Week 9- Suction & Trach Management

Question 1

Pt care equipment standards- pg 99-107

Question 2

What do we use suctioning for?

Answer 2

Used to clear the airway of:
- Vomit, saliva, blood, food, foreign objects that might block airway

Question 3

When do we suction during a call?

Answer 3

• Can be preformed anytime during the call as required
• Goal is to clear the airway & prevent aspiration

Question 4

What is aspiration?

Answer 4

• happens when food, liquid, or other material enters a person’s airway and eventually the lungs by accident.
• Can lead to serious health issues like pneumonia and chronic lung scaring

Question 5

All Ontario EMS Ambulance must have according to the Equipment Standards… (suction devices)

Answer 5

• A portable suction device
• Hand held manually operated or electric/ battery operated unit
• Wall unit kept in Patient Compartment of Ambulance

Question 6

What are the standards to a portable suction device?

Answer 6

• Has to be able to be operated by one hand of the medic
• Be compatible with industry catheters and connectors
• Be capable of rapid disassembly and assembly, if applicable & designed to minimize incorrect assembly
• Be designed to treat infants, children, & adults
• Be disposable & or allowing cleaning of non disposable parts

Question 7

Portable suction- V-vac

Answer 7

• V-vac manual suction unit is a portable emergency unit designed for suctioning fluids and vomit from a patient’s airway
• Once squeezed, the units provide a powerful suction range between 170-380 mmHg and 70 lpm
• Intake valve is designed to minimize the risk of clogging problems, back-flow of suctioned matter, tube occlusion (blockage) and soft tissue injury
• Small and lightweight; offers one-handed operation
• Canister holds 425 mls

Question 8

Portable Suction- Electric/ battery

Answer 8

• Have a battery system that will allow 20 mins of continous operation
• Be able to plug into 12 DC electrical system in vehicle
• Reach >300 mmHg within 4 sec with everything connected tubing/ canisters
• Include a vacuum indicator at min. 100 mmHg & provide a range from 0-550mmHg
• Include non kinking suction tubing
• Collection container must hold min 300 mls
• Have a hydrophobic submicron filter 99% efficiency against bacterial/ viral organisms

Question 9

Laerdal Compact Suction Unit

Answer 9

• Light weight
• 45 min of battery life
• Used on peds/ adults
• Hold 300 mls

Question 10

S-Cort Suction Portable Suction

Answer 10

• Lightweight/ 500 mmHg for adult
• 125 mmHg for children
• Disposable collection canister

Question 11

Vehicle Wall Unit

Answer 11

• Has to have a bag or canister that can hold a min of 1.1L
• Have an on/ off switch
• Vacuum gauge that can register 0-550 mmHg

Question 12

Suction Tubing according to MOH standards…

Answer 12

• Must be disposable
• Be clear non conductive medical grade material
• Withstand 560 mmHg suction power without collapsing
• Be approx 6 in length & 7mm diameter
• Have ability to connect to various suction catheters via connectors

Question 13

What are the 3 types of suction catheters carried?

Answer 13

• Wide bore
• Yankauer
• In line/ closed suction

Question 14

What is the oral suctioning set for adults?

Answer 14

500-550 mmHg

Question 15

What is the oral suctioning set for childs?

Answer 15

200-220 mmHg

Question 16

What is the oral suctioning for infants?

Answer 16

80-100 mmHg

Question 17

What is the deep suctioning for trach or ETT for adult?

Answer 17

100-150 mmHg

Question 18

What is the deep suctioning for trach or ETT for child?

Answer 18

100-120 mmHg

Question 19

What is the the deep suctioning for trach or ETT for infant?

Answer 19

60-100 mmHg

Question 20

How do we suction the oropharynx?

Answer 20

• Open pt’s airway & insert suction tip/ catheter
• Never go past base of tongue: (could trigger gag reflex)
• In young pt, could trigger vagal response (decrease heart rate)
• Suction for 5-10 sec on the way out

Question 21

What is the oropharynx procedure?

Answer 21

The goal is to clear the airway
- with larger amounts of blood, vomit, secretions, roll the pt or sit them up to manually clear the airway
- set the correct pressure for the pt
- put the large bore/ cath in the mouth
- Occlude the hole in initiate suction
- Suction only on the way out of the mouth 5-10 secs max
- Pt will require oxygenation in between attempts

Question 22

What is the procedure for tracheostomy suctioning?

Answer 22

• set correct pressure
• Insert the cath until you meet resistance or the pt coughs
• Suction for 10 secs on the way out
• Ventilate/ oxygenate in between 1 min
• Have saline for clearing catheter’s

Question 23

When suctioning through mouth what should you use?

Answer 23

• Large bore tip or caetheter- yankauer

Question 24

When suctioning through OPA what should you use?

Answer 24

• catheter

Question 25

When suctioning through NPA/ Nares what should you use?

Answer 25

- catheter

Question 26

When suctioning through trach stoma what should you use?

Answer 26

- catheter

Question 27

What are the parts of the trach?

Answer 27

- Inner cannula - Neck plate- where all the info is - Ties or straps - Obturator

Question 28

What is the directive for reinsertion of tracg?

Answer 28

- Patient with an existing trach where the inner and/ or outer cannula(s) have been removed from the airway AND - Respiratory distress AND - Inability adequately ventilate AND - There is no family member or caregiver who is available and knowledgeable to replace the tracheostomy cannula

Question 29

How do you reinsert a trach?

Answer 29

*Ask family member If family member not able to, Paramedic will attempt to reinsert to a max of 2: - A reinsertion attempt is defined as the insertion of the cannula into the tracheostomy - A new replacement inner cannula is prefers over cleaning and reusing an existing one - Replacing the outer cannula with a new or cleaned one is preferred - Try twice if failed ventilate

Question 30

What are the steps for reinsertion?

Answer 30

1. Ensure Sp02 is applied 2. Ascertain if pt breaths via mouth & trach or just trachea 3. Oxygenation as needed 4. Suction as needed 5. Assess urgency of situation 6. Tracheostomy Tube: have available 7. Same size & one size smaller 8. Use obturator if available 9. If no obturator insert new tube following natural curve of stoma 10. Should only take 30 secs

Question 31

How do you apply oxygen to a trach?

Answer 31

- Apply oxygen to both the patient's face & tracheostomy site. (if there has been a laryngectomy, no connection between upper airway & trach) - Assess for breathing (air movement) by looking, listening, and feeling at both the mouth and trach - Waveform capnography should be applied if available - If ventilating via mouth, occlude the trach - If ventilation via trach place 02 mask of BVM, directly over the trach (inner cannula must be in place to attach BVM)

Question 32

What is ETC02?

Answer 32

End tidal carbon dioxide is the level of carbon dioxide that is released at the end of an exhaled breath. ETC02 levels reflect the adequacy with which C02 is carried in the blood back to the lungs and exhaled.

Question 33

What is normal ETC02?

Answer 33

35-45 mmHg