Airway Maintenance

Question 1

why do we suction pts

Answer 1

to keep nose, mouth and trachea free of excessive secretions
prevent atelectasis and pneumonia
collect sputum for testing

Question 2

what indications would you suction a pt

Answer 2

if a pt is unable to effectively cough

-AND airway is compromised/ with decreased o2

Question 3

what equipment do you need for oral pharyngeal suctioning

Answer 3

Yankauer(tonsil tip suction)
suction device/tubing
towel
PPE (gloves mask goggles)
cup of water
suction canister/tubing

Question 4

what should a suction be set at on adults?

children?

Answer 4

adults- 100-150mmHg

child- 100-120mmHg

Question 5

for a nasopharyngeal/nasotracheal suctioning what size catheters should be used

Answer 5

infants-5-8F
children-8-10F
adults 12-18F

Question 6

what is the suctioning rate for nasopharyngeal/nasotracheal suctioning

Answer 6

adults 100-120mmHg

child 50-100mmHg

Question 7

what position should the pt be in when being suctioned

Answer 7

high fowlers and head is hyperextended throughout the procedure.
want to prevent the suction from going into the trachea

Question 8

how long should you perform nasopharyngeal/nasotracheal suctioning

Answer 8

no longer the 15 seconds

if the pt needs more suctioning- let them recover and go down again

Question 9

how many times should you attempt nasopharyngeal suctioning in one procedure

Answer 9

no more than 3 passes in one session.

allow 20-30 seconds between suctioning attempts

Question 10

what are the goals for suctioning

Answer 10

airway cleared of secretions
improved breath sounds
oxygenation improves

Question 11

what are complications of suctioning

Answer 11

hypoxia (sats drop- need to get sats back up into the 90s)
cardiac dysrhythmias
hypotension
tachycardia
vomiting/aspiration
mucosal trauma and bleeding

Question 12

what are things you need to do after suctioning prior to leaving the room

Answer 12

• reset O2 at ordered rate
• reassess lung sounds, respiratory status, O2 sats
• Reposition pt
• Rinse tubing
• dispose of catheter

Question 13

steps for oral-pharyngeal suctioning

Answer 13

• sit pt upright
• place towel across chest
• insert catheter or yankauer into mouth along gum line to pharynx
• move around until secretions are clear
• encourage pt to cough

Question 14

when does suctioning need to be sterile

Answer 14

when it passes the pharynx and enters the trachea
or if you are performing
nasopharyngeal

Question 15

what is the pt position for nasotracheal suctioning

Answer 15

semi or high fowlers

with head HYPERextended to open airway

Question 16

how do you know if you have gone in far enough with nasotracheal suctioning

Answer 16

when you meet resistance and/or stimulate a strong cough

Question 17

how do you prevent hypoxia when suctioning a pt.

Answer 17

hyperoxgynate the patient prior to suctioning and after suctioning

if they are on 2L turn up the o2 to 4-6 L

Question 18

why do you suction the mouth first if there are a lot of secretions present

Answer 18

because the mouth has a lot of bacteria that can cause infection if they are introduced to the trachea via suction

Question 19

what should be documented when suctioning is performed

Answer 19

• the type of suctioning technique
• the number of attempts
• how the pt tolerated the procedure
• any adverse effects that occured
• the secretion description

Question 20

why would a cuff tracheostomy be used

Answer 20

• to decrease the risk of aspiration
• to prevent leakage of air
• permit mechanical ventilation

Question 21

when would a pt have an uncuffed tracheostomy

Answer 21

• in smaller children

- in an established tracheostomy without the need for mechanical ventilation

Question 22

what must be done before a pt can speak with a tracheostomy

Answer 22

• it must be a fenestrated tracheostomy

- the inner cannula needs to be removed and the cuff deflated

Question 23

what will happen if the fenestrated tracheostomy is plugged while the inner cannula is in palce

Answer 23

it will lead to suffocation because the tracheostomy will be plugged and that is the only source of air flow

Question 24

how do you suction a fenestrated tracheostomy

Answer 24

the same as a regular tracheostomy except
the inner cannula MUST be replaced PRIOR to suctioning

if its not the catheter can pass through the fenestra and injure the tracheal wall