Control Comp #4 (OPA-NPA Airways, BMV, NT-Tracheal Sx) Flashcards
Suctioning: Sterile NT (Nasal) / Tracheal
(16 Steps)
PROCEDURAL STEPS
1. Scans chart for pertinent data and contraindications
2. Gathers equipment
3. Utilizes and maintains standard precautions as required
4. Identifies patient, introduces self and department
5. Explains procedure to patient and if applicable, confirms understanding
6. Assesses patient before procedure
7. Assures patient is properly oxygenated before and t/o procedure
8. Assures the proper level of vacuum is provided
9. Prepares equipment in a sterile field
10. Perform steps in accordance with facility protocol
11. Always assesses the patient for side effects and gives the patient time to recover between suctioning passes
12. Assesses patient post procedure
13. Correctly cares for equipment following the procedure
14. Thanks patient, ensures patient’s safety and needs
15. Disposes of PPE; washes/gels hands
16. Documents appropriately
Suctioning: Sterile NT (Nasal) / Tracheal
(Steps 1 - 6)
PROCEDURAL STEPS
1. Scans chart for pertinent data and contraindications
2. Gathers equipment
3. Utilizes and maintains standard precautions as required
4. Identifies patient, introduces self and department
5. Explains procedure to patient and if applicable, confirms understanding
6. Assesses patient before procedure
Suctioning: Sterile NT (Nasal) / Tracheal
(Steps 7 - 11)
- Assures patient is properly oxygenated before and t/o procedure
- Assures the proper level of vacuum is provided
- Prepares equipment in a sterile field
- Perform steps in accordance with facility protocol
- Always assesses the patient for side effects and gives the patient time to recover between suctioning passes
Suctioning: Sterile NT (Nasal) / Tracheal
(Steps 12 - 16)
- Assesses patient post procedure
- Correctly cares for equipment following the procedure
- Thanks patient, ensures patient’s safety and needs
- Disposes of PPE; washes/gels hands
- Documents appropriately
Suctioning: Sterile NT (Nasal) / Tracheal
Suction Pressure Ranges
Adult
Children
Neonates
Adult: 100 - 120 mmHg
Child: 80 - 100 mmHg
Neonate: 60 - 80 mmHg
- When suctioning you want to be in/out of nasal passage or trachea in 15sec max.
- Patient will always be in a semi-fowler position
Airways (Oro/Nasopharyngeal) OPA / NPA (nasal trumpet)
(10 Steps)
PROCEDURAL STEPS
1. Selects equipment
2. Utilizes and maintains standard precautions as required
3. Identifies patient correctly, introduce self and department
4. If applicable, explains procedure to the patient
5. Selects appropriate airway measures correct size
6. Lubricates nasal airway
7. Positions patient appropriately and inserts airway correctly
8. Thanks patient and ensures safety and needs
9. Disposes of PPE; washes / gels hands
10. Documents
Airways (Oro/Nasopharyngeal) OPA / NPA (nasal trumpet)
(Steps 1 - 4)
PROCEDURAL STEPS
1. Selects equipment
2. Utilizes and maintains standard precautions as required
3. Identifies patient correctly, introduce self and department
4. If applicable, explains procedure to the patient
Airways (Oro/Nasopharyngeal) OPA / NPA (nasal trumpet)
(Steps 5 - 7)
- Selects appropriate airway measures correct size
- Lubricates nasal airway
- Positions patient appropriately and inserts airway correctly
Airways (Oro/Nasopharyngeal) OPA / NPA (nasal trumpet)
(Steps 8 - 10)
- Thanks patient and ensures safety and needs
- Disposes of PPE; washes / gels hands
- Documents
Airways (Oro/Nasopharyngeal) OPA / NPA (nasal trumpet)
Sizing of NPA and OPA
NPA: Tip of Nose to Tragus (ear). When inserting NPA you want BEVAL UP then rotate 180 degrees while inserting. BEVAL DOWN is how it will end up. Top part of NPA will be flush with nostril
