Suction drainage is a fundamental intervention in the chest cavity. If this intervention is carried out carefully, then the possibility of postoperative complications is reduced to a minimum, and many serious, life-threatening diseases will be healed. If drainage is used incorrectly, recovery will not occur and septic complications may develop. The drainage-suction apparatus consists of a drainage tube, which is inserted into the pleural cavity, and a suction system connected to the drainage. The number of suction systems used is very large.
Suction tube
For suction drainage of the pleural cavity, various rubber and synthetic tubes are used.
For the most commonly used drainage, a rubber tube about 40 cm long with several side holes at the end is used. This tube is placed along the lung (from the base to the apex) and passed over the diaphragm from the pleural cavity to the outside. The drainage is attached to the skin with a knotted U-shaped suture. When the suction drain is removed, the threads are tied again, thereby sealing the hole in the chest. A three-barrel suction catheter (Viereck) is advantageous, allowing free passage of the tube inserted inside.
Insertion of suction drainage
In the chest between the two pleural layers, the intrapleural pressure is lower than atmospheric pressure. If air or liquid gets between the pleural layers, then the normal physiological state can only be restored by long-term suction drainage. A closed drainage system is used to suction pleural fluid for recurrent pneumothorax and to treat empyema. This drainage is now usually inserted into the intercostal space through a trocar. The thickness of the drainage tube is determined in accordance with the consistency of the substance being sucked out (air, as well as watery fluid or serous, fibrinous, bloody, purulent fluid).
On the drainage, mark with paint or thread the place to which it will be inserted. The size of the trocar must correspond to the size of the drainage. It is advisable to have at least three trocars of different sizes with suitable tubes of 5, 8 and 12 mm in diameter. Before inserting the trocar, you must make sure that the selected drainage tube passes through it easily.
The site of the skin incision is filtered with novocaine to the pleura. A test puncture in the designated area makes sure that the desired air or liquid is really there. The assistant gives the patient the necessary position: the patient must sit and lean on the highly raised operating table so that the puncture area protrudes as much as possible, and the selected intercostal space is, if possible, expanded. A scalpel is used to cut the skin over an area slightly larger than the size of the trocar. Then the trocar is inserted with a strong movement along the upper edge of the rib into the pleural cavity. After removal of the trocar, unimpeded release of fluid or free entry and exit of air indicates its correct insertion. Drainage is performed and the trocar tube is removed. If you are not convinced that the drainage is in the right place, you should, in order to prevent the trocar from puncturing the lung, heart or large vessel, perform the puncture again, taking all measures to localize it under X-ray control.
Before closing each thoracotomy hole, a drainage is introduced into the pleural cavity, which is brought out above the diaphragm through a separate hole in the intercostal space. Through a hole measuring about 1-2 cm, a forceps is inserted into the pleural cavity under the control of the eyes and under the protection of the left hand to ensure the correct position of the drainage from the inside. The drainage is pulled through the chest wall with a forceps from the inside to the outside. Pay attention to the fact that the drainage section, free from holes, is at least 5 cm in the chest cavity. If the fixation of the drainage to the skin is broken, then it slips out, and the first side hole appears outside the pleural cavity above the skin. In this case, the closed system turns into an open one, suction becomes ineffective, and pneumothorax often occurs.
Suction systems
There are so-called individual (“bed side”) and centralized suction systems. The suction action due to the hydrostatic effect can be obtained by a tube lowered under water, a water or gas pumping device (in this case the action is based on the valve effect) or an electric pump. Both individual and central systems must ensure individual regulation. If the release of air from the lung is insignificant, then due to its simplicity, the Biilau drainage system is still successfully used today, which can be sufficient to straighten the lung. A glass tube immersed under water (disinfectant solution) is equipped with a valve made from a finger cut off from a rubber glove, which protects against reverse suction. The Biilau system uses the physical law of communicating vessels to move bottles under the bed to create a suction effect.
The Fricar air pump best meets modern requirements. This device can work for many days without interruption and without heating up. The strength of the suction effect can be precisely adjusted.
