midterm: suction technique Flashcards
1
Q
Difficulty with clearance is secondary to .. (3)
A
- thick secretions
- poor cough/neuromuscular issue
- amount of secretions
2
Q
Retained secretions will cause .. (6)
A
- obstructed airways (atelectasis)
- pneumonia / infection
- o2 levels decrease
- co2 levels rise
- increased WOB
- increased Raw
3
Q
Clinical Levels of Suction
A
infants: -60 to -80mmHg (max -100mmhg)
children: -80 to -100mmHg (max -125mmHg)
adults: -100 to -120mmHg (max -150mmHg)
4
Q
Suction Equipment
A
- source
- regulator
- collection chamber
- connecting tubing
- yankeur/catheter
- gloves
- sterile N/S and container
- water based lubricant
- local anesthesia (+/-)
- specimen traps to sample (+/-)
5
Q
how to determine French size based on ID of ETT
A
Fr = ID x 2; then go down 2 Fr
i.e. ID = 8mm
Fr = 8x2 = 16 Fr .. down 2 = 14 Fr
6
Q
technique for open suction
A
- wash hands
- assemble equipment
- inform patient
- assess patient (check chart/rn, inspection, auscultation, vitals, hemodynamic monitoring, Sao2, palpation, percussion)
- Don gloves (dominant hand sterile and can only touch catheter)
- lubricate catheter
- pre oxygenate
- add PEEP adaptor to BVM
- insert catheter until obstruction felt, pull back 1/2 inch
- apply suction
- withdraw slowly
- rotate catheter while withdrawing
- limit attempts to 15-20 seconds
- re oxygenate and re ventilate
- monitor quality and quantity of suction contents
- assess patient
- repeat sequence as needed
- suction above chords, orally, and nasally
- discard equipment
- wash hands
- chart
7
Q
what should we chart when suctioning?
A
- scant, small, moderate, copious
- thick, sticky, tenacious, purulent, mucoid/clear, blood tinged/blood
- date/time, # attempts, was PEEP necessary
- was hyperventilation required before/after if alveoli partially collapse
8
Q
closed suction precautions
A
- deoxygenate b/w attempts
- black line should be visible at t-piece
- lock thumb valve
- “catheter creep”
- note day change sticker
- inadvertent bronchial lavage
- HME and rinsing catheter (don’t flood HME)
- don’t cut ETT with catheter in airway
- proper vacuum setting
9
Q
complications of suctioning
A
- discomfort and anxiety
- coughing
- bronchospasm
- hypoxemia
- cardiac arrhythmias secondary to vagal stimulation or hypoxemia
- hypertension/hypotension
- atelectasis
- pneumothorax
- mucosal airway trauma
- infection
- hemorrhage
- increased ICP
10
Q
VAP diagnostic criteria
A
- radiographic abnormalities
- and at least one of: WBC >/= 12,000 or <4000 OR temperature > 38dgC
- and at least one of: tracheal secretions (new, changing, increasing); increasing suctioning requirements; inspiratory crackles or bronchial breath sounds; worsening gas exchange
11
Q
5 must do with VAP
A
- elevation of the head of the bed to 45dg when possible; otherwise maintain head at angle > 30dg
- daily evaluation of readiness for extubation
- utilization of ETT with subglottic secretion drainage
- oral care and decontamination with Chlorhexidine
- initiation of safe enteral nutria w/in 24-48h of ICU admission
