Manual Secretion Removal Techniques & Airway Clearance

Postural Drainage

• Principle:
• Positioning a patient so that the bronchus of the involved long segment is perpendicular to the ground.
• Using gravity, these positions assist the mucociliary transport system in removing excessive secretion from the tracheobronchial tree.

  

  Fig.1: Postural drainage

  
  

Percussion

1. Percussion is a force rhythmically applied with the therapist's cupped hands to the patient's chest wall (Fig. 1).

2. The technique is administered for 3 to 5 minutes over each involved long segment.

3. Percussion release the pulmonary secretion from the wall of the airways into the lumen of the airway and with the help of postural drainage position for specific lung segment, the probability of secretion removal is enhanced.

Fig. 2: Percussion

Shaking

1. A bouncing maneuver is applied with the therapist's open hands to the rib cage throughout the expiratory phase of breathing.

2. 5 to 7 deep breaths with shaking on exhalation are appropriate for easy removal of secretion from the mucociliary transport system.

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Airway Clearance

Once the secretion has been mobilized with postural drainage, percussion, and shaking, the task of removing the secretion from the airways under the airway clearance technique (Fig.3).

Fig.3: Airway clearance therapy

Coughing is the most common way of clearing the airway.

Huffing is an alternative method of airway clearance that is useful for patients with obstructive pulmonary disease.