Central suction devices are triggered by an oxygen canister system or a powerful suction pump. The system of outgoing tubes, if necessary, supplies hospital departments located on different floors. Depending on the need, the required number of hospital beds can be connected. An oxygen-powered system has the advantage that the suction and supply of oxygen to individual hospital beds is provided by the same tubing system. The suction effect is provided by a valve tube mounted along the oxygen flow. In this case, however, the effect produced by the central suction pump is not achieved.
Individual adjustment can be carried out using a dosimeter tap connected to a well-functioning pressure gauge, or through the so-called. three bottle system. The latter can be easily prepared by yourself. This system also has the advantage that it can easily and reliably create a very low suction effect (from 10 to 20 cm of water column). It is rarely possible to achieve such low pressure values using factory pressure gauges.
Indications for suction drainage
Spontaneous and traumatic pneumothorax, hemothorax
Spontaneous pneumothorax occurs at a young age, more often as a result of rupture of single pulmonary alveoli in the apex of the lung, in older people - as a consequence of rupture of alveolar vesicles with diffuse emphysema. Due to the fact that the number of patients with emphysema is constantly increasing, the number of cases of spontaneous pneumothorax is becoming more frequent. The same applies to traffic accidents that result in closed injuries in the chest cavity, which often occur with pneumothorax or hemothorax.
Correctly performed pleural puncture for spontaneous pneumothorax is practically safe, and its benefits can hardly be disputed. If the flow of air from the damaged lung is completely stopped and the perforation site is closed, then it may be possible to completely remove the air that created the pneumothorax with a simple closed puncture. If pneumothorax recurs after puncture (even repeated), then drainage with long-term suction should be used. Recurrence of pneumothorax, even after prolonged drainage with suction, can only be reliably eliminated by surgery.
Traumatic pneumothorax most often results from rib fractures. When a rib fragment injures the lung, most often a significant amount of air comes out of it, and a tension pneumothorax occurs. At the same time, subcutaneous or even mediastinal emphysema may occur. Spontaneous pneumothorax can also occur when the pulmonary alveoli rupture or due to blunt force on an emphysematous lung. Therefore, in patients with pulmonary emphysema, chest injuries are often associated with the occurrence of pneumothorax, often severe tension pneumothorax. The principles of treatment for spontaneous and traumatic pneumothorax are the same.
If clinical symptoms indicate tension pneumothorax (severe respiratory failure, subcutaneous emphysema, mediastinal shift), then drainage of the pleural cavity should be performed immediately. If these symptoms are not present, then a closed puncture is performed and the air is sucked out. After this, the needle is left inserted into the pleural cavity, and its nozzle is connected to a pressure gauge and the pressure in the pleural cavity is determined (whether it is higher or lower than atmospheric). If the pressure in the pleural cavity is indicated by the pressure gauge needle in the positive direction, it means that air continues to be released into the pleural cavity, and, therefore, drainage is necessary. This issue can, of course, be resolved by X-ray examination. If there is a total pneumothorax, then drains are inserted in two different places. One of them runs along the posterior axillary line above the diaphragm in the VII-VIII intercostal space, the other is inserted along the midclavicular line between the 1st and 2nd ribs. In our experience, drainage inserted under the collarbone performs the task of straightening the apex of the lung better.
In case of encapsulated limited pneumothorax, drainage should be inserted locally, under X-ray control after a test puncture.
Empyema of the pleura
Pleural empyema is a disease for which treatment with suction from the pleural cavity is absolutely indicated.The principle of treatment of empyema does not depend on the causative agent of the disease. It consists of gluing the pleural layers and eliminating the empyema cavity through early drainage and suction of fluid. Treatment with suction from the pleural cavity is combined with targeted local chemotherapy, based on the identification of the pathogen and its resistance to the drugs used. Most empyemas result from infection of the exudate. In this case, incorrect and insufficient suction from the pleural cavity plays a certain role. In cases where pockets with delimited fluid form in the pleural cavity, their complete emptying becomes increasingly difficult, more difficult, and infection is more likely. In such cases, complete recovery can only be ensured by surgery.
