Suctioning - Airway Clearance Te

Document Sample
Suctioning - Airway Clearance Te Powered By Docstoc
					Airway Clearance Techniques RsCr 224
Wyka Chapter 20
Various AARC Clinical Practice Guidelines

Airway Clearance Techniques
• Suctioning - negative pressure applied within the airway
   – Can be via ET or Trach tube or

   – Through the nose into the trachea

      • This is called NT or naso-tracheal suctioning

• Bronchoscopy
   – Flexible Fiberoptic bronchoscopy

   – Rigid tube bronchoscopy

Indications for Suctioning
• Patient has an inability to clear secretions
   – Ineffective or absent cough with

   – Evidence of retained secretions in upper airway

• A sample of sputum is to be obtained for lab analysis purposes
   – Use a sterile “sputum trap” (Lukens trap)

Contraindications to NT Suctioning
• Absolute contraindication:
  •   evidence of croup or epiglottitis
• Relative contraindications;
    – Occluded nasal passages

    – Nasal bleeding

    – bleeding disorder

    – Acute facial, head or neck injury

Hazards & Complications of NT Suctioning
• Hypoxia/Hypoxemia
• Trauma to nasal passages, pharynx or trachea
• Cardiac or respiratory arrest
• Cardiac dysrhythmias or bradycardia
• Atelectasis
• Bronchospasm

When do patients need suctioning?
• Listen over anterior chest with stethoscope
   – Evidence of loud rhonchi?

• Does patient have audible crackles when breathing with their mouth open?
• Place hand on anterior chest
   – Does patient have tactile fremitus?

• Have patient cough. What is the character of the cough? Loose but non-productive?

Monitoring During Suctioning
•   Respiratory rate & pattern
•   ECG tracing (if available), Heart rate
•   Skin color; SpO2
•   Subjective response
•   Sputum character; color, consistency, amount and any odor
•   Evidence of airway bleeding?

Equipment Used During Suctioning
• Suction Regulator attached to wall OR portable suction unit (see next slide)
• Suction canister to collect secretions
• Suction supply tubing
• Suction kit; sterile (sheathed or unsheathed) catheter, sterile gloves; basin for
  irrigation water; sterile water; Lubifax or KY Jelly (for NT suctioning)

Procedure for Suctioning
• Assess need
• Turn on & set suction pressure on regulator
   – Adults: negative 100 - 120 mmHg

   – Children: negative 80 - 100 mmHg

   – Infants: negative 60 - 80 mmHg

• Prepare patient: Communicate!!!!!!!!!!
• Make sure patient is well oxygenated
• Open necessary sterile saline or water containers; open lubricating jelly containers
• Open kit and put glove(s) on
• Lubricate catheter (NT suction only)
• Insert catheter slowly
• Apply suction only while withdrawing using rotating motion (10-15 seconds only)

•   Make sure patient is reoxygenated after catheter has been removed
•   Monitor patient and assess need for additional suctioning
•   Repeat as necessary based upon need and ability for patient to tolerate procedure

Sizes of Catheters
•  When suctioning though an ET tube;
    – Take ET tube size (I.D.) and multiply by 2

    – 7.5 mm tube X 2 = 15

    – Next closest size is 14 French

•  Mostly commonly used adult size is 14 F
•  Largest current adult size is 14 French
•  Other smaller sizes are 12F; 10F; 8F; 6F

•   Therapeutic bronchoscopy
     – To visualize and remove mucus from the airway

•   Diagnostic bronchoscopy
     – To visualize tumors and obtain tissue samples for pathology analysis

Also can be used in difficult intubations!!