05: Suctioning Flashcards
Equipment for sterile-hand suctioning
Sterile gloves, saline, sx source, bag mask w O2, protective equipment
Equipment for in-line closed system suctioning
gloves, saline, sx source, bag mask w O2, protective equipment
Equipment for sterile-hand suctioning per ET and trach tube
Sterile gloves, saline, sx source, bag mask w O2, protective equipment, suction catheter
How to determine correct size of suction catheter for ET/trach
ID x 2 then size next even number down
Purpose of coudé catheter
Guide suction catheter in L or R mainstem
Purpose of sputum trap
Collect sample?
Purpose of endotracheal suctioning
Maintain patent airway by
-moving secretions, food, foreign body out of aw
-pulmonary hygiene with cough
Physical findings indicative of needing suction
Rhonchi
Visible secretions
Increased dyspnea/respiratory distress
Pt types requiring suctioning
Nervous system depression
Artificial airway
Inability to take a deep breath
Thick secretions, pain, postop
Negative pressure ranges
Infant: -80 to -100
Child: -100 to -120
Adult: -120 to -150
Indications for lavage solutions during suction
Thick, tenacious, secretions
Types of solutions for lavage
Normal saline
Mucomyst
Appropriate time for lavage during procedure
Completely prepped for insertion and suction
Lavage solution for sputum sample
Normal saline
What to monitor during suctioning
BS
O2 sats
Resp rate/pattern
HR, BP
EKG
Cough effort
ICP (if installed)
General suctioning procedure
Preoxygenate pt (100%)!!!!!!
Insert -> resistance-> withdraw 1-2 cm -> intermittent suctioning
<15 seconds in aw!!!!!
Twist as u withdraw
Maintain sterility
Relative contraindications of nasotracheal suctioning
Blocked nasal passage
Epistaxis
Acute facial, neck, or head injury
Upper aw infection
Irritable aw
Laryngospasm
Preventing hypoxemia during suctioning
Hyperoxygenate greater than or equal to 1 min
No longer than 10-15 sec
Vagal stimulation causes and how to prevent
Bradycardia
Quick/gentle
Appropriate vacuum pressure
Dysrhythmias in suctioning are caused by and present as
Hypoxia
Tachycardia/PVCs
How to prevent dysrhythmias in suctioning
10-15 sec to suction
Preventing trauma in suctioning
Use lowest pressure possible (w/in range)
Other complications/hazards of suctioning
Hemoptysis
Atelectasis
Bronchospasm
Preventing mucosal trauma in nasotracheal suctioning
NPA
How to prevent infection in nasotracheal suctioning
Maintain sterility/be gentle
How to prevent arrhythmias in nasotracheal suctioning
Maintain oxygenation/vent
Time is within 10-15 sec
Suctioning at home
Clean procedure
Boiled/distilled water to rinse -> air dry -> store in dry/clean area (use up to 24 hrs)
Vinegar 1:3 for 60 min
Boiling water
70% isopropyl for 5 min
Watch for fever and change in color of sputum
Absolute contraindications of suctioning and what to use
Epiglottitis
Croup
Nasotracheal
Retained secretions can lead to
Increased WOB and Raw
Atelectasis
Hypoxemia
Hypercapnia
Pulmonary infections
Oral suctioning is
Catheter -> mouth
Nasotracheal suctioning
Catheter -> nares
Sterile-hand suctioning
Sterile technique -> catheter -> trachea
Oropharynx suctioning
Upper airway
Yaunker
If a pt is on oxygen with an open airway, what should you do with the O2 device during tracheal/bronchial suctioning
Remove
If a patient has a closed airway (vent), what should be done with O2 during lower airway suctioning?
Leave them on O2 and use in-line
When vacuum is occluded, the pressure on the gauge should
Increase
Vacuum suction absent?
Leak
Vacuum can’t maintain pressure?
Leak
A suction catheter size should never be
Greater than half of ID
Dysrhythmias seen in suctioning indicative of hypoxia
Tachycardia/PVCs
How to tell if pt has Epiglottitis
Drooling
If pt has high peep, what kind of suction should you use and what value of PEEP will you see?
Closed system suction
>10 cmH2O
NPAs can help
Decrease mucosal trauma in long term nasotracheal suctioning
Closed (in-line) sx catheter indications
High vent requirements (PEEP >10, MAP >20, I time >1.5 sec, FiO2 >60%)
Frequent sx required
Hemodynamic instability
Active TB
Inhaled agents
Aw irritation from sx can lead to
Bronchospasm (wheeze)
Vent requirements indicating in-line suctioning
PEEP >10
MAP >20
I time >1.5 sec
FiO2 >60%