Suction treatment may fail for two reasons: one is the presence of pleural cords, the other is a bronchopleural fistula.
Pleural moorings are often the result of insufficient emptying of the pleural cavity. When moorings have already formed in the pleural cavity and the walls of the empyema cavity are thickened, there is little chance of eliminating the empyema by suctioning out the fluid. The ability to expand the lung in this case is also very controversial. In this case, drainage with suction is a preparatory measure before the inevitable operation. Radical surgery (decortication) is performed only after the patient’s general condition has improved by washing the pleural cavity and targeted antibiotic therapy.
Bronchopleural fistula reduces the effectiveness of suction and thereby the prospect of lung expansion. In cases where there is a large bronchial fistula and its closure is contraindicated (for example, a rupture of the cavity, tumor disintegration, rupture of a cystic, emphysematous lung that has lost its elasticity), success cannot be expected from the use of suction. On the other hand, suction can also be used in cases where surgery is indicated. In elderly patients, with low general resistance and the possibility of severe complications, surgery becomes impossible. Then all that remains is to leave the patient with permanent drainage.
In case of chronic pleural empyema, drainage should be inserted into the pleural cavity at its lowest point. Large-diameter drains are used so that the thick liquid does not close the lumen and it is easy to wash the pleural cavity. Often, in the area where the drainage will be introduced, a rib resection (2-3 cm) is performed.
Postoperative suction from the pleural cavity
In order to remove fluid that accumulates after thoracotomy from the pleural cavity and maintain normal intrapleural pressure, a suction drain should be available.
If during pleural operations and mediastinal, transthoracic interventions on the esophagus, stomach, heart and large vessels there was no damage to the lung, then the chest can be closed with the introduction of one perforated drainage into the pleural cavity. Drainage is carried out above the diaphragm along the midaxillary line with its pleural end installed at the level of the apex of the lung.
Two drains are inserted into the pleural cavity if the lung was damaged during separation of adhesions, as well as after resection or excision of lung tissue. In such cases, one of the drains is inserted along the anterior, and the second - along the posterior axillary line. The use of a third drainage may be considered relatively appropriate when it is brought to the site of anastomosis of the esophagus or bronchus or when thoracoplasty is performed in combination with lung resection (for suction from the subscapular space).
After removing the lung, one drain with a diameter of 12-15 mm is inserted into the pleural cavity and placed in the lower part of the cavity so that a piece of drainage 10-12 cm long is equipped with 2-3 side holes. Active suction through this drain is prohibited.
After median sternotomy, a drainage is inserted retrosternally and its second end is brought out in the epigastrium.
Intensity and duration of suction
The intensity of suction through drainage from the pleural cavity depends on the cause of the disease, the condition of the lung and the nature of the operation. The flow of air from the lung into the pleural cavity is of decisive importance. If this occurs, then more air should be sucked out of the pleural cavity per unit time than is supplied there. Only in this way can gluing of the pleural layers be achieved. In practice, however, this is often not feasible. If the connection of the bronchus with the pleural cavity is significant (for example, in the case of a bronchial fistula), then intensive suction cannot achieve the goal. If you increase the suction force, then at the same time the patient will experience increased respiratory failure due to “air theft” from the tidal volume. Despite this, the lung will not be able to expand. In such cases, surgery is inevitable.
When the lung is damaged or after lung surgery, air most often escapes from a hole the size of a pinprick. In this case, specialized suction is indicated. In children and adolescents, due to the fact that their lung parenchyma is healthy and not affected by fibrosis and emphysema, it does not matter with what force the suction is performed. It doesn’t matter whether they suction with an intensity of 25 cm of water. Art. or simple underwater drainage, the lung will expand within 24-48 hours. The drainage can be removed after 48-72 hours. This is the advantage of elastic tissue capable of lung retraction in young patients. With emphysematous lung in an elderly person, the situation is different. The pinprick holes become gaping holes in the lung because the surrounding tissue is unable to contract. If you try to reduce the flow of air coming from the damaged lung by increasing the intensity of suction, you can easily get a paradoxical effect. The flow of air from the lung will increase. Small holes, due to prolonged suction, stabilize and turn into fistulas.
