Lecture 8 - Suctioning an Adult ICU patient

Question 1

how often are assessments performed in ICU

Answer 1

every 2nd hour in conjunction with auscultation

Question 2

What are some indications for suctioning

Answer 2

• audible, visible, palpable secretions
• increased RR,
• Crackles
• desaturation, rising PIP, decreasing Vt, increased RR
• saw tooth pattern on flow-volume loop/exp
• restless agitated
• increased HR/BP

Question 3

on a normal ventilatory graphic, what percentage is expired in 1 second

Answer 3

80% - should be triangle shape

Question 4

What does a saw tooth graphic indicate

Answer 4

loose secretion build up in ETT or condensate in tubing

occurs on insp and exp

Question 5

What does a prolonged expiration indicate? (on vent graphic)

Answer 5

prolonged expiration is less than 80% expired in 1 sec

• evidence of gas trapping - build up of pressure indicating severe fixed obstruction - secretion build up in inner tracheostomy tube
• prolonged exp flow indicating fixed obstruction. flow never returning to zero, indicating next breath delivered before full exp

Question 6

what are some hazards and complications to suctioning

Answer 6

• decrease in dynamic lung compliance and FRC
• atelectasis
• hypoxia
• tissue truama/infection
• increased or decreased BP
• increaed ICP

Question 7

How long should suctionign procedure be?

Answer 7

<15 secs

Question 8

When do you stop inserting the catheter

Answer 8

pass until resistance is felt or cough stimulated, withdraw 1-2cm, apply suction

Question 9

Suction cather should be how big?

Answer 9

half the diameter of the ETT

Question 10

What is max suction pressure

Answer 10

20 Kpa

Question 11

When is above the cuff suction indicated?

Answer 11

should be used for mechanically ventilated patient who are expected to be ventilated >72 hours

Question 12

What is post intensive care syndrome?

Answer 12

poor physical, functional, cognitive outcomes for 3-8 years

Question 13

how prevalent is ICU acquired weakness

Answer 13

25-60% of mechanically ventilated patients (ventilated greater than 1 week)

Question 14

What are the positive effects of early mobilization

Answer 14

peripheral mm strength, resp mm strength, inidicates physical function

Question 15

What are some treatment progressions for mobilization

Answer 15

1) Active, resisted bed exercises once patient is awake - if patient can lift both arms to 90 degrees against gravity –> 2) Sit on edge of bed supported or unsupported –> SOOB –> Stand / march –> ambulation with or without assistance