"Suctioning Devices Flashcards "

Retained secretions Increase airway resistance & WOB Can cause hypoxemia, hypercapnia, atelectasis, and infection Thickness, amount, and/or patients ability to generate an effective cough can make clearing secretions difficult Retained secretions or other semi-fluid liquids are removed from the airways by: Suctioning - Application of negative pressure through a catheter or suction tip Bronchoscope

Vacuum source Vacuum regulator Trap bottle Collection tubing Suction catheter

A hospital piped vacuum system Vacuum pump A diaphragm pump that works in reverse of an air compressor Battery-operated suction device For field and transport use

Partially obstructing the flow Bleed in valve (Portables esp.) Greater the flow drawn from the room, the less suction applied to the patient’s airway

Used to collect secretion removed from the airway Prevents secretions from contaminating the vacuum regulator or suction machine The bottle is usually equipped with a system to stop suction when the bottle is full.

Upper Airway (oropharynx) Ridge tonsillar or Yankauer Yankauer tip or tonsil suction is a rigid suction device for the upper airway. Lower Airway (trachea and bronchi) Place a flexible catheter through an artificial airway (endotracheal suctioning) or the nose (nasotracheal suctioning) Avoid tracheal suctioning through the mouth because it causes gagging.

There is various designs with side ports to minimize mucosal damage. Catheter tips should be smooth and molded to prevent mucosa damage. Curved tip catheters (Coude and Bronchitrac) increase the chances of entering the left bronchus.

Suction Catheters General catheters are 22 inches long (Long enough to enter the mainstem bronchi) and sized in French units The catheter must have some means of interrupting the vacuum The thumb port’s internal diameter must be larger than the internal diameter of the catheter to prevent residual vacuum Rigid enough to pass through the airway but flexible enough to not damage the airway mucosa Catheter should slide through the airway with minimal resistance

A catheter that obstructs the airway quickly evacuates lung volume and causes atelectasis and hypoxemia Outer diameter of a suction catheter should be 1/2 to 2/3 of the airway’s inner diameter

The use of sterile saline in the removal of secretions remains unclear Saline irrigation can increase the incidence of nosocomial pneumonia Saline may aid in loosing thick sections or plugs from the airways When secretions are very tenacious a mucolytic or 2% sodium bicarbonate may be more effective (Requires a physician’s order) Proper systemic hydration can aid with secretion removal

Step 1: Assess patient for indications Even if BS are clear, you should periodically pass a suction catheter Airway tip can plug Very thick secretions may not move with airflow so adventitious BS may not be created. Endotracheal Suctioning Procedure Step 2: Assemble and check equipment Adjustable sx source / collection system Suction pressure should be limited to -100 to -120 mm Hg for adults, -80 to -100 mm Hg for children, and -60 to -80 mm Hg for infants Sterile suction catheter with thumb port Sterile gloves Goggles, mask, and gown (standard precautions) Sterile saline for instillation Oxygen delivery system (AMBU Bag or ventilator) Step 3: Preoxygenate and hyperinflate the pt. Use a manual resuscitator or manual breaths on a ventilator Avoid breath stacking by allowing adequate E-Time Give 100% oxygen for at least 30 sec Step 4: Insert the catheter until you feel resistance. Apply suction and gently pull back on the catheter Endotracheal Suctioning Procedure Step 5: Apply suction / clear catheter Apply sx while rotating the catheter limit suction time to 10 - 15 seconds After removing the catheter clear it with sterile saline from a basin If an adverse reaction occurs while suctioning, immediately remove the catheter and oxygenate and ventilate the patient Step 6: Reoxygenate and hyperinflate the patient. Step 7: Monitor the patient and assess outcomes Repeat steps 3 through 7 as needed until you see improvement or observe an adverse response

Adherence to the above procedure is the best way to avoid or minimize complications Preoxygenation helps to minimize hypoxemia To avoid mucosal trauma Limit the amount of negative pressure used Rotate the catheter while withdrawing (?) Do not stab the catheter into the airway Increased ICPs due to hypertension and coughing give lidocaine 15 min prior to suctioning

Cardiac arrhythmias occur due to hypoxemia and to lesser degree from airway reflexes Vagal stimulation can cause bradycardia or asystole Tachycardia can result from patient agitation or hypoxemia Hypotension can be due to arrhythmias or decreased venous return due to coughing or manual ventilation Hypertension from hypoxemia, increased sympathetic tone (stress, anxiety, or pain)

Atelectasis can be avoided by Limiting the amount of negative pressure Keeping the duration of suctioning as short as possible Pre and post hyperinflation In-line suction allows suctioning without patient disconnection from the ventilator Helpful in patients are on high levels of PEEP (>10 cmH₂0) or long I Times When suctioning neonates, make sure you match the numbers on the suction catheter to the numbers on the ETT Do not stimulate the carina

Closed-systems are standard care for ventilated pts This catheter can be reused of 24 hours High FIO₂ and PEEP can be maintained Pre-oxygenation with 100% oxygen is still required Preferably still use large volume sighs Reduces chances of cross contamination Cost is lower than using multiple suctioning kits