Suctioning Flashcards
Suctioning (Mechanical Aspiration)
-Airway obstruction- foreign body, secretions, structural change
-Retained secretions cause airway resistance, increased work of breathing and can cause -Hypoxemia, hypercapnia, atelectasis, and infection -Difficulties clearing airway -PT inability to effectively cough, thick/tenacious secretions, and large amounts of secretions -To clear airway above or in main stem bronchi -Below main stem bronchi, requires bronchoscopy
Suctioning (Mechanical Aspiration)
Tools for Airways
-Upper airway- oropharynx
-Uses rigid tonsillar suction- Yankauer -Lower Airway, trachea and main stem bronchi -Flexible suction catheter down nose or artificial airway
Suctioning (Mechanical Aspiration) Passage ways
-Passage ways to facilitate suctioning
-Endotracheal (ET tube) -Tracheostomy -Nasotracheal (NT) -Open and closed suction used along with sterile techniques
Artificial Airway Suctioning
-Indication
-Removal of accumulated secretions
-Obtain a sputum specimen “ lukens trap” -Maintain patency and integrity of artificial airways -Need to stimulate cough in Pt with mental status change/ medications -Presence of atelectasis or consolidation (form Secretion retention)
Artificial Airway Suctioning
-Contraindications
-Necessary in all PT with artificial airways
-NO absolute contraindications when indication is present -Not suctioning may in fact be lethal
Endotracheal/ Tracheostomy Suctioning
-Hazard and Complications
-Hypoxia/ Hypoxemia
-Tracheal/ Bronchial mucosal trauma
-Cardiac or Respiratory arrest
-Cardiac arrhythmias (bradycardia from vagal response)
-Pulmonary atelectasis
-Bronchoconstriction/ Bronchospasm
-Infection
-Pulmonary Hemorrhage/ bleeding
-Incr. Intracranial pressure
-Interruption of mechanical ventilation
-Hyper/ Hypotension
Endotracheal/ Tracheostomy Suctioning
Suctioning
-Assessment of Outcome 4 improvements
-Improvement in breath sounds
-Improvement in Vent pressure
-Improvement in Oxygenation per ABG or Pulse Ox
-removal of pulmonary secretions
Endotracheal/ Tracheostomy Suctioning
Suctioning
-Monitoring
-Breath sounds
-SpO2
-Respirations
-Pulse Rate, BP, EKG (if available on monitor)
-Sputum
-Cough Effort
-Assessment of Need
-Should be routine part of every Pt/ Ventilator system check
Endotracheal/ Tracheostomy Suctioning
-Equipment and Procedure Steps
-Step 1 assess need, never done on a “ Routine” basis
-Step 2 Assemble and check equipment
-Step 3: Pre Oxygenate and hyperinflated pt
-Step 4: Insert catheter
-Step 5: Apply suction/ Clear catheter
-Step 6: Oxygenate and Hyperinflate PT
-Step 7: Monitor pt and assess outcomes ( have breath sounds and ventilation pressures improved) repeat as needed
Endotracheal/ Tracheostomy Suctioning
Equipment needed
Adjustable suction source/ collection system
Sterile suction catheter with thumb port
Sterile glove
Goggles, mask, and gown (standard precautions)
Sterile basin for rinsing catheter
Sterile water or saline
Saine for instillation down tube/ airway
Oxygen delivery System BVM or ventilator
Endotracheal/ Tracheostomy Suctioning
Pressure set- What are the pressures
Adult -120 to -150 mmHG
Child -100 to -120 mmHG
Infant -80 to 100mmHg
Endotracheal/ Tracheostomy Suctioning
Catheters
.1) 22 inches long
2.) External Circumference sizes in french units 3.) additional side ports to minimize mucosal trauma
4.)Coupe tip (Curved) used to access the left main stem bronchi
5.)Size Very Important
Too Big obstruction airway, decrease lung volume, causes atelectasis and hypoxemia
External diameter MUST BE no greater than ½ internal diameter of endotracheal tube
Endotracheal/ Tracheostomy suctioning
Sizes
-Formula: Catheter Size= ID size/ 2 *3
-Example ETT size 6.0 -Answer ½ of a size 6.0 ID tube would be 3.0mm. (3.0 * 3 = 9FR) this would result in a size 10 Fr catheter -Note: Adjust up one size if no correct size is available. For example, 12Fr catheter not available, then increase to size 14Fr catheter -Example: What size suction Catheter would be appropriate to use for pts with a size 8.0 ID endotracheal tube? -Answer ½ of a size 8.0 tube would be 4.0mm (4.0 * 3=12Fr) This would be a size 12Fr catheter.
