40 Questions
What is the primary goal of airway clearance techniques?
To improve secretions clearance
What is the purpose of suctioning in patients with artificial airways?
To aspirate secretions when patients have difficulty handling them
What is the recommended method for accessing the lower airway?
Through the nose (Nasotracheal suctioning)
What should be removed from the oropharynx using a rigid tonsillar or Yankauer suction tip?
Secretions or fluids
Why is tracheal suctioning through the mouth not recommended?
It causes gagging
What is required for removing foreign bodies, secretions, or tissue masses beyond the main stem bronchi?
Bronchoscopy
What is the application of negative pressure to the airways through a collecting tube connected to a suction machine or wall suction outlet?
Suctioning
What is the role of respiratory therapists in performing bronchoscopy?
They assist the physician in performing bronchoscopy
What is the main reason for suctioning in upper airways?
To maintain patency and integrity of the artificial airway
What is the benefit of using a whistle-tipped suction catheter?
It is less irritating to respiratory tissues
What is the unit of measurement for suction catheter sizes?
French units
What is the recommended size of suction catheter for adults?
#12 to #18 Fr
What is the purpose of the thumb port on a suction catheter?
To control suction
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
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
What is the typical length of most suction catheters for adult general purposes?
22 inches
What is the recommended duration of delivering 100% oxygen to patients before suctioning?
30 to 60 seconds
What is the purpose of hyperinflating the patient before suctioning?
To facilitate the suctioning process
What is the advantage of using the closed suction technique?
It does not require disconnecting the patient from the ventilator
How should the suction catheter be inserted into the artificial airway?
Gently but quickly during inspiration
What should be done when resistance is met or the patient coughs during suctioning?
Pull the catheter back 1 cm
What is the recommended time for the catheter to remain in the airway during suctioning?
10-15 seconds
What should be done to the catheter and connecting tube after suctioning?
Rinse the catheter and connecting tube with normal saline
Why is it recommended to encourage the patient to deep breathe after suctioning?
To help the patient recover from the suctioning process
What position should the patient assume to facilitate catheter passage through the larynx?
Sniffing position
What is the purpose of twisting the catheter if resistance is felt in the nose?
To overcome resistance in the nose
What is the indication for sputum induction?
Cough without sputum
What is the technique used in sputum induction?
Inhalation of hypertonic saline with ultrasonic nebulizer
What percentage of patients obtain an adequate specimen through sputum induction?
85-99%
What type of PPE is recommended for suctioning oral secretions and open suctioning of airways?
Gloves and mask/goggles or face shield
What is a technique to minimize or decrease complications of suctioning?
Suctioning only as needed
What type of PPE is recommended for sputum induction in a patient with suspected TB?
Gloves and mask/goggles or face shield
What is the result of vagal nerve stimulation due to irritation of the larynx or trachea?
Bradycardia
What should be done if hypotension or hypertension occurs during suctioning?
Stop suctioning and administer O2 and ventilation
What is the recommended technique to prevent mucosal damage during suctioning?
Limit pressure and use shallow technique
What is the recommended duration of suctioning to prevent micro-atelectasis?
Less than 15 seconds
What is the recommended position for semi-conscious patients during suctioning?
On their side
What is the purpose of using sterile water-soluble lubricating jelly in nasotracheal suctioning?
To aid in catheter passage through the nose
What is the key difference between nasotracheal and endotracheal suctioning?
Use of sterile water-soluble lubricating jelly
What should be considered for patients who require repeated, long-term nasotracheal suctioning?
Use of a nasopharyngeal airway
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
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.
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