What to do in such cases? Begin gentle suction from the pleural cavity (5-6 cm of water column) and pay attention to ensure that tension pneumothorax does not occur. Thanks to this, the resulting fibrin seals small holes in the lung. Within 24 hours, a decrease in the release of air from the damaged lung begins to be detected. The intensity of suction can be increased slightly. On the fourth day you can already suction with an intensity of 10 cm of water. Art., if no unforeseen complications arise, then the drainage can be removed on day 4-5.
The same principles are followed when treating spontaneous and traumatic pneumothorax with suction.
If there is a significant intake of air from the emphysematous lung, they begin to carefully perform suction with a gradual increase in its intensity. If, after many days of treatment with suction, the release of air from the lung does not stop, then it is recommended to immediately undertake surgery, without waiting for the development of infection in the pleural cavity. If suction from the pleural cavity continues for more than a week, the development of infection becomes real.
In cases where the patient does not undergo surgery due to low general resistance, suction from the pleural cavity remains to be continued. Prolonged and specialized suction under the guise of drug treatment may be more or less effective. The pleural layers are glued together completely or partially. Only small limited cavities remain that do not lead to complications. The drain can be removed.
In the treatment of pleural empyema, long-term use of suction drainage is a common method. The empyema cavity gradually becomes smaller and smaller, the amount of fluid decreases, and in the end it can become bacteriologically sterile. If the daily amount of fluid extracted from the pleural cavity does not exceed 10-15 ml, then the suction is stopped, the drainage is shortened, but left until the residual cavity is completely closed.
The respiratory organs not only provide air exchange, but also serve as a special filter for the human body. They remove carbon dioxide, take part in blood filtration, and trap unnecessary dust particles and microorganisms that enter the air. Clearing the respiratory tract is beneficial even for a healthy person. It is especially important to remove mucus during bronchitis and other respiratory diseases..
Normally, the bronchial mucosa produces about 100 ml of secretion daily. In a healthy body, this secretion is transparent, slightly viscous and is called mucus. It retains everything that is inhaled and is expelled from the body by coughing. Such secretions are considered a physiological norm and are even necessary to protect the respiratory tract.
Sputum is the pathological mucus that is formed during respiratory diseases.. Its color and consistency differ from the physiological norm, and the very presence of sputum in the bronchi only makes breathing difficult and slows down the healing process. This discharge from the respiratory tract consists not only of mucus, but also contains dead immune cells, bacteria, viruses, allergens and more.
It is very important to clear the airways of abnormal mucus, although sometimes its thick consistency makes this difficult even with a strong cough. Special exercises for expectoration will help improve expectoration.
Breathing exercises
Proper breathing exercises can significantly speed up the healing process. Pulmonologists recommend doing it even to a healthy person. Gymnastics helps:
- Reduce the inflammatory process.
- Improve blood circulation and increase hemoglobin levels.
- Facilitate the removal of mucus from the bronchi in a child even without taking medications.
- Prevent complications of bronchitis.
- Strengthen your immune system.
Rules of breathing exercises:
- Inhalation is done sharply, making effort.
- Exhalation is passive, without the participation of the abdominal muscles and diaphragm.
- Breathing is carried out alternately through the nose and mouth.
- The rhythm of breathing is observed, as when marching.
- When inhaling through the mouth, the nose does not need to be involved in breathing.
The classic example is. The exercises she recommends are performed 2 times a day, duration – 2-3 weeks. An example of two basic exercises:
- The patient leans forward slightly, arms hanging down freely. Inhale through the nose with a slight tilt of the torso, exhale freely, lifting the body. After 8 breaths, you need to rest and clear your throat.
- Hands are located at shoulder level and bent at the elbows. On inhalation they cross, on exhalation they separate. Breathing alternates through the nose and mouth.
You can see several exercises in the video below:
For bronchial asthma, the Buteyko method is popular, which is based on studying your breathing, maintaining its natural rhythm and inhaling only through your nose. It can also be used for dry coughs, as it not only removes phlegm, but also normalizes metabolism in the body as a whole.
