Respiratory Care Therapeutics: Suctioning

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Questions and Answers

What is the primary goal of airway clearance techniques?

To increase airflow resistance

To promote coughing in patients

To induce gagging in patients

To improve secretions clearance (correct)

What is the purpose of suctioning in patients with artificial airways?

To aspirate secretions when patients have difficulty handling them (correct)

To remove tracheal tubes from patients

To facilitate coughing in patients

To improve oxygenation in patients without airways

What is the recommended method for accessing the lower airway?

Through the esophagus

Through an artificial airway (endotracheal suctioning)

Through the nose (Nasotracheal suctioning) (correct)

Through the mouth

What should be removed from the oropharynx using a rigid tonsillar or Yankauer suction tip?

Secretions or fluids Signup and view all the answers

Why is tracheal suctioning through the mouth not recommended?

It causes gagging Signup and view all the answers

What is required for removing foreign bodies, secretions, or tissue masses beyond the main stem bronchi?

Bronchoscopy Signup and view all the answers

What is the application of negative pressure to the airways through a collecting tube connected to a suction machine or wall suction outlet?

Suctioning Signup and view all the answers

What is the role of respiratory therapists in performing bronchoscopy?

They assist the physician in performing bronchoscopy Signup and view all the answers

What is the main reason for suctioning in upper airways?

To maintain patency and integrity of the artificial airway Signup and view all the answers

What is the benefit of using a whistle-tipped suction catheter?

It is less irritating to respiratory tissues Signup and view all the answers

What is the unit of measurement for suction catheter sizes?

French units Signup and view all the answers

What is the recommended size of suction catheter for adults?

#12 to #18 Fr Signup and view all the answers

What is the purpose of the thumb port on a suction catheter?

To control suction Signup and view all the answers

What is the rule of thumb for estimating the proper size of suction catheter to use with a given endotracheal tube?

Multiply the inner diameter by 2 Signup and view all the answers

Why is it important to avoid using a suction catheter with a diameter larger than 50% of the internal diameter of the artificial airway?

To avoid atelectasis and hypoxemia Signup and view all the answers

What is the typical length of most suction catheters for adult general purposes?

22 inches Signup and view all the answers

What is the recommended duration of delivering 100% oxygen to patients before suctioning?

30 to 60 seconds Signup and view all the answers

What is the purpose of hyperinflating the patient before suctioning?

To facilitate the suctioning process Signup and view all the answers

What is the advantage of using the closed suction technique?

It does not require disconnecting the patient from the ventilator Signup and view all the answers

How should the suction catheter be inserted into the artificial airway?

Gently but quickly during inspiration Signup and view all the answers

What should be done when resistance is met or the patient coughs during suctioning?

Pull the catheter back 1 cm Signup and view all the answers

What is the recommended time for the catheter to remain in the airway during suctioning?

10-15 seconds Signup and view all the answers

What should be done to the catheter and connecting tube after suctioning?

Rinse the catheter and connecting tube with normal saline Signup and view all the answers

Why is it recommended to encourage the patient to deep breathe after suctioning?

To help the patient recover from the suctioning process Signup and view all the answers

What position should the patient assume to facilitate catheter passage through the larynx?

Sniffing position Signup and view all the answers

What is the purpose of twisting the catheter if resistance is felt in the nose?

To overcome resistance in the nose Signup and view all the answers

What is the indication for sputum induction?

Cough without sputum Signup and view all the answers

What is the technique used in sputum induction?

Inhalation of hypertonic saline with ultrasonic nebulizer Signup and view all the answers

What percentage of patients obtain an adequate specimen through sputum induction?

85-99% Signup and view all the answers

What type of PPE is recommended for suctioning oral secretions and open suctioning of airways?

Gloves and mask/goggles or face shield Signup and view all the answers

What is a technique to minimize or decrease complications of suctioning?

Suctioning only as needed Signup and view all the answers

What type of PPE is recommended for sputum induction in a patient with suspected TB?

Gloves and mask/goggles or face shield Signup and view all the answers

What is the result of vagal nerve stimulation due to irritation of the larynx or trachea?

Bradycardia Signup and view all the answers

What should be done if hypotension or hypertension occurs during suctioning?

