Pulmonary Hygiene
Postural Drainage & Percussion
Frequently Known As
“Pulmonary Toilet”
Postural Drainage & Percussion

Postural Drainage : Positioning the
patient so that retained secretions in
the bronchopulmonary tree can
drain by gravity out of the lungs.

Percussion : A rhythmic percussion
on the thoracic wall to loosen
secretions and assist the mucociliary
elevator to rid the lungs of retained
secretions
Percussion…How Is Done ?

It is performed with a cupped hand
and with most of the motion coming
from the hand and wrist


A cyclic tapotement over the thoracic
wall makes a popping sound
Very little movement comes from the
elbow and shoulder

Both hands participate - the right
hand is constantly in motion setting
a regular rhythm while the left hand
is the dissonant rhythm hand
Hand Position

Research has shown that a 30-45
minute PD & P session can clear the
lung fields of secretions. An x-ray of
the lungs pre and post treatment
demonstrates a dramatically
improved lung.
Left Lung Atelectasis - Postmortem
Hemothorax On X-Ray
Left Lung Atlectasis On X-Ray
Positioning The Patient

Positioning the patient is important
to allow the bronchi of each
bronchopulmonary segment to be
vertical so that the fluid inside the
bronchus will move toward the
mainstem bronchi and out of the
lung.
Positioning The Patient

The Sitting Positions :
Apical
Segments of Right & Left
upper Lobes
Anterior Segment of the Left
Upper Lobe
The Apical Segment Of The Right
& Left Upper Lobes

The bronchial feed into these
segments are :
forward
upward
lateral

Postural Position :
High
Long Sitting
Angled 30-45 degrees backward
in reclined sitting

Percussion & Auscultation :
Over
the trapezius between the
clavicle anteriorly and the
scapula posteriorly
Left Anterior BP Segment Of The
Left Upper Lobe

The bronchial feed into this
segment is :
obliquely
forward
upward

Postural Position :
45
- 60 degrees reclined long
sitting

Percussion & Auscultation :
Over
the Pectoralis Major
muscle on the left side
Positioning The Patient

The Near-Prone & Prone Positions
Posterior
BP Segment Of The Left
&The Right Upper Lobe
Superior
or Apical BP Segment Of
The Right And the Left Lower Lobes
Posterior
Basilar BP Segment Of The
Right & Left Lower Lobes
Posterior BP Segment
Of The Left Upper Lobe

The bronchial feed into this
segment is :
Posterior
Obliquely
Upward

Postural Position :
Prone
onto right side with left
shoulders pillowed & rotated up
off of the bed

Percussion & Auscultation :
Over
the scapula
Posterior BP Segment
Of The Right Upper Lobe

The bronchial feed into this segment
is :
Posterior
Obliquely
upward

Postural Position :
Prone
onto left side with right
shoulders pillowed & rotated up
off of the bed

Percussion & Auscultation :
Over
the scapula
Superior or Apical BP Segment Of
The Right & Left Lower Lobes

The bronchial feed into these
segments is :
Posterior

Postural Position :
Prone
flat

Percussion & Auscultation :
Over
the thorax just at the
inferior angle of the scapula
Posterior Basilar BP Segment Of
The Right & Left Lower Lobes

The bronchial feed into these
segments is :
Posterior
Obliquely
downward

Postural Position :
Prone
with head below horizon

Percussion & Auscultation :
Over
the posterior thorax just
above the inferior border of the
thoracic cage
Positioning The Patient

Supine Positions :
Anterior
BP Segment Of The
Right Upper Lobe
Anterior
Basilar BP Segments
Of The Right & Left Lower
Lobes
Anterior BP Segment Of The
Right Upper Lobe

The bronchial feed into this
segment is :
Forward

Postural Position :
Supine
flat

Percussion & Auscultation :
Over
the Pectoralis Major
muscle on the right side
Anterior Basilar BP Segments Of
The Right & Left Lower Lobes

The bronchial feed into these
segments is :
Forward
Obliquely
Downward

Postural Position :
Supine
& inclined with head
below horizon

Percussion & Auscultation :
Over
the thoracic wall on the
anterior surface just above the
inferior border of the thorax
Positioning The Patient

The Right Side-Lying Positions
The
Lingula Of The Left Upper
Lobe
Lateral Basilar BP Segment Of
The Left Lower Lobes
The Lingula Of The Left Upper
Lobe

The bronchial feed into these
segments is :
Lateral
Obliquely
Downward

Postural Position :
Right
side-lying inclined with
head below horizon
Left shoulder rotated down
toward the bed

Percussion & Auscultation :
Over
the thoracic wall on the left
lateral surface over the nipple
and the thorax in the midaxillary line
Lateral Basilar BP Segment Of
The Left Lower Lobes & Right
Cardiac BP Segment Of The Right
Lower Lobes

The bronchial feed into these
segments is :
Left Side = Lateral
Right Side = Medial
Obliquely Downward

Postural Position :
Right
side-lying inclined with
head below horizon

Percussion & Auscultation :
Over
the thoracic wall on the
left lateral surface in the midaxillary line

The Cardiac or Medial Basilar BP
Segment Of The Right Lower Lobes
Cannot Be Auscultated Nor
Percussed
Positioning The Patient

The Left Side-Lying Positions
The
Right Middle Lobes
Lateral Basilar BP Segment Of
The Right Lower Lobes
The Right Middle Lobes

The bronchial feed into these
segments are :
Lateral
Forward
Obliquely
Downward

Postural Position :
Left
side-lying inclined with
head below horizon and the
right shoulders rotated down
towards the bed

Percussion & Auscultation :
Over
the thoracic wall on the
right thoracic wall over the
nipple extending into the midaxillary line
Lateral Basilar BP Segment Of
The Right Lower Lobes

The bronchial feed into this segment
is :
Lateral
Obliquely
Downward

Postural Position :
Left
side-lying inclined with
head below horizon

Percussion & Auscultation :
Over
the right thoracic wall in
the mid-axillary line at the
inferior border of the thorax