Breathing exercises, massage, drainage
A method that combines breathing and drainage exercises is very effective in getting rid of phlegm. During the height of bronchitis at elevated temperatures, such physical exercises are prohibited, but during the recovery period they significantly speed up recovery.
The idea is that the patient performs breathing exercises while lying down, and then facilitates the removal of phlegm by vibrating the chest. You can lie on your side, back or stomach, taking into account the location of sputum stagnation. The head should be located below the body. When changing body position or exercise, you need to take a deep breath and cough several times. Exercises are performed several times a day, here is an example of some of them:
- Lie on your side without a pillow, take a few deep breaths and clear your throat.
- Lie for half an hour without a pillow with your legs elevated, walk around a little and repeat.
- To expectorate mucus from the upper parts of the lungs, you can rotate your arms at the shoulder joints with your elbows bent.
- Position yourself on the bed so that your torso hangs down from the edge. turn to the other side. Repeat several times.
Exercises for children
Breathing exercises are as beneficial for children as they are for adults. But the massage should be done more carefully, using less effort and taking into account the age of the child.
A few examples of breathing exercises for a child:
- Blow hard into a whistle, ball or dandelion.
- Tie a feather to a rope and blow on it. Inhale through the nose and exhale through the mouth.
- Walking around the room, during which you need to clap your hands behind your back, above your head and in front of you. Breathing is done through the nose.
All exercises should last no longer than 5 minutes. For bronchial asthma, such exercises are recommended to be done daily to regularly clear the airways of mucus and prevent attacks
Positional drainage
The technique is based on the fact that gravity promotes the removal of sputum. To do this, the patient needs to take a certain body position, depending on the location of the clot accumulation. Exercises are done twice a day for 30 minutes. Some recommendations on how to properly cough up phlegm using positional drainage:
- For pneumonia and sputum in the lower parts of the lungs the patient is positioned lying down, at an angle to the floor, head down. In this case, you need to breathe deeply using the muscles of the diaphragm.
- Removal of mucus from the lungs in the upper regions take a sitting position, making circular movements with the shoulder joints. The arms are spread to the sides and bent at the elbows.
- Ease coughing After such exercises, a prolonged, forceful exhalation will help so that the air from the respiratory tract pushes the mucus out. Before you need to use bronchodilators.
Drainage gymnastics
Drainage to cleanse the bronchi and lungs uses various muscle groups, most often the abdominals.
- In a lying position, the arms are located along the body. As you inhale, spread them apart, then pull your knees to your chest and, as you exhale, clasp them with your arms. After coughing, repeat the exercise.
- Lying on your back, one arm goes down along the body, the other goes straight behind the head. Hands alternate at a fast pace for 1 minute.
- Lying on your stomach, hold your hands under your chin, alternately move your legs back, straining your back muscles.
Drug stimulation
Effect of for bronchitis will be significantly higher if you combine exercises with drug therapy. For this purpose, drugs from the group of mucolytics (thinning sputum), expectorants and antihistamines, and bronchodilators are used.
Many patients notice a good effect from using yoga exercises for bronchitis. They are different from the classic
Postural drainage is a medical procedure for quickly cleansing the inflamed bronchi from excess mucus accumulated as a result of developed lung disease. These therapeutic procedures are carried out exclusively in a hospital setting of the pulmonology department, and the procedure is performed by a pulmonologist with the participation of auxiliary medical personnel. In fact, this is a physiotherapeutic procedure to influence the pleural space through the use of special techniques. This procedure is indicated in particularly severe cases when the patient’s respiratory system is not able to clear the bronchi of mucus using the body’s own forces.
Carrying out postural drainage of the lungs (often called positional) is intended for the outflow of sputum from areas of the bronchi that are located below the level of the tracheal bifurcation. These are the lower lobes of the lungs, in which stagnation of mucus and fluid that accumulates due to prolonged inflammation is most often observed.
In general, the principle of drainage outflow of fluid from the pleural cavity of the chest is as follows:
The final principle for completing pulmonary drainage is for the patient to intensively expectorate sputum while still in the supine position. To make this process more effective, the doctor performs a vibrating massage on the patient’s back and chest and periodically taps them using special rhythmic movements.
