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Airway Clearance Techniques

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Suctioning - negative pressure applied within the airway. Can be via ET or Trach tube or ... Parts of the Fiberoptic Bronchoscope. Picture from Therapeutic Bronch ... – PowerPoint PPT presentation

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Title: Airway Clearance Techniques


1
Airway Clearance Techniques
  • By Jim Clarke

2
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

3
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)

4
Lukens Trap for Obtained Sputum Sample
5
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

6
Hazards Complications of NT Suctioning
  • Hypoxia/Hypoxemia
  • Trauma to nasal passages, pharynx or trachea
  • Cardiac or respiratory arrest
  • Cardiac dysrhythmias or bradycardia
  • Atelectasis
  • Bronchospasm

7
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?

8
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?

9
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)

10
Suction Regulator
11
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

12
Suctioning Procedure Continued
  • 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)

13
Suctioning Procedure Continued
  • 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

14
Closed-System Multi-Use ET Catheter
15
Closed-System Multi-Use Trach. Catheter
16
Unsheathed Sterile Catheter
17
Sterile Suction Kit
18
Cath-n-sleeve Catheter
19
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

20
Bronchoscopy
  • Therapeutic bronchoscopy
  • To visualize and remove mucus from the airway
  • Can be used to intubate in situations where
    standard intubation techniques have failed
  • Diagnostic bronchoscopy
  • To visualize tumors and obtain tissue samples for
    pathology analysis

21
Parts of the Fiberoptic Bronchoscope
22
Picture from Therapeutic Bronch
23
Picture from Diagnostic Bronch
24
THE END!
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