catheter
Closed System multi use suction catheter
-1. Hooked into vent circuit note correct length for EET ot trach
-2. Allows suctioning without disconnecting pt from vent -3. Cross contamination less likely keeps sterile -4. Lower cost
Check suction catheter for suction
. Check suction catheter for suction applied when thumb port is covered (on regular suction catheter) or depressed button (on an inline vent closed suction system)
Pre Oxygenate and hyperinflated pt
BVM or ventilator breaths
100% oxygen for at least 30 sec before suctioning
How far do you Insert catheter, and what do you do afterward
Until you feel resistance
Withdraw a few centimeters before applying suction
Apply suction/ Clear catheter
Apply suction only while withdrawing the catheter
Use rotating motion while withdrawing ( difficult with closed suction device)
Use intermittent suction while withdrawing
After removal of cath, clear using sterile basin and sterile water
If any untoward response, immediately remove cath and oxygenate pt
If secretions are very thick and tenacious may need to install saline down ET tube to thin secretions
1. Via port on Closed Suction 2. Down suction cath or tube 3. Studies mixed on efficacy of installation
Oxygenate and Hyperinflate PT
Repeat Step 3 (Pre Oxygenate and hyperinflated pt)
Minimum of 1 mon instead of 30 sec
Monitor pt and assess outcomes ( have breath sounds and ventilation pressures improved) repeat as needed
If using closed suction device, ensure that suction button is rotated off to prevent suction from being applied to airway inadvertently once you are done
Ensure Pts vital have returned to pre suction levels
Minimizing Complications. Adverse Reactions with ET or TRach Suction
- Careful adherence to procedure, best way to avoid problems
- Preoxygenation, helps to avoid hypoxemia
- Preoxygenation with hyperinflation
a. Helps to avoid atelectasis b. More effective when done through vent
- Use of closed suction device better than using individual cath with sterile procedure
- Watch cardiac monitor- vagal stimulation can cause Bradycardia or asystole
- Limit atelectasis
a. Using correct size cath b. Limiting time if suctioning (15 sec MAx) c. Provide hyperinflation before and after
- Limit Mucosal Traumaa.Rotate Cathb. Withdraw After meet resistance before applying neg pressure
- Increased ICP
-A. Usually very short lived and not significant
-B. In pt with increased ICP, may be significant may need to anesthetize the airway before suctioning
Nasotracheal Suctioning
-Indications:
-Indications: need to maintain a PTs airway and remove secretions or foreign materials
Nasotracheal Suctioning
-Contraindications:
-Absolute No!!! Epiglottis and Croup
-Relative: -Occuluded nasal passage -acute head, facial, or neck injury -Nasal bleeding -Laryngospasm -Irritable airway -Bronchospasm
Nasotracheal Suctioning
-Hazards/ Complications
-Hypoxia/ Hypoxemia
-Nasal, Pharyngeal, tracheal trauma/ pain -Cardiac or respiratory arrest Cardiac arrhythmias/ Bradycardia -Atelectasis -Bronchoconstriction/ Bronchospasm -Infection -Mucosal trauma -Gagging vomiting -Elevated ICP -Uncontrolled coughing/ laryngospasm -Hyper/ hypotension
Nasotracheal Suctioning
-Assessment of need
-Auscultate chest
-Assess effectiveness of Pts cough -Signs of respiratory distress (Sp02, WOB)
Nasotracheal Suctioning
-Assessment of Outcome
-Effectiveness reflected by improved breath sounds, removal of secretions, increased SP02
Nasotracheal Suctioning
-Monitoring
-Breath sounds
-Skin Color -RR/ rhythm -Pulse Rate, arrhythmia, EKG (if available) -Sputum (color, consistency, amount) -Presence of bleeding/ evidence of trauma -Subjective response (pain) -Cough effort -ICP (if indicated/ available)
Nasotracheal Suctioning
-Equipment and procedure
-A. Assess Ot and per oxygenate 100% is preferred
-B. Assemble equipment and select appropriate neg pressure
-C. Setup sterile gloved and water, soluble lub jelly for catheter and determine which nare is most patent
-D. Consider using Nasopharyngeal airway in PTss requiring frequent NT suctioning
-E. Catheter insertion
-1. Lub Cathe
-2. Direct Cath toward floor of nares or septum
-3. Gently insert cath during inspiration of have pt cough, if any resistance felt, stop and withdraw cath and insert into other nostril
-4. Continue to advance until Pt coughs or resistance again felt. Withdraw cath 1-2 cm and apply intermittent suction not exceeding 15 seconds
-Assess Pt repeat if necessary
Nasotracheal Suctioning
-Minimizing complications:
-Insertion of cath into oropharynx or esophagus can cause gagging or vomiting
-Always be ready to lie PT on side and suction oropharynx
-Avoid suctioning PT too soon after a meal or tube feeding
-Airway trauma (exhibited by blood in sputum)
-Avoid using excess force
-Adequate lub of cath
-Use of nasopharyngeal trumpet is repeated suctioning is needed
-Contamination/ infection
-Sterile technique
-General insertion, raising cath
Sputum Sampling
-Follows same procedure, but adding a collection device in line between cath and suction tube called a lukens trap
-Very important to use sterile technique to avoid contaminating specimen
-Attach flexible tubing on collection device to rigid nozzle to close container
-Labe and place in biohazard bag Ensure delivery to lab for analysis
