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  • RSPT 1410 Tracheal Aspiration

    1

    1

    RSPT 1410

    2

    Tracheal Aspiration

    is the use of ________________ to facilitate the removal of secretions from the respiratory tract.

    Under normal circumstances, patients with normal coughing do not have difficulty in removing secretions.

    3

    Tracheal Aspiration

    Indications CNS depression Placement of ________________ Debilitating diseases Pain Anything that decreases the patients ability to

    _______________ When there is a overwhelming amount of secretions,

    even when patient can cough

  • RSPT 1410 Tracheal Aspiration

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    4

    To Promote Cough

    Ask patient ________________

    Spontaneous Ambu bag, mask IPPB 5% CO2

    5

    To Promote Cough

    Insert sterile ________________ into trachea Instill sterile ________________ into trachea

    through suction catheter, ETT Suprasternal notch pressure

    6

    Orotracheal Suctioning

    Best done sitting up 45 Difficult to hit trachea Causes gagging, vomiting

  • RSPT 1410 Tracheal Aspiration

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    Nasotracheal Suctioning

    Better ________________ Easier to hit trachea Does not cause gagging, etc.

    8

    Suction Equipment

    Suction source Portable or piped-in wall outlet

    Suction setting"intermittent or"

    continuous"

    Collecting"bottle"

    One-way valve"

    Connecting tube"

    9

    Suction Equipment

    Safe suction ranges Adult: ________ to _______ mmHg Pediatric: -60 to -80 mmHg Neonatal: -40 to -60 mmHg

  • RSPT 1410 Tracheal Aspiration

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    10

    Suction Equipment

    One-way valve __________ valve

    __________ valve

    Collection jar Glass or plastic Marked in ml to measure Special containers for sterile samples

    11

    Suction Equipment

    Catheters should not take up more than 50% of airway Sizes 6-18 Fr. (Fr. = O.D. x 3)

    Catheter with"thumb control"

    Catheter without"thumb control"

    12

    Suction Equipment

    In-Line or Closed "suction catheter"

  • RSPT 1410 Tracheal Aspiration

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    13

    Suction Equipment

    Yankauer"

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    Suction Equipment

    Catheters are designed as ___________ Procedure should be sterile

    sterile catheter 2 gloves

    Catheters should have thumb port

    15

    Suction Equipment

    Distal end of catheter is designed to reduce trauma to mucosa standard or whistle tip ring tip Coud tip

  • RSPT 1410 Tracheal Aspiration

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    16

    Suction Equipment

    Catheter tips

    Whistle-tip" Ring-tip"

    Coud"

    Bronchitrac"

    17

    Suction Procedure

    Suctioning Simulation Nasotracheal suctioning Artificial airway (ETT) suctioning Closed system suctioning

    18

    Suction Procedure

    Tracheal aspiration is not a __________ procedure and should be performed on a PRN or as needed basis only

    Tracheal aspiration is just that - tracheal As with any patient procedure, a good

    _____________________ is first

  • RSPT 1410 Tracheal Aspiration

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    19

    Suction Procedure

    _________________ patient cooperation depends on it

    _________________ airway straight and open semi-Fowlers is best (head up at least 45)

    20

    Suction Procedure

    Preoxygenation/hyperinflation increase _________________

    if patient is on O2, liter flow if patient is not on O2, it would be best to set it

    up encourage/assist patient with 5-10 deep breaths

    21

    Suction Procedure

    Catheter insertion slow, gentle motion use sterile water-soluble lubricant (e.g. K-Y) NEVER force advancement - can cause mucosal

    damage DO NOT apply suction on insertion

  • RSPT 1410 Tracheal Aspiration

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    Suction Procedure

    Catheter insertion advance catheter as far as possible, then withdraw

    slightly if suctioning through an artificial airway, catheter

    external diameter should be no more than the internal diameter of the airway

    23

    Suction Procedure

    Applying suction suction should be applied only during

    _________________ of catheter suction should be intermittent, never continuous _________________ catheter 180 between

    fingers during withdrawal

    24

    Suction Procedure

    Applying suction suction should be applied for no more than

    _________________ seconds total procedure time, insertion to complete

    withdrawal, should take no more than 20 seconds

  • RSPT 1410 Tracheal Aspiration

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    25

    Suction Procedure

    Applying suction stop procedure if dysrrhythmias occur (indicates

    possible _____________ stimulation or hypoxia) ventilate as necessary with 100% O2 until vital

    signs and cardiac rhythm return to normal

    26

    Suction Procedure

    Reoxygenation/hyperinflation patient should receive O2 and be encouraged/

    assisted with deep breathing following procedure monitor cardiac _________________ and