Stop suctioning and administer O2 and ventilation Signup and view all the answers

What is the recommended technique to prevent mucosal damage during suctioning?

Limit pressure and use shallow technique Signup and view all the answers

What is the recommended duration of suctioning to prevent micro-atelectasis?

Less than 15 seconds Signup and view all the answers

What is the recommended position for semi-conscious patients during suctioning?

On their side Signup and view all the answers

What is the purpose of using sterile water-soluble lubricating jelly in nasotracheal suctioning?

To aid in catheter passage through the nose Signup and view all the answers

What is the key difference between nasotracheal and endotracheal suctioning?

Use of sterile water-soluble lubricating jelly Signup and view all the answers

What should be considered for patients who require repeated, long-term nasotracheal suctioning?

Use of a nasopharyngeal airway Signup and view all the answers

Study Notes

Suctioning

Suctioning is the application of negative pressure (vacuum) to the airways through a collecting tube (flexible catheter or suction tip) connected to a suction machine or wall suction outlet for aspirating secretions from the airways.
The goal of airway clearance techniques is to improve secretions clearance, prevent secretion retention, decrease obstruction of airways, and improve gas exchange.

Sites for Suctioning

Upper airways:
- Nasopharyngeal suctioning
- Oropharyngeal suctioning
Lower airways:
- Endotracheal suctioning
- Tracheostomy suctioning

Indications for Suctioning

Need to maintain patency and integrity of the artificial airway
Need to remove accumulated pulmonary secretions
Need to obtain a sputum specimen to rule out or identify pneumonia or other pulmonary infections
Need to obtain a sputum specimen for sputum cytology

Contraindications for Suctioning

No absolute contraindications to endotracheal suctioning, but there are hazards and complications to be aware of

Equipment: Suction Catheters

Suction catheters are either open-tipped or whistle-tipped
Catheter sizes are measured in French units (external circumference)
Sizes: #12 to #18 Fr for adults, #8 to #10 Fr for children, #5 to #8 Fr for infants
Rule of thumb: to estimate the proper size of suction catheter, multiply the inner diameter of the endotracheal tube by 2, then use the next smallest size catheter

Endotracheal or Tracheostomy Tube Suctioning

Hyperinflate and/or hyperoxygenate the patient before suctioning
Use 100% oxygen for 30 to 60 seconds, especially for patients at risk for hypoxemia
Use either open or closed suction technique
Insert the catheter into the artificial airway without applying suction, then pull back 1 cm
Apply intermittent suction by placing and releasing the non-dominant thumb over the vent of the catheter
Withdraw the catheter while rotating it back and forth between the dominant thumb and forefinger

Hazards and Complications of Suctioning

Vagal nerve stimulation: bradycardia, tachycardia, or hypotension
Mucosal damage: trauma to the mucosa due to using suction while inserting a catheter
Micro-atelectasis: using too large a suction catheter or applying too much negative suction pressure
Aspiration: risk of aspiration in semi-conscious patients
Infection: follow protocol for sterile procedure and use closed suction technique

Nasotracheal Suctioning

Indicated for patients who have retained secretions but do not have an artificial airway
Similar to endotracheal suctioning, but with additional equipment and supplies
Use sterile water-soluble lubricating jelly to aid catheter passage through the nose
Insert the catheter gently through the nostril, directing it toward the septum and floor of the nasal cavity

Techniques to Minimize Complications of Suctioning

Suction only as needed
Use sterile technique
Hyperinflate
Hyperoxygenate
Use safe catheter size
No saline instillation
Use closed suction technique
Never suction while inserting a catheter

Sputum Induction

Indications: cough without sputum, negative sputum smear with high clinical suspicion of tuberculosis
Technique: inhalation of hypertonic saline (3%) with ultrasonic or air compressor nebulizer, possible addition of B2 agonist
Yield: adequate specimen obtained in 85 to 99% of cases

PPE for Suctioning

Suctioning oral secretions and open suctioning of airways: gloves and mask/goggles or a face shield, sometimes gown
Sputum induction in a patient with suspect TB: masks and gowns

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Description

Learn about the objectives of suctioning, including identification, sites, indications, and contraindications. Explore the differences between oropharyngeal, nasopharyngeal, endotracheal, and tracheostomy suctioning, as well as hazards and complications.