Airway Suctioning Review PDF

Airway Suctioning Reoh B.Daños, RTRP, MHA FEU-NRMF School of RT  Suctioning Removal of airway substances, by applying negative pressure to the airways through a collecting tube (Flexible catheter), using a suction device. Note: Vacuum pressures sufficient to remove mucus must...

Airway Suctioning Reoh B.Daños, RTRP, MHA FEU-NRMF School of RT  Suctioning Removal of airway substances, by applying negative pressure to the airways through a collecting tube (Flexible catheter), using a suction device. Note: Vacuum pressures sufficient to remove mucus must also take out air containing oxygen. Which of the following is/are associated of airw uctioning?. To remove retained secretions that the patient cannot mobilize.. To maintain patency of artificial airways To obtain sputum for culture and sensitivity testing. A and C. All of the above  Indications To remove retained secretions that the patient cannot mobilize. To maintain patency of artificial airways To obtain sputum for culture and sensitivity testing  Hazards Hypoxemia – caused by aspiration of oxygen from the airway. Arrhythmias – caused by hypoxemia and vagal nerve stimulation, Vagus nerve is stimulated as catheter irritates the oral or nasal mucosa, tracheal mucosa and carina, causing bradycardia. Hypotension – caused by bradycardia and prolonged coughing episodes Atelectasis – caused by using a suction catheter that is too large or excessive suction pressure.  Tissue trauma – caused jabbing catheter during insertion and improper lubrication during nasal suctioning Pneumonia (Infection) Accidental extubation In suctioning, what is the recommended negative pressure for pediatric patient? a. 50 – 80 mm Hg b. 80 – 120 mm Hg c. 120 – 150 mm Hg d. None of the above  Recommended Amount of Negative (-) Pressure by Koff Infant 60 – 80 mm Hg 8 – 10 cm H2O Pediatric 80 – 120 mm Hg 10 – 18 cm H2O Adult 120 – 150 mm Hg 18 – 38 cm H2O Recommended Amount of Negative (-) Pressure by Persing Infant -60 to -80 mm Hg Pediatric -80 to -100 mm Hg Adult -80 to -120 mm Hg  Technique of Suctioning Hyperoxygenate and hyperinflate the patient, this is done to help prevent hypoxemia, which may lead to tachypnea. Insert the catheter without applying suction and advance until an obstruction (the carina is met or the patient begins coughing. Do not jab with the catheter, because this may cause carinal damage and bradycardia (vagal stimulation).  Technique of Suctioning Withdraw the catheter approximately 1 to 2 cm if the carina is reached and apply suction while rotating the catheter between the thumb and finger. Never leave the catheter in the airway for more than 15 sec. Upon removal of the catheter, reoxygenate and hyperinflate the patient; wait 30 sec to 1 min before entering the airway again. What is the proper size of suction catheter for 7.0 mm ET tube? a.8 b.10 c.12 d.14 e.None of the above Selecting the Proper Size of Catheter The suction catheter should not occupying more than one-half to two- thirds of the internal diameter of the tub. (Suction catheter are sized by French “Fr” units). To estimate the proper catheter size, multiply the internal diameter of the ET tube by 2 then use the next smallest size.  Estimated size of suction catheter: ETT inner diameter X 2 = (***? )then use the next smallest size of catheter. Example ETT ID = 6 x 2 = 12, then the next smallest size is 10 Note: applicable for intubated patients only  Sizes of Suction Catheter Age/Weight Suction Catheter(Size) < 1,000 g 5 1,000 to 2,000 g 6 2,000 to 3,000 g 8 > 3,000 g 8 Newborn – 3 years old 8 5 to 16 years old 10 Adult 12  Endotracheal Suctioning Suctioning in mechanically ventilated patients with artificial airways. Two Techniques: a. Open system – sterile technique requires disconnecting the patient from the ventilator. b. Closed system – using sterile, closed in-line suction catheter attached to ventilator circuit so that the suction catheter can be advanced into the patient’s endotracheal airway, without disconnecting the patient from the ventilator.  Deep suctioning - the catheter is inserted until resistance is met and then withdrawn approximately 1 cm before applying suction.  Shallow suctioning – the catheter advanced to a predetermined depth, usually the length of the airway plus the adapter. Note: Shallow suctioning is recommended in infants and children.  Indications of ET suctioning Need to maintain patency and integrity of the artificial airway. Need to remove accumulated pulmonary secretions as evidenced by one of the following: Sawtooth pattern on the flow-vol. loop on the monitor screen of the ventilator Presence of coarse crackles over trachea. Increased peak inspiratory pressure on vol. control ventilation. Deterioration of O2 saturation or ABG result  Visible secretions in the airway Inability of patient to generate an effective cough Acute respiratory distress Suspected aspiration of gastric or upper airway secretions Need to obtain a sputum specimen to rule out or identify pneumonia or other pulmonary infection or for sputum cytology.  Indication of Closed Suctioning PEEP > 10 cm H2O Mean airway pressure > 20 cm H2O Inspiratory Time > 1.5 sec. FIO2 > 60% Frequent suctioning (6 times/day) Hemodynamic instability associated with ventilator disconnection Respiratory infections requiring airborne or droplet precautions Inhaled agents that cannot be interrupted by ventilator disconnection ( nitric oxide, helium/O2 mixture).  Contraindications of ET Suctioning *Relative to patient’s risk of developing adverse reactions. *Worsening clinical condition as a result of the procedure. Note: there is no absolute contraindication to ET suctioning because the decision to withhold suctioning to avoid possible adverse reaction may be lethal.  Assessment of outcome Improvement in appearance of ventilator graphics and breath sounds Decreased peak inspiratory pressure Improvement in arterial blood gas values or O2 saturation Removal of pulmonary secretion  Monitoring The following should be monitored before, during and after the procedure. Breath sound O2 saturation and Skin color RR and pattern Hemodynamic parameters Pulse rate and Blood pressure Sputum characteristics and Cough characteristics Nasa Diyos ang awa nasa tao ang gawa!