    _________________ until pre-procedure status returns

    27

    Suction Procedure

    Repetition procedure may be repeated as necessary repeat all steps each time

  • RSPT 1410 Tracheal Aspiration

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    Suction Procedure

    Documentation record __________, _________________ and

    viscosity of removed secretions record any problems or adverse effects

    29

    Therapeutic Considerations

    Use largest catheter possible that meets size requirements/limitations

    If possible, suction _____________ the cuff of artificial airways first

    DO NOT ________ disposable catheters Properly discard all disposable items

    30

    Therapeutic Considerations

    DO NOT apply suction during ________ Be aware that your patient may have a

    deviated septum or obstructed nasal passages

    Be prepared for gagging, retching or vomiting as catheter is passed into the pharynx

  • RSPT 1410 Tracheal Aspiration

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    Therapeutic Considerations

    The tongue may be held forward using a gloved hand or sterile 4 X 4

    Instruct patient to breathe deeply and slowly to assist in passing catheter through _________________

    32

    Therapeutic Considerations

    Apply intermittent suction _______________ catheter Limit actual suction time to ___________

    seconds Limit procedure to _________ seconds

    33

    Complications/Hazards

    Hypoxia monitor for _______________ limit suction time

    Vagal Stimulation monitor for _______________ perform slow, gentle insertion limit _______________

  • RSPT 1410 Tracheal Aspiration

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    34

    Complications/Hazards

    Atelectasis Cause

    Suctioning removes ____________________ Prevention

    _______________

    _______________

    Oxygenate between suction passes

    Use proper size suction catheter

    35

    Complications/Hazards

    Trauma to the airway Catheter tip contacts mucosa + suction =

    Hemorrhage Mucosal damage Local inflammation

    Well documented by autopsy reports: when suction applied, mucosa is elevated into catheter holes - epithelial cells are removed for entire length of suction time

    36

    Complications/Hazards

    Trauma to the airway Prevention

    Ring-tip catheters _______________ catheter while withdrawn Intermittent suction Limit suction ____________ & pressure

  • RSPT 1410 Tracheal Aspiration

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    Complications/Hazards

    Cardiac arrhythmias Cause

    Usually secondary to _______________ Also caused by hypoxia + vagal stimulation

    Carina, trachea, pharynx, larynx Vagal stimulation alone causes bradycardia &

    hypotension Hypoxia can cause _______________

    38

    Premature Ventricular Contraction (PVC)

    39

    Premature Ventricular Contraction (PVC)

  • RSPT 1410 Tracheal Aspiration

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    Premature Ventricular Contraction (PVC)

    41

    Premature Ventricular Contraction (PVC)

    42

    Premature Ventricular Contraction (PVC)

  • RSPT 1410 Tracheal Aspiration

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    Premature Ventricular Contraction (PVC)

    44

    Complications/Hazards

    Cardiac arrhythmias Prevention

    ____________ with suction catheter Short suction times Well ______________ & ______________

    45

    Complications/Hazards

    Hypotension Cause

    Bradycardia from ______________ stimulation Prolonged coughing which interrupts venous

    return Prevention

    Gentle with suction catheter Short suction times Well ______________ & ______________

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    Complications/Hazards

    Infection ____________________ & most easily prevented Cause

    Non-sterile technique Repeated passes with catheter

    Prevent ______________ technique with sterile

    equipment ________________________________

    47

    Sterile Sputum Specimens

    Lukens tube Bottle in-line All samples labeled,

    bagged, sent to lab ASAP C & S - anytime AFB - AM x 3 Cytology

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