endo tracheal suctioning
Post on 18-Aug-2015
Embed Size (px)
Endo Tracheal Endo Tracheal SuctioningSuctioning
Presented by-Presented by-
Jasleen Kaur Jasleen Kaur BrarBrar
The patient with an The patient with an artificial airway is not capable artificial airway is not capable of effectively coughing, the of effectively coughing, the mobilization of secretions mobilization of secretions from the trachea must be from the trachea must be facilitated by aspiration. This facilitated by aspiration. This is called suctioning.is called suctioning.
WHAT IS SUCTIONING?WHAT IS SUCTIONING?
Endotracheal Endotracheal suctioning is the suctioning is the removal of secretions removal of secretions from tracheobroncheal from tracheobroncheal tree through an tree through an endotracheal tube with endotracheal tube with the help of mechanical the help of mechanical suction device.suction device.
To maintain a patent airway by To maintain a patent airway by removing retained tracheobroncheal removing retained tracheobroncheal secretions.secretions.
To prevent lower respiratory tract To prevent lower respiratory tract infection from retained secretions.infection from retained secretions.
To provide effective ventilation.To provide effective ventilation.
To stimulate coughing.To stimulate coughing.
Noisy breathingNoisy breathing Visible secretions in the airwayVisible secretions in the airway Decreased SpODecreased SpO22 in the pulse oximeter in the pulse oximeter
& Deterioration of arterial blood gas & Deterioration of arterial blood gas valuesvalues
Patient’s inability to generate an Patient’s inability to generate an effective spontaneous cougheffective spontaneous cough
Presence of pulmonary atelectasis or Presence of pulmonary atelectasis or consolidation, presumed to be consolidation, presumed to be associated with secretion retentionassociated with secretion retention
During special procedures like During special procedures like Bronchoscopy & EndoscopyBronchoscopy & Endoscopy
The need to obtain a sputum The need to obtain a sputum specimen / ETA (Endo Tracheal specimen / ETA (Endo Tracheal Aspiration) for investigations.Aspiration) for investigations.
COMPLICATIONS COMPLICATIONS Hypoxia Hypoxia Tracheal or bronchial mucosal Tracheal or bronchial mucosal
traumatraumaCardiac or respiratory arrestCardiac or respiratory arrestPulmonary hemorrhage / bleedingPulmonary hemorrhage / bleedingCardiac dysrhythmiasCardiac dysrhythmiasPulmonary atelectasisPulmonary atelectasisBronchospasmBronchospasmHypotension / hypertensionHypotension / hypertensionElevated ICPElevated ICP
TYPES OF ET TYPES OF ET SUCTIONINGSUCTIONING
OPEN SUCTION CLOSED SUCTION
ASSESSMENTASSESSMENTPREPARATION OF PATIENT & PREPARATION OF PATIENT & ARTICLESARTICLESIMPLEMENTATIONIMPLEMENTATIONEVALUATIONEVALUATION
ASSESSMENTASSESSMENTPatient should be monitored prior to, Patient should be monitored prior to,
during & after the procedure for during & after the procedure for following :following :
Breath soundsBreath sounds Oxygen saturationOxygen saturation Respiratory Rate & patternRespiratory Rate & pattern Hemodynamic parameters (pulse rate, Blood Hemodynamic parameters (pulse rate, Blood
pressure)pressure) Cough effortCough effort ICP (If indicated and available)ICP (If indicated and available) Sputum characteristics (color, volume, Sputum characteristics (color, volume,
consistency & odor)consistency & odor) Ventilator parameters (PIP, Vt & FiOVentilator parameters (PIP, Vt & FiO22))
Assess the Assess the depth and depth and rate of respiration, rate of respiration, auscultate breath auscultate breath sounds.sounds.
Assess for wheeze or Assess for wheeze or rattling sound in rattling sound in chest: chest: a harsh sound a harsh sound caused by partial caused by partial obstruction of the obstruction of the airwaysairways
Patient PreparationPatient Preparation
Explain the procedure to the Explain the procedure to the patient if conscious.patient if conscious.
The patient should receive The patient should receive hyper oxygenation by the hyper oxygenation by the delivery of 100% oxygen for delivery of 100% oxygen for >30 seconds prior to the >30 seconds prior to the suctioningsuctioning
Position the patient in supine Position the patient in supine position.position.
