Suctioning - PowerPoint PPT Presentation

Loading...

PPT – Suctioning PowerPoint presentation | free to view - id: 45d1b7-YmQwN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Suctioning

Description:

Suctioning Endotracheal Nasotracheal Open vs Closed Suction Systems Sputum sample Rationale To remove secretions from lower airway when patient intubated or trached ... – PowerPoint PPT presentation

Number of Views:2471
Avg rating:3.0/5.0
Slides: 58
Provided by: kumcEduS
Category:
Tags: suctioning

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Suctioning


1
Suctioning
  • Endotracheal
  • Nasotracheal
  • Open vs Closed Suction Systems
  • Sputum sample

2
Rationale
  • To remove secretions from lower airway when
    patient intubated or trached
  • Or cannot cough effectively
  • To obtain sputum sample for culture and
    sensitivity

3
Indications
  • Adults - suction when secretions present
  • auscultation
  • observed
  • Do not suction routinely - except for infants
  • Suction catheter passes ensure tube patency
  • Infants more susceptible to mucus plugging

4
Suctioning
  • Advance plastic tube down ETT or trach
  • Apply vacuum to evacuate secretions

5
Complications of ETT Suctioning
  • Hypoxemia
  • Atelectasis
  • Tracheal damage
  • Cross contamination
  • Bronchoconstriction
  • Cardiac arrhythmias
  • Increased intracranial pressure

Fisher JT, Waldron MA, Armstrong CJ. Effects of
hypoxia on lung mechanics in newborn cats.Can J
Physiol Pharmacol 1987 65 1234-1238.
6
Hypoxemia
  • Most important
  • Hypoxemia will cause arrhythmias such as
    tachycardia, PVCs, or v fib
  • Anytime arrhythmias occur - STOP SUCTIONING and
    VENTILATE with 100 OXYGEN IMMEDIATELY

7
To Prevent Hypoxemia
  • Pre and post oxygenate with 100 O2 and limit
    suction pass to 15 seconds or less.
  • Can also supply oxygen across mouth of ETT

8
Applying O2 Across Mouth of ETT
9
Lung Collapse (atelectasis)
  • Suctioning air as well as secretions
  • If suction catheter too large, room air cannot
    enter ETT
  • All suctioned air then comes from the lungs and
    lungs collapse
  • Atelectasis worse with 100 compared to
    preoxygenation with 30
  • Atelectasis reversed with 20 breaths at 20 ml/kg
    post suctioning. This study used 60 sec suction
    interval to ensure differences.

Qin Lu, Andre Capderou, Philippe Cluzel, Eric
Mourgeon, Lamine Abdennour, et al. A computed
tomographic scan assessment of endotracheal
suctioning-induced bronchoconstriction in
ventilated sheep. Am J Respir Crit Care Med
2000162 1898-1904.
10
To Prevent Atelectasis
  • SUCTION CATHETER should be NO LARGER than 1/2
    THE INTERNAL DIAMETER OF THE ETT/TRACH TUBE (AARC
    CPG)
  • (ETT mm ID/2) x 3 suction catheter size in
    French
  • 1 mm 3 French since circumference 3.14 x
    diameter
  • HYPERINFLATE after suctioning (or give sigh
    volumes 20 ml/kg)

11
SX
SX
12
With proper sized suction catheter, catheter
mid-position in ETT draws approximately equal
amounts from both ends of ETT.
X
ETT
13
Trauma
  • Suction ports will grab mucosa causing tissue
    damage
  • Hitting resistance during catheter insertion
    damages tissue, especially with infant trachea

14
To Reduce Trauma
  • Advance suction catheter gently
  • Apply suction intermittently
  • Never suction going down
  • Use appropriate vacuum pressures
  • - 100 torr adults (-100 to -150 - 80 to -100)
  • - 100 torr children (-100 to -120)
  • - 80 torr infants ( -80 to -100)
  • - 60 torr neonates (-60 to -80)
  • Use catheters with pre-marked insertion distance
    in infants.

Shapiro, BA. Clinical Application of Respiratory
Care. 3rd ed. Year Book Medical Publishers
1985 251.
15
Argyle
whistle tip
16
Coudé tip suction catheter
17
Cross Contamination
  • Natural defense mechanisms by-passed with
    ETT/trach
  • Easy to contaminate lower airway through ETT

18
To Prevent Cross Contamination
  • USE ASEPTIC TECHNIQUE
  • Dont touch suction catheter to anything but the
    inside of ETT
  • Dont reuse catheter after rinsing
  • Glove hand holding catheter

19
Bronchoconstriction
  • Stimulation of airway irritant receptors causes
    reflex bronchoconstriction
  • Hypoxemia may contribute to an increase in
    bronchomotor tone via vagal stimulation and from
    the release of bronchoconstrictor mediators by
    mast cells
  • Reduced with preoxygenation of 100 oxygen

Qin (2000)
20
To Prevent Bronchoconstriction
  • Preoxygenate with 100
  • May want to aerosolize lidocaine before
    suctioning or give IV
  • Aerosol tx with 200 mg of 5 lidocaine before
    suctioning completely prevented
    bronchoconstriction
  • Lidocaine also antitussive so prevented coughing
    (although patient may cough if it is directly
    instilled)
  • Cough increases intracranial pressure (want ICP ?
    20 mm Hg) - lidocaine also has direct effect on
    reducing ICP.

