nebul & suction

7/29/2019 Nebul & Suction

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Nebulizing & Suctioning

Laily Hidayati


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Nebulizing

Nebulization is a process of adding fine drops of

moisture or fine particles of medication to

inspired air The water or medication is usually broken up by

gas under pressure or by high-frequency

vibrations (ultrasonic nebulization).

Nebulization improves the clearance ofpulmonary secretions by altering the tracheo-

bronchial mucosa.


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Equipment

Aerosol Face Mask / Trach Mask / mouth

piece

Connective tubing

Nebulizer manifold

Normal saline

Medication as per doctor order

stethoscope


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Implementation

1) Gather all required equipment.

Check to ensure that all medications are available and

expiration dates are current.

2) Provide privacy and wash hands.

3) Place person in a comfortable sitting position in a

wheelchair or semi-fowler's position.

Diaphragmatic expansion and lung compliance are greater in this

position. This ensures maximal effectiveness of medication(aerosolized

particles) to the basilar areas of the lungs.

4) Wash hands.

5) Take person's heart rate before and after the treatment.


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Implementation

6) Add the prescribed amount of medication and saline to

the nebulizer.

7) Connect the tubing to the Nebulizer machine

8) Place the face mask on person and verbally encourage

him to breath deeply.

9) Observe for person's chest expansion.

10) Turn Nebulizer machine on.A fine mist from the device should be visible. Nebulization will

normally take 15-20 minutes.


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Implementation

11) On completion of the treatment, there may be

increased secretions and coughing. Encourage several

deep breaths.

The medication may dilate airways, facilitating expectoration of

secretions.

12)Assess for need to suction.

13)Record medication used, description of secretionsand amount suctioned.

Note tolerance of the treatment.

14)Change nebulizer filters every 6 months.


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SUCTIONING


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Suctioning

Used to clear the airway of excessive

secretions when the patient is unable to

clear the respiratory tract with coughing.


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Signs and symptoms

of excess secretions

1) Assess oral cavity:

gurgling noise on inspiration or expiration,

obvious oral secretions,

gastric secretions or vomitus in mouth, and

productive cough without expectorating

secretions from the mouth.


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Signs and symptoms

of excess secretions

2) Assess for lower airway obstruction:

coughing, secretions in the airway,

labored breathing,

restlessness or irritability,

unilateral breath sounds,

cyanosis,

decreased oxygen saturations or level of consciousness,

increased fatigue, dizziness,

increased pulse rate,

increased respiratory rate and/or elevated blood pressure.


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Three primary

suctioning techniques

1) Oropharyngeal suctioning-used when the patient

is able to cough effectively but is unable to clear

secretions by expectorating or swallowing.2) Nasotracheal suctioning-necessary when the

patient with pulmonary secretions is unable to

cough and does not have an artificial airway.

3) Tracheal suctioning-accomplished through anartificial airway. The artificial airway may be an

endotracheal or nasotracheal tube or it may be a

tracheostomy tube.


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Preparation

1) Assess lung sounds

Auscultating all lung fields for adventitious

sounds such as rhonchi, rales and orwheezing.

2) Assess the patients understanding of the

procedure

Remove excess secretions by one of the

primary suctioning techniques.


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Procedures

1. Verify MD/PA order as required for procedure. Some hospitals

require a physicians order to suction the trachea

2. Explain the procedure to the patient and the reason that it is tobe done. Explain how the procedure with help clear the airway

and relieve breathing problems and that temporary coughing,

sneezing, gagging, or shortness of breath is normal.

3. Gather equipment necessary to correctly perform the

procedure. Some facilities have commercially preparedsuctioning kits. Check what is available in your facility or check

procedural manuals for equipment lists.

4. Don gloves (nonsterile) and use mask or face shield as per

local policy.


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Procedures

5. Fill basin or cup with approximately 100 cc of water

6. Connect one end of connecting tubing to suction

machine. Check that equipment is functioning properly bysuctioning a small amount of water from basin

7. Turn on suction device. Set regulator to appropriate

negative pressure: wall suction, 80-120 mm Hg; portable

suction, 7-15 mm Hg for adults


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Oropharyngeal

suctioning

1. Attach suction catheter to connecting tubing. Remove oxygen

mask from patient if present. Nasal cannula or prongs may be

left in place while performing this type of suctioning.

2. Assist the patient to assume comfortable position for theprocedure. Usually this will be a semi-Fowlers position or

sitting upright. Proper positioning reduces stimulation of the

gag reflex, promotes patient comfort and aids in secretion

drainage.

3. Insert catheter into patients mouth. With suction applied, movethe catheter around the mouth, including the pharynx and the

gum line until secretions are cleared. If the catheter does not

have a suction control to apply intermittent suction, take care

not to traumatize oral mucosal surfaces with continuous

suctioning.


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Oropharyngeal

suctioning

Encourage the patient to cough. Coughing moves secretions from

the lower and upper airway into the mouth where they can be

easily suctioned.

Repeat suctioning as needed until the mouth is clear of excess

secretions.

Replace the oxygen mask if removed earlier.

Suction water from the basin through the catheter until the catheter

is cleared of secretions. Clearing secretions from the catheter andthe tubing before they dry reduces the possibility of transmission

of microorganisms and insures delivery of accurate suction

pressures.


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Oropharyngeal

suctioning

Place the catheter in a clean, dry area for reuse with the suction

turned off. If the patient has been taught to use the suction

catheter, leave the suction on and the catheter within reach of

the patient.

Dispose of water and clean the basin as per policy. Remove

your gloves and dispose of per local policy.


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Oropharyngeal

suctioning

NOTE: Oropharyngeal suctioning is usually

performed using a rigid plastic catheter with one large

and several small eyelets that mucous enters when

suction is applied. This type of catheter is called aYankauer or tonsil suctioning device. Alert patients

can be taught to use this device to control excess

secretions in the mouth.


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HAND SUCTION

nebul & suction

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