In particularly severe cases, it is possible to perform postural drainage of the lungs 3 times a day.
This intensity of pulmonary manipulation is typical for patients with chronic respiratory diseases and a severely weakened immune system.
If the patient cannot be in a lying position for objective reasons, or due to his physiological characteristics, then this procedure is performed in a static position of the body, but with a set of procedures to stimulate the outflow of sputum. The latter treatment option is less effective, since it is not always possible to stimulate the movement of fluid from the lower part of the lung lobe to its higher segments. It is even more difficult to do this when the patient is immediately diagnosed with bilateral pneumonia with damage to the bronchi and alveoli.
Indications for drainage
This procedure is used only in extreme cases and is not a routine method of treating simple forms of pneumonia, bronchitis or pleurisy. Postural drainage is indicated for patients who have been diagnosed with the following types of diseases:
This medical procedure allows doctors to quickly clear the airways of mucus and fluid and cause productive contractions of the bronchial muscle tissue in the patient. Due to the latter effect, the patient develops a persistent cough and expectorates the remaining mucus on his own. Together with mucus and liquid, a large number of pathogens are removed, the level of intoxication of the body and the load on the immune system are reduced.
Preparation for the procedure
Before starting the procedure, the patient must dilute the sputum by administering special expectorants. As a rule, mucolytics and alkaline drinking are used. Then the patient is given a warming chest massage. Start from the front of the chest, smoothly move to the ribs on the sides, and end on the back. This is necessary in order to ensure maximum blood flow to the lungs and enhance the drainage effect. There are different approaches to preparing for postural drainage for children and adults. The individual characteristics of the patient’s body and the severity of the inflammatory process are also of great importance.
Method of performing postural drainage
Drainage of the respiratory system is carried out in three options. It is possible when the patient lies on his side, back or stomach. The position of the patient during massage manipulations plays a great role in the effectiveness of the procedure. The doctor fixes the patient’s body based on which part of the lungs has accumulated the largest amount of sputum, which does not allow air to fully circulate through the respiratory canals.
The bronchial drainage method is performed in compliance with the following rules:
- The patient is placed on a bed or couch with a hard surface. The procedure will bring absolutely no therapeutic effect if the patient’s chest falls inward on a soft bed.
- Regardless of whether the patient is lying on his back, stomach or side, his head should be tilted and shifted closer to the body. The ideal option would be if a person can touch the tip of his chin to his chest.
- The doctor lubricates his hands with cream or massage oil and begins manipulations in the form of treating areas of the sternum, inside which sputum or fluid formation is concentrated. The therapeutic drainage technique consists of clapping on the surface of the back and sternum, massage of the vertebral processes on both sides, and intense impact on the ribs located in the lower part of the chest.
On average, the method of removing mucus from the lungs using the postural drainage technique lasts 15 minutes. This is the optimal length of time for this procedure. Upon completion, the doctor asks the patient to draw as much air as possible into the lungs and cough well. If during the session all exercises and procedural aspects were performed correctly, then the patient begins to produce a large amount of sputum during coughing.
The greatest therapeutic effect is achieved during drainage in the morning and evening.
How to perform positional drainage for a child?
Young children most often suffer from a type of respiratory disease such as acute bronchitis. Regardless of the severity of its course, children are shown massage drainage of sputum from the bronchi. When performing these manipulations, it is necessary to take into account the physiological characteristics of the child’s still unformed body and adhere to the following recommendations:
- The baby's head should be below chest level. To do this, it is best to place a hard pillow or a special cushion under the baby’s stomach.
- All movements must be performed smoothly without strong impact. It is best to start by stroking the back, gradually increasing the pressure.
- Massage manipulations are carried out in the direction from the lower back along the spine to the shoulder blades and further to the neck.
- Each side of the chest is treated in turn. To improve gliding, use baby cream.
