Safe Suctioning
Safe Suctioning
Safe Suctioning
A Nursing Approach
Mr. Nestlee Sio Cabaccan RN,MSN
Aims
To ensure the highest standards of patient care through theoretical and practical teaching of suction techniques, together with safe and effective use of suctioning equipment, to nursing student.
Objectives
After This Session Candidates will
Be familiar with the anatomy and physiology of related structures and have an under standing on nursing procedure. Be able to identify key features in assessing the need of suction. Be able to state ways in reducing Mucosal trauma and preventing Hypoxia Valsalva Maneuver. Be able to identify a safe value for negative suctioning pressure and will be able to dismantle, clean, set up and adjust suction machines accordingly. It is anticipated that student will have the opportunity to demonstrate safe suctioning techniques to a competent student with the supervision of the clinical instructor.
Content
1. 2. 3. 4. 5. Definition of suctioning Brief history Anatomy and Physiology Purpose Guidelines
Definition
Suctioning is a method of removing excessive secretions from the airway. May be applied to: a. Oral b. Nasopharyngeal c. Tracheal passages
In 1984, Kergin et al., Using oximetry, again reported reduction in blood oxygen saturation during suctioning.
Larynx
Trachea
Rt Superior Lobe
Lt Superior Lobe
Bronchial Tree Cardiac Notch
RT Middle Lobe
Lt Inferior Lobe Rt Lower lobe Diaphragm
Purpose
INDICATION
Therapeutic
Diagnostic
NECESSARY EQUIPMENT
Vaccum source with adjustable regulator suction jar stethoscope Sterile gloves for open suctioning method Clean gloves for closed suctioning method Sterile catheter Clear protective goggles, apron & mask Sterile normal saline Bains circuit or ambu bag for preoxygenate the patient Suction tray with hot water for flushing
VAGUS NERVE
Indications for suction: Secretions are present which are: Detrimental to the patient. Accessible to the catheter. Neither the patient nor the nurses are able to clear the secretions by any other means.
HAZARDS & COMPLICATIONS Hypoxia / hypoxemia Tracheal and / or bronchial mucosal trauma Cardiac or respiratory arrest Pulmonary hemorrage / bleeding Cardiac dysrhythmias Pulmonary atelectasis Bronchoconstriction / bronchospasm Hypotension / hypertension Elevated ICP Interruption of mechanical ventilation
TYPES OF SUCTIONING
OPEN SUCTION
CLOSED SUCTION
MONITORING
The following should be monitored prior to, during & after the procedure:
Breath sounds Oxygen saturation RR & pattern Haemodynamic parameters (pulse rate, Blood pressure) Cough effort ICP (If indicated and available) Sputum characteristics (colour, volume, consistency & odor)
For a size 10 tracheostomy tube, use a size 14 fg catheter. It is essential to use the right size catheter for the lumen of the tracheostomy tube: a 10FG catheter is appropriate for a size 6 tube, a 12FG catheter for a size 8 tube; a 14FG catheter for a size 10 tube, It is occasionally necessary to us a proportionately larger diameter of catheter, especially if secretions are viscous, but this must be done with care. (Mallet 1985).
cough reflex is initiated or resistance is felt upon encountering either of these conditions, the nurse should withdraw the catheter 1cm , apply suction and withdraw the catheter.
For patients with copious or tenacious secretions, who are showing signs of ineffective airway clearance, deeper suctioning is suggested. Care plans should include specific guidelines for catheter insertion and should be updated routinely by the caregiver. Individualisation of the care plan is essential.
Being Gentle.
The airway mucosa is extremely sensitive to pressure and is easily damaged. Chronic irritation can result in scar formation, which may necessitate surgical intervention and prolonged hospitalisation. Therefore, any suctioning of the airway must be done with extreme gentleness. This again will reduce the likely hood of vagal stimulation, bronchospasm and trauma and will greatly reduce patient anxiety.
Patient Preparation
Explain the procedure to the patient (If patient is concious). The patient should receive hyper oxygenation by the delivery of 100% oxygen for >30 seconds prior to the suctioning (Either with Bains circuit or by increasing the FiO2 by mechanical ventilator). Position the patient in supine position. Auscultate the breath sounds.
PROCEDURE
Perform hand hygiene, wash hands. It reduces transmission of microorganisms.
Turn on suction apparatus and set vacuum regulator to appropriate negative pressure. For adult a pressure of 100-120 mmHg, 80100/120Lmmhg for children & 60-80/1ooLmmhg for infants.
Continue..
Place the dominant thumb over the control vent of the suction port, applying continuous or intermittent suction for no more than 10 sec as you withdraw the catheter into the sterile sleeve of the closed suction device Repeat steps above if needed Clean suction catheter with sterile saline until clear; being careful not to instill solution into the ETtube Suction oropharynx above the artificial airway Wash hands
ASSESSMENT OF OUTCOME
Improvement in breath sounds. Decreased peak inspiratory pressure; Increased tidal volume delivery during ventilation. Improvement in arterial blood gas values or saturation as reflected by pulse oximetry. (SpO2) Removal of pulmonary secretions.
CONTRAINDICATIONS
Most contraindications are relative to the patient's risk of developing adverse reactions or worsening clinical condition as result of the procedure. Suctioning is contraindicated when there is fresh bleeding. When indicated, there is no absolute contraindication to endotracheal suctioning because the decision to abstain from suctioning in order to avoid a possible adverse reaction may, in fact, be lethal.
LIMITATIONS OF METHOD
Suctioning is potentially an harmful procedure if carriedout improperly. Suctioning should be done when clinically necessary (not routinely). The need for suctioning should be assessed at least every 2hrs or more frequently as need arises.