postural drainage, the use of positioning to drain secretions from specific segments of the bronchi and the lungs into the trachea. Coughing usually expels secretions from the trachea. Also called bronchial drainage. See also cupping and vibrating. ▪ METHOD: Positions that promote drainage from the affected parts of the lungs are selected. Pillows and raised sections of the hospital bed are used to support or elevate parts of the body. The procedure is begun with the patient level, and the head is gradually lowered to a full Trendelenburg position. Inhalation through the nose and exhalation through the mouth are encouraged. Simultaneously the nurse or other health care provider may use cupping and vibration over the affected area of the lungs to dislodge and mobilize secretions. The person is then helped to a position conducive to coughing and is asked to breathe deeply at least three times and to cough at least twice. ▪ INTERVENTIONS: A patient who is dyspneic or who has hemoptysis or signs of cerebral hemorrhage, increased intracerebral pressure, or lung abscess is not placed in a head-down position without caution and a specific medical order. Suction is kept available in all cases in which the patient may not be able to expel the secretions that have drained into the trachea. The patient’s tolerance for the procedure and the position is carefully observed. Fatigue is prevented. ▪ OUTCOME CRITERIA: Effectiveness of the procedure depends on positioning that allows drainage by gravity and on liquefaction, ciliary action, and effective breathing. As the secretions are cleared, the patient becomes better able to breathe, is more comfortable, and may move about more freely; thus the respiratory passages may remain freer of obstructing secretions and resume their expected function.
