Airway clearance in ICU Flashcards
ETT entry
patients who are intubated and ventilated are unable to expectorate independently are likely to have an inhibited cough reflex- need suctioning to clear secretions, usually performed every 4 to 6 hours
what is suctioning
tracheal suctioning involves the removal of pulmonary secretion from the respiratory tract, using an applied negative pressure. a suction pressure of 80-120mmHg (11-16 kpa, can go up to 20 with thick secretions), suction should last no longer than 15 seconds, reassurance and support should be given to minimise discomfort
why do we suction ventilated patients
removal of bronchial secretion’s is important for gas exchange, the stasis of secretions encourages infection, so ventilated patients require regular suctioning through their ETT or tracheostomy, suctioning clears tracheostomy tube
methods of suctioning via an artificial airway
open suction= taking off ventilator then suctioning, closed suction- patient remains attached to the ventilator, this involves the permanent attachment of a sterile, reusable in line suction catheter
advantages of closed suction
reduced loss of 02 and PEEP, reduced infection risk to patient and HCP as no potential for spray
saline instillation
normal (0.9%) saline instillation is sometimes used prior to suctioning, installation refers to the administration of saline directly into the trachea via an artificial airway,, this should not be routinely performed prior to performing ETT suctioning but may assisted with the removal of thick secretions- warm saline to reduce bronchospasm
quantity- 2-10 mls
complications of suctioning
hypoxia/hypoxemia, cardiac arrest, tissue trauma to the tracheal &/or bronchial mucosa &/or pulmonary haemorrhage, atelectasis, bronchospasm, infection, increased ICP, increased/decreased BP, interruption in mechanical ventilation, pneumothorax, psychological effects
minimising risk of complications
pre & post oxygenate, limiting the procedure time helps with hypoxia and arrhythmias, correct catheter size and design, chose correct suction pressure the lower pressure the less hypoxia/atelectasis and trauma, do not twist catheter, use sterile technique, wear protective clothing, suction only when necessary, be prepared and observe patient before/during/after
how to select correct catheter size
use the ETT or tracheostomy tube size minus 2 and times by 2
each different catheter size has a different coloured top to easily distinguish it
if secretions are thick then go up one size
suctioning technique when a patient is ventilated
pre oxy patient with 100% oxygen, insert the catheter gently into the airway as far as it will go without applying suction, stop when you reach resistance/ patient cough, withdraw 0.5cm and apply suction, immediately reattach patient to the ventilator, wind the catheter around gloved hand and turn it inside out,
applying sterile gloves
open the inner packaging using the outer edges of packaging only until gloves are exposed, separate gloves using left hand and then apply glove
suctioning when patients are not ventilated
suctioning of the nose and mouth in a relatively simple procedure requiring only cleanliness and sensible care in the removal of liquids obstructing the nasal and oral passages
access through nose or mouth and into the trachea to remove secretions from upper respiratory tract and trachea when they cannot be removed by spontaneous coughing or less invasive methods
retained secretions will be evident in
visible, audible or palpable secretions, decreased oxygen sats, increase O2 requirements, poor cough/inability to generate effective spontaneous cough, reduced movement/ breath sounds of the chest, signs of distress
other routes of entry
use of a guedel oran airway- allows for oral suctioning
catheter size
minitracheostomy, nasal-pharyngeal airway, nasal-pharayngeal without airway= size 10 (black) catheter
