Positioning for VQ

Question 1

Rationale behind Positioning for VQ

Answer 1

By positioning a patient correctly, you can optimise their VQ ratio or help to treat problems leading to mismatch.

Positioning for VQ is often used alongside other treatment techniques such as postural drainage and manual techniques

Better VQ = better gas exchange

Can reduce breathlessness/WOB

Question 2

Physiological effects of VQ positioning

Answer 2

Allows for more efficient gas exchange, more oxygen delivered around the body, less breathless

Question 3

What structures are affected by this treatment?

Answer 3

Alveoli in the lungs
Accessory muscles & diaphragm (positions used to give them a biomechanical advantage)

Question 4

How would you treat a patient using VQ positioning?

Answer 4

1. Introduce yourself
   2.Explain purpose of the treatment and check contraindications
   3.Gain informed consent
2. Ensure environment is suitable
3. Position patient appropriately using pillows and provide towel/blanket for comfort as required
   Positions include: sitting leaning forward, Sitting leaning forward at a table, sitting upright, high side lying, standing leaning forward & Standing leaning back or sideways
4. Observe effects on patient in this position
5. Ensuring you monitor the patient carefully throughout for any adverse reactions and check they are comfortable with the technique and consent for you to continue
6. When treatment complete re-assess patient and check for any adverse effects
7. Consider the position you will leave your patient in following your treatment and any instructions/advice you would give to other

Question 5

Name some VQ positions

Answer 5

sitting leaning forward
Sitting leaning forward at a table
sitting upright
high side lying
standing leaning forward
Standing leaning back or sideways

Question 6

Precautions

Answer 6

Acute illness e.g. nausea, vomiting, dizziness
Cardiovascular instability
Raised intracranial pressure (ICP)
Recent thoracic, abdominal or spinal surgery
Burns, wounds or healing tissue in area of weight bearing

Question 7

Contraindications

Answer 7

Head and neck injury until stabilised
Active haemorrhage with hemodynamic instability
Recent spinal surgery or acute spinal injury unless agreed with consultant
Active haemoptysis
Broncho-pleural fistula
Large pleural effusions
Pulmonary embolism
Pulmonary oedema associated with congestive heart failure
Rib fracture with or without flail chest
Subcutaneous emphysema
Undrained pneumothorax
Recent epidural, spinal infusion or spinal anaesthesia

Do you have any circulatory issues?
Any heart or lung conditions?
Any head or neck injuries?
Recent chest or spine surgery?
Generally feeling well?

Question 8

How would you document this?

Answer 8

Date, Time, Patient name
Explanation of procedure & gaining informed consent
Patient position & why
Any adverse effects?
Sign