OPA: Corner of Mouth to Angle of Jaw. When inserting OPA you initially want the hook up and then rotate 180 degrees. The hook will be facing down once done
Manual Resuscitation: Bag Mask Ventilator (BMV)
AMBU Bag (8 Steps)
PROCEDURAL STEPS
1. Applies PPE
2. Gathers and assembles equipment
3. Checks breathing and pulse
4. Applies resuscitator to appropriate airway (Trach, ETT, Stoma, or Face)
5. Ventilates patient and assesses ventilation and oxygenation is appropriate
6. If indicated, adds PEEP valve to resuscitator
7. Assesses the patient for cyanosis, gastric distention, vomiting*
8. Disposes of PPE, washes / gel hands
Manual Resuscitation: Bag Mask Ventilator (BMV)
AMBU Bag (Steps 1 - 4)
PROCEDURAL STEPS
1. Applies PPE
2. Gathers and assembles equipment
3. Checks breathing and pulse
4. Applies resuscitator to appropriate airway (Trach, ETT, Stoma, or Face)
Manual Resuscitation: Bag Mask Ventilator (BMV)
AMBU Bag (Steps 5 - 8)
- Ventilates patient and assesses ventilation and oxygenation is appropriate
- If indicated, adds PEEP valve to resuscitator
- Assesses the patient for cyanosis, gastric distention, vomiting*
- Disposes of PPE, washes / gel hands
Manual Resuscitation: Bag Mask Ventilator (BMV)
AMBU Bag
- O2 Flow Rate
- Breaths per minute
- Basic CPR
- Minimum of 10 LPM
- 1 breath per 6 seconds (slow and steady)
10 - 12 breaths/minute - 2 breaths after each compression cycle
Manual Resuscitation: Bag Mask Ventilator (BMV)
AMBU Bag
Open Airway Methods
- Head Tilt Chin Lift (HTCL) “Sniffing Position”: Used on patients with no head injury
- Jaw Thust: Used on patients with suspected spinal injury
End Tidal CO2 Indicator
A device that is used on intubated patients to ensure that they were intubated correctly. The indicator will turn from purple to yellow if the patient was intubated correctly. The indicator turns color when CO2 is indicated.
PEEP Valve
- Indicated when patient’s oxygenation is not improving (Refractory hypoxemia) Can improve oxygenation by increasing alveolar recruitment
Indications that air is meeting some type of resistance when using the AMBU
Due to Obstruction
1. Excessive secretions that need to be removed
2. Patients head position needs to be changed
3. Bronchospasm. Will need a bronchodilator
4. Foreign objects. Remove F.O.
Flow is not meeting any resistance or chest not rising when using the AMBU
Due to Leak
1. The seal on the mask is not completely sealed correctly. Reposition the mask and ensure a complete seal.
2. Valve Leaks. Troubleshoot or get new BMV
3. Device Leaks. Troubleshoot or get new BMV
Technique used when sealing the mask with the AMBU
The C & E Technique
Extend the patient’s head back/neck extended. Seal the mask with your hand in a “C” position. “E” Elevate the Chin.
Hazards of Manual Resuscitators (3)
Delivery of excessively high airway pressures
1. Barotrauma
2. Gastric Distention
3. Pneumothorax
Indicators for Manual Resuscitators (2)
- Bradypneic or Apneic (ventilator-dependent) patients
- Ventilates patients during CPR
Indication for using an oral pharyngeal airway (3)
- An unconscious patient to avoid gagging and regurgitation
- Used as a bite block for Pts. with oral tubes
- Maintain a patent airway
Indication for using a nasal pharyngeal airway (2)
- A patient who requires frequent nasotracheal suctioning
- Maintain a patent airway
Indications for suctioning (2)
- Retained secretions due to patient with ineffective cough
- Maintain a patent airway
Hazards of suctioning (3)
- Hypoxemia: minimize by preoxygenating patient. minimize by using closed suction technique
- Cardiac dysrhythmias: (bradycardia/tachycardia) if either occurs, stop suctioning, administer O2 and ventilation
- Mucosal Trauma: Limit amount of negative suction pressure used. use shallow suctioning method
