Beth
Willey-Courand MD, Terry B White PhD, Bruce C Marshall MD, and the Clinical Practice
Guidelines for Pulmonary Therapies Committee. RESPIRATORY CARE APRIL 2009 VOL 54 NO
4.
2. AARC Clinical Practice Guidelines: Effectiveness of Nonpharmacologic Airway Clearance Therapies
in Hospitalized Patients.” Strickland SL, Rubin BK, Drescher GS, Haas CF, O’Malley CA, Volski
TA, Branson RD, Hess, DR. Respiratory Care. 2013 Dec: 58(12):2187-93.
3. AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in
Hospitalized Patients Shawna L Strickland PhD RRT-NPS ACCS AE-C FAARC,
Bruce K Rubin MD MEngr MBA FAARC, Carl F Haas MLS RRT-ACCS FAARC,
Teresa A Volsko MHHS RRT FAARC, Gail S Drescher MA RRT, and
Catherine A O’Malley RRT-NPS RESPIRATORY CARE JULY 2015 VOL 60 NO 7 pp 1071-1077.
4. CF Foundation Website: Airway Clearance Techniques 2016.



Approved by Director and Medical Director of Respiratory Care: