Practical 2 - Advanced Treatment Techniques Flashcards
How do you set up suction via an ET tube (also state how you would expect to find the patient regarding the equipment)
- Put on gloves, an apron and goggles
- The ET Tube is already in the patient and should have a suction catheter attached to it
- Check that the suction mechanism is not locked, if it is unlock it (the button should be able to be pressed all the way down
- Turn the vacuum dial on the wall to below 20 and ensure that it goes up to 20 when you apply the device to your hand
- Attach the suction tubing to the suction catheter (the suction tubing should be attached to the suction canister which should also be connected via a different tube to the vacuum equipment at the wall
- Feed the suction catheter down the patient’s airways until you feel resistance, this should be the carina (a sensitive area that initiates the cough reflex)
- Press the button to create suction and pull the suction catheter slowly out of the patient’s airways, if you find a mucus plug hover there for a couple of seconds
- You can repeat with this equipment without changing things round as it is a closed environment using this method
What size should an NP airway be relative to the patient?
The same size as from the nostril to the tragus of the ear following the general curve of the airway
Why is an NP tube used instead of a Gadell/OP tube for a conscious patient
NP tube is a lot easier to tolerate than an OP tube
How do you setup and suction via an NP airway?
- Put on gloves, apron and goggles
- Choose a suction catheter that is the right size - Take the size of the NP airway, multiply it by 2 then subtract 2
- Open the suction catheter and attach the end to the suction tubing coming from the suction mechanism at the wall
- Set the vacuum pressure on the wall to just below 20 and check that when you suction it goes to 20
- Pull out a section of the suction catheter and loop it round but DO NOT TOUCH it. Tuck it under your arm (still NOT TOUCHING the suction catheter)
- Use one hand to stabilise the small bottom of the sterile glove and slip the other hand into the sterile glove (you cannot touch anything other than the suction catheter with this hand and nothing else can touch the sterile glove before you put it on)
- Insert the suction catheter into the airway and push until you reach resistance
- Put your finger over the hole to create suction and pull out slowly stopping at any mucus plugs for a couple of seconds (and holding the mechanism in place with one hand)
- If you want to suction again you must change the equipment
What size should the gadell be relative to the patient?
Same size as from the corner of the mouth to the angle of the jaw
How do you insert a gadell?
Insert upside down, twist and then push into the airway
Why do you use this for patients who are unconscious
To keep the tongue from precluding the airway
How do you set up and suction via a gadell?
- Put on gloves, apron and goggles
- Open the suction catheter and attach the end to the suction tubing coming from the suction mechanism at the wall
- Set the vacuum pressure on the wall to just below 20 and check that when you suction it goes to 20
- Pull out a section of the suction catheter and loop it round but DO NOT TOUCH it. Tuck it under your arm (still NOT TOUCHING the suction catheter)
- Use one hand to stabilise the small bottom of the sterile glove and slip the other hand into the sterile glove (you cannot touch anything other than the suction catheter with this hand and nothing else can touch the sterile glove before you put it on)
- Insert the suction catheter into the airway and push until you reach resistance
- Put your finger over the hole to create suction and pull out slowly stopping at any mucus plugs for a couple of seconds (and holding the mechanism in place with one hand)
- If you want to suction again you must change the equipment
What are precautions of suctioning?
Cardiovascular instability
Increased intercranial pressure
Hypoxia
Facial trauma
Malignancy in the area
Recent upper GI and thoracic surgery
Clotting disorder
Haemoptysis
What are contraindications of suctioning and why
Basal skull fractures - the brain can herniate out of the nose
Severe bronchospasm/stridor - Putting a foreign body into the airways and stimulating coughing with heighten the inflammatory process worsening the bronchospasm
How do you setup manual hyperinflation?
- Attach the bag via the tube to the oxygen supply and set to 15L/min
- Allow the bag to inflate
- Take the ventilation off the patient’s tube and attach the hyperinflation bag
- Hold the base of the bag to support it and ensure it doesn’t come detached from the patient’s tubing and use the other hand to squeeze the bag to deliver a breath
- If the patient is trying to assist breathing, perform in rhythm with them, if not deliver long slow breaths
What is the purpose of manual hyperinflation?
To enable time for collateral ventilation to occur to open up the airways to increase lung volume and aid with sputum retention as air gets behind the sputum making it easier to expel
What are the collateral ventilation channels
Inter-broncheolar channels of martin
Alveolar pores of Kahn
Bronchiolar-alveolar channels of lambert
What are some precautions for manual hyper inflation
PEEP between 10 and 15 cmH2O
Peak inspiratory pressure between 30 and 40cmH2O
Unexplained haemoptysis
Recent lung surgery
Unstable BP
Lung abcess
Emphysematous bullae
Acute head injury/compromised CNS
Drained pneumothorax
What are some contraindications for manual hyperinflation
Cardiovascular instability
High compliance
Severe bronchospasm
Undrained pneumothorax