Auscultate the breath sounds. Auscultate the breath sounds.
Explain the Explain the procedure to procedure to the patient the patient and and importance of importance of coughing if coughing if conscious.conscious.
EQUIPMENT EQUIPMENT ASSEMBLYINGASSEMBLYING
StethoscopeStethoscopeVacuum source with Vacuum source with
adjustable regulator adjustable regulator suction jarsuction jar
Sterile glovesSterile glovesSterile suction catheterSterile suction catheterProtective goggles, apron Protective goggles, apron
& mask& maskSterile normal salineSterile normal salineAMBU bag for pre & post AMBU bag for pre & post
SUCTION CATHETERSUCTION CATHETER
Catheter can be selected according to the ET tube size. Sterile suction catheter of 12-14 Fr is used for adults and for children 8-10 Fr is used.
SUCTION PRESSURESUCTION PRESSURE
Turn on suction apparatus to appropriate negative pressure for:
adults-100-120 mmHgchildren-50-100 mmHginfants-40-60 mmHg.
HAND WASHHAND WASH Perform hand Perform hand
hygiene, wash hygiene, wash hands. It hands. It reduces reduces transmission of transmission of microorganismmicroorganisms.s.
Goggles, mask & apron should Goggles, mask & apron should be worn to prevent splash be worn to prevent splash from secretionsfrom secretions
Open the end of the suction Open the end of the suction catheter package & connect it catheter package & connect it to suction tubing (If you are to suction tubing (If you are alone)alone)
Wear sterile gloves with Wear sterile gloves with sterile techniquesterile technique
With a help of an assistant With a help of an assistant open suction catheter open suction catheter package & connect it to package & connect it to suction tubingsuction tubing
Continue…..Continue…..With a help of an assistant With a help of an assistant
disconnect the ventilatordisconnect the ventilatorKink the suction tube & Kink the suction tube &
insert the catheter in to insert the catheter in to the ETtube until resistance the ETtube until resistance is feltis felt
Resistance is felt when the Resistance is felt when the catheter impacts the carina catheter impacts the carina or bronchial mucosa, the or bronchial mucosa, the suction catheter should be suction catheter should be withdrawn 2cm out before withdrawn 2cm out before applying suctionapplying suction
Continue.....Continue.....Apply continuous suction Apply continuous suction
while rotating the suction while rotating the suction catheter during removalcatheter during removal
The duration of each The duration of each suctioning should be 10-suctioning should be 10-15sec.15sec.
Instill 3 to 5ml of sterile Instill 3 to 5ml of sterile normal saline in to the normal saline in to the artificial airway, if artificial airway, if requiredrequired
Give four to five manual Give four to five manual breaths with bag or breaths with bag or ventilatorventilator
Continue…..Continue…..Return patient to Return patient to
ventilatorventilatorFlush the catheter with Flush the catheter with
NS in the suction trayNS in the suction traySuction nares & Suction nares &
oropharynx above the oropharynx above the artificial airwayartificial airway
Discard used Discard used equipmentsequipments
Flush the suction tube Flush the suction tube with hot waterwith hot water
Wash handsWash hands
POST PROCEDURE POST PROCEDURE CARE…CARE…
When the procedure When the procedure is complete is complete hyperventilate the hyperventilate the patient again.patient again.
When the airway When the airway becomes clear, becomes clear, return the patient return the patient to ventilator or to ventilator or oxygen source.oxygen source.
Record the time of Record the time of suctioning, nature & suctioning, nature & amount of secretions.amount of secretions.
Document indications Document indications for suctioning & any for suctioning & any changes in vitals & changes in vitals & patient’s tolerance.patient’s tolerance.
CAUTION..CAUTION..Suctioning is potentially Suctioning is potentially
an harmful procedure if an harmful procedure if carried out improperly.carried out improperly.
Suctioning should be Suctioning should be done when clinically done when clinically necessary (not routinely).necessary (not routinely).
The need for suctioning The need for suctioning should be assessed at should be assessed at least every 2hrs or more least every 2hrs or more frequently as need arises.frequently as need arises.
Thank youThank you