Postural drainage has proven its effectiveness even in children with purulent pneumococcal lung infection. The increased therapeutic result is due to the fact that in children, blood circulation in the chest organs occurs under high blood pressure and any massage effect on this part of the body causes an abundant blood flow.
What is "postural drainage"? This is a set of therapeutic measures aimed at clearing the respiratory tract of excessive mucus and phlegm.
The technique is carried out in the inpatient department of pulmonology. In this article we will find out what the indications and methods of the procedure are, and what results can be achieved.
The essence of postural drainage
Using postural or in other words, positional drainage, stagnant pathological fluid is removed from the lungs. It includes a set of manipulations in the form of stroking, tapping, and clapping. 1 session of such drainage massage can relieve the patient of 200 ml of sputum.
Due to the force of gravity, which is used in the massage technique, stagnant fluid can be moved from the draining bronchus into the main bronchus and trachea, and then removed from the body by coughing.
Indications for postural drainage
The method is used in extreme clinical situations: with a simple form of pneumonia or bronchitis, drainage is not appropriate.
The procedure is performed on patients diagnosed with the following pathological conditions:
Contraindications to postural drainage
Although at first glance drainage is a simple procedure that can be done at home, it is not suitable for all patients.
Results of the procedure
Drainage massage allows you to achieve the following therapeutic effects:
- Provokes the appearance of a productive cough, stimulates muscle contraction of the bronchi. These processes accelerate the removal of mucus and phlegm.
- Not only pathological fluid is removed from internal organs, but also pathogenic microorganisms.
- Reduces intoxication load.
For a speedy recovery and better therapeutic results, cleansing sessions are carried out three times a day for a week.
Preparing for treatment sessions
Before drainage is performed, doctors prescribe the patient medications that thin the sputum (mucolytics). Next, the patient is given a chest massage to increase blood flow to the lungs and achieve maximum therapeutic effect during drainage. Massage movements begin from the center of the chest, smoothly move to the side, and then to the back. 
Positional drainage in small patients
The technique can alleviate the baby’s condition with acute bronchitis. When performing drainage on a child, the doctor takes into account the peculiarities of the anatomical structure of his body, which is not yet fully formed. How to properly carry out the procedure for children?
Postural drainage: features of implementation
Algorithm of actions for removing fluid from the lungs:
Postural drainage technique
The technique of postural drainage is simple. The patient lies down on a flat, hard surface and a pillow is placed under his stomach. In this case, the patient can take several positions per session (on his side, lying on his stomach or on his back). The choice of position is determined by the attending physician. During pregnancy, the position “on the stomach” is excluded.
Important! The head should be located below the spinal column.
- The doctor lubricates his hands with oil and begins to slowly, and then more rhythmically rub the spine area up and down for 1 minute.
- Next, the area of the shoulder blades and ribs is rubbed for 2-3 minutes.
- Then the doctor folds his palms into a “boat” and begins to pat the back from the sides to the center.
- The doctor proceeds to massage the chest to speed up the flow of mucus.
- At the end of the session, the specialist uses elements of breathing exercises: he asks the patient to take a deep breath and clear his throat. The patient can also bend and rotate the body.
Care for the patient after drainage remains the same: taking mucolytics, bed rest, and lack of physical activity.
Positional drainage alleviates many diseases associated with the respiratory system. With it, the body's recovery after illness occurs twice as fast.
Video
Postural bronchial drainage is a medical procedure that facilitates the removal of bronchial contents by placing the patient in a special drainage position. Carrying out postural drainage makes it possible to move the contents of the bronchi under the influence of gravity in the direction of the main bronchi and trachea, from where it is eliminated by coughing. When in the drainage position, the affected area of the respiratory system is located above the tracheal bifurcation. In order to drain the basal segments in the lower lobes of the lungs, it is necessary to take a lying position on your side, which is opposite to the affected area, while the end of the bed must be elevated; to drain the segment of the apex of the lower lobe - a similar position with a half turn on the stomach; upper lobes - sitting position; in order to empty the bronchi of the anterior segment, it is necessary to bend backward; posterior segment - forward deviation; drainage of the reed segments is performed in a lying position on the right side, the left shoulder should be lowered down; middle lobe - lying on your back, pulling your legs to your chest or raising the end of the bed in which your legs are located.