Qin (2000) Rudy E, M Baun, K Stone, B Turner.
The relationship between endotracheal suctioning
and changes in intracranial pressure A review of
the literature. Heart Lung. 198615 (5)
488-494.
21
Vagal Stimulation
  • Vagus innervates entire respiratory tract
  • Vagal stimulation causes BRADYCARDIA,
    bronchospasm, cough (or laryngeal spasm with NTS)
  • Cough increases intrathoracic pressure which
    increases cerebral venous pressure causing a
    transient increase in intracranial pressure.

22
To Reduce Vagal Stimulation
  • Advance catheter gently until meet resistance,
    withdraw slightly, then apply suction
  • May aerosolize lidocaine if ICP gt 20 mm Hg prior
    to suctioning.
  • Use premarked suction catheter with infants.

23
Complications Minimized By
  • Pre and post oxygenation with 100
  • pre gt 30 sec, post gt 1 min (CPG)
  • Hyperinflation via bagging
  • Aseptic technique
  • Proper suction catheter size
  • Applying suction on the way out only
  • Suctioning to 10 - 15 seconds (CPG)
  • Proper vacuum levels
  • Gently advancing catheter

24
Thumb Control
Connecting tubing to suction
20 - 22 inches long 14 Fr
Coude -
Angled tip
25
(No Transcript)
26
(No Transcript)
27
ETS Infants
  • Pneumothorax reported with deep tracheal suction.
  • Advance catheter to predetermined depth
  • Use suction catheter that has distance markings
    on catheter
  • Suction catheter should extend only 0.5 cm beyond
    the tip of ETT

Kleiber C, N Krutzfield, E F Rose. Acute
histologic changes in the tracheobronchial tree
associated With different suction catheter
insertion techniques. Heart Lung, 1988 17 (1)
10-14.
28
Insertion Depth
  • Find oral-carinal distance
  • Add length of tube extending out from mouth to
    oral-carinal distance insertion depth.
  • This will not be the same depth if want suction
    catheter tip to extend only 0.5 cm out from end
    of ETT. Compare markings on suction catheter and
    ETT before using.

29
Oral-Carinal Distance from Branson,
Hess,Chatburn, Table 6-1
30
Differences with infants.
  • Stress may cause bradycardia and apnea.
  • May take ETT adapter off to suction down tube.

31
Nasotracheal Suction (NTS)
  • Patients without ETT or Trach
  • Need help clearing secretions
  • A few differences in technique

32
Differences with NTS
  • Lubricate suction catheter with water soluble
    lubricant
  • Use smaller sized catheter
  • Advance suction catheter without being connected
    to suction
  • Apply oxygen via face mask
  • Cannot NTS infants
  • Trachea positioned more anteriorly than adults
  • Will suction nasopharynx, however

33
Assessment - Oro-pharynx Trachea
Sinus Turbinate Eustachian Tube Uvula Tongue
Epiglottis Larynx
34
Pathway of NT suction catheter
Sinus Turbinate Eustachian Tube Uvula Tongue
Epiglottis Larynx
35
Indications for NTS (AARC 2004 Guidelines)
  • Inability to clear secretions evidenced by
  • visible secretions in airway
  • coarse, gurgling BS
  • Increased tactile fremitus
  • Suspected aspiration
  • Increased work of breathing
  • Deteriorating ABGs
  • CXR atelectasis/consolidation
  • Restlessness
  • To stimulate cough
  • To obtain a sputum sample

36
Contra-indications for NTS (relative unless
indicated)
  • Occluded nasal passages
  • Nasal bleeding
  • Epiglottis or croup (absolute)
  • Acute head, facial, or neck injury
  • Coagulopathy or bleeding disorder
  • Laryngospasm
  • Irritable airway
  • Upper respiratory tract infection
  • Tracheal surgery
  • Gastric surgery with high anastomosis
  • Myocardial infarction
  • Bronchospasm

37
Closed Suction Systems
  • Use swivel adapter
  • Use Ballard suction catheter

38
Swivel Adapter
port
39
(No Transcript)
40
(No Transcript)
41
Problems with Swivel Adapter
  • Difficult to prevent port contamination.
  • Would have to change frequently, which is costly.
  • Does relieve torque on tube, however.

42
Ballard Suction Catheter
  • Suction catheter contained within plastic sheath
  • System remains closed
  • Be sure catheter is completely withdrawn when
    finished
  • Suction OFF

43
Lock/ Unlock Control Valve
Black Line
To Suction
Patient Wye
ETT
44
(No Transcript)
45
(No Transcript)
46
Lock/ Unlock Control Valve
LOCK
Unlock To Apply Suction
47
(No Transcript)
48
Open compared to Closed Suctioning
Closed
Open
0 baseline 1 After HIS 2 immediately
after suction 3 30 seconds after suction
Johnson 1994
49
Open compared to Closed Suctioning
Closed
Open
0 baseline 1 After HIS 2 immediately
after suction 3 30 seconds after suction
Johnson 1994
50
Yankauer (tonsil sucker)
51
Obtaining Sputum Sample