Suctioning

Question 1

Why would we suction patients?

Answer 1

Pts who have secretions can increase airway resistance & WOB = hypoxia, hypercapnia, atelectasis & infection
Thick and copious secretions = airway obstruction (lethal and emergency situation)
Cough can help in prevention, but many pts especially if intubated have ineffective or even no cough

Question 2

Indications for Endotracheal Suctioning: Open AND Closed

Answer 2

• Integrity of lumen q4-8hrs
• Visible secretions in ETT
• Coarse crackles over trachea and/or ronchi over lungs
• Saw-tooth pattern in flow/time waveform on VTR
• Need for sputum sample to R/O infection
• ABG deterioration - no cause
• Apparent distress - no cause
• Increase in P. when VTR is volume controlled
• Decrease in Volume when VTR is P. controlled

Question 3

Contra-indications for Endotracheal Suctioning

Answer 3

• O2 DESAT, cardiac arrhythmias

- Hemo-dynamically unstable or very anxious

Question 4

Harm in using too large of a catheter?

Answer 4

Can quickly evacuate lung volume leading to atelectasis and hypoxemia
Can obstruct all or part of the airway

Question 5

Suction regulator negative pressure setting

Answer 5

Adult: 120-150mmHg
Children: 100-120mmHg
Neonates: 80-100mmHg

Question 6

FiO2, duration and targeted SpO2 values for hyper-oxygenation?

Answer 6

Peds & adults: FiO2-> 100% for 30-20 seconds
** Preferred (suction support): 15-20% increase in FiO2 for 2-5 minutes to prevent hypoxia & absorption atelectasis
Neonates: FiO2-> 10% more than already given

Question 7

Equipment for Open ETS

Answer 7

Suction tubing + yankuer for the end
sterile suction kit/catheter
Sterile water
PPE
Pulse oximetry & cardiac monitoring
Normal saline nebules in case
Sputum Trap IF NEEDED

Question 8

Total suction application time

Answer 8

less than 10 seconds

Question 9

Complications with ETS

Answer 9

• Risk of cardiac dysrhythmias
• Damage fo airway mucosa/carina
• Atelectasis due to large lung volume withdrawn
• Vagal stimulation
• Tachycardia
• Mucosal trauma
• Increased ICP
• Lower airway contamination from NS

Question 10

Advantages & disadvantages of saline instillation

Answer 10

PROS:
-helps remove, mobilize & loosen thick & tenacious secretions
-increases secretion volume
CONS:
-causes lower airway contamination 
-cold liquid=bronchospasm

Alternate method: heated humidity & I.V. hydration to loosen secretions

Question 11

Specific indications for Closed/Inline suctioning

Answer 11

• PEEP: >9 cmH2O
• MAP: >19 cmH2O
• FiO2: >0.60
• Frequent suctioning: >6x/day
• Hemodynamic instability
• Airborne disease/infections: TB, measles, varicella, smallpox, coronavirus, legionellosis
• inhaled agents
• NEONATES

Question 12

Specific indications for Naso-tracheal suctioning

Answer 12

• Maintain patent/integrity of airway by removing secretions, blood, vomit, saliva, foreign material -> inability to clear secretions with cough
• Sputum sample for analysis

Question 13

Patient body & head position for NTS

Answer 13

Semi-Fowlers. 35 degrees or more
*avoid supine
Head slightly hyper-extended (sniffing position), unless contra-indicated

Question 14

NTS suction parameter?

Answer 14

-120 to -150 mmHg

Question 15

How much xylo-gel do you insert in EACH nostril and how long does it take to effect?
What is a contra-indication of its use

Answer 15

2-3 ml of xylo-gel in each. so withdraw 5-6 ml
3-5 minutes onset effects
*if pt allergic to xylo

Question 16

What does it indicate when the patient is coughing or not coughing during NTS?

Answer 16

Coughing: catheter is likely in the trachea

Not coughing: possible absent gag reflex or in the esophagus = partial withdrawal and head-positioning required

Question 17

Contra-indications for NTS

Answer 17

• occluded nasal passages
• nasal bleeding/coagulopathy
• tracheal/gastric surgery
• croup or epiglottitis
• TBI
• broncho or laryngospasm
• MI

Question 18

Complications for NTS

Answer 18

• causing gag or even vomit
• nasal turbinates laceration
• airway trauma
• avoid NTS if pt just ate
• rest are similar to ETS