Depending on the tolerance of the drainage position, the time spent in it also changes, varying from ten minutes to half an hour. At the final stage of being in the drainage position, expectoration of sputum is performed. In order to improve sputum production during postural drainage, massage with vibration and effleurage of the chest wall is used. It is recommended to perform postural bronchial drainage three times a day. Postural drainage, performed in a static position, is recommended to be combined with drainage exercises performed dynamically, including body rotations, bending and other movements.
Postural drainage indications
Postural drainage is prescribed to patients with the following diseases: bronchitis, pneumonia, cystic fibrosis, bronchiectasis and other diseases of the respiratory tract that are chronic or pathological.
This therapeutic procedure helps eliminate mucus formed in the trachea, promotes the appearance of a productive cough and muscle contractions of the bronchi. Sputum discharge occurs only if all the above criteria are strictly followed. Postural drainage is performed in almost all medical centers. Its technique is quite simple and accessible to everyone.
Carrying out postural drainage
Before performing postural drainage, mucus should be thinned with mucolytic drugs and alkaline drinks. When performing this procedure, there is a significant difference in body position and intensity of the procedure in children and adults. To achieve significant progress in the treatment of diseases of the bronchi and lungs, it is necessary to adhere to the instructions for implementation.
Postural drainage technique
Postural drainage is performed in three variations: on the side, on the back, on the stomach. The required position is determined by the person conducting the therapy. All provisions permitted by the doctor may be used. The patient should be positioned on a hard, flat surface, with a blanket or pillow placed under the knees so that the head is located below the spine.
Hands are lubricated with cream or oil and rhythmic movements are made up and down along the back for about half a minute. After this, the area of the shoulder blades and ribs is rubbed, and the rhythm gradually accelerates. After about three minutes, when the back is well warmed up, you can begin to pat, folding your palm in the shape of a boat, towards the spine from the sides on both sides. After all manipulations are completed, the entire sternum should be massaged to ensure better mucus drainage. Having completed all the exercises, the patient should be asked to take a deep breath and cough so that the liquid that has collected in the trachea comes out.
A set of therapeutic sessions aimed at cleansing should be carried out for five days, two to three times a day.
Postural drainage technique
The technique of postural drainage is very simple - the foot end of the patient's bed is raised, the pillow is removed from under his head and he is forced to turn from one side to the other, while coughing up mucus. After the patient gets tired of being in this position, after a quarter of an hour his bed is set to the standard position and after three hours the drainage continues. Sometimes it makes sense to place the patient across the bed so that he can rest his elbows on his chest and hang his head. By tossing from side to side in this position, the patient is able to cough up sputum for 15 minutes.
The technique of postural drainage is given great importance, especially in the treatment of patients with bronchiectasis in the lower lobe. The entire complex of measures taken with the use of large doses of penicillin or streptomycin, which are used intramuscularly, cannot protect the patient from the onset of intoxication.
Postural drainage for a child
Postural drainage should be performed in children with bronchitis, since this type of treatment for this disease in children has repeatedly proven its effectiveness. This terminology (drainage) in the medical lexicon means a method that is effective in creating an outflow of fluid in the body.
The most important thing when performing massage on children is proper body positioning. Drainage massage should be performed on a child when the position of his chest is higher than the position of his head. If the child is large, you can place a bolster or pillow under his chest. A child under the age of one year can be placed on your lap, while supporting him with your free hand under the shoulders and chest. Before starting a drainage massage for a child, in order to facilitate sliding, you can use baby cream.
There are several ways to provide postural massage to a child.
“Wave” method. It is performed on both sides of the spine, from the middle area of the back, while grasping a certain amount of skin; the hands should be moved towards the shoulders. After which you need to retreat a couple of centimeters to the outside and repeat the movement. Performed to the sides. The wave should be carried out in each segment up to twenty times;
The same number of strokes on the back should be carried out intensively with the entire area of the palm from bottom to top;
Along the areas of the shoulder blades, you need to run the edges of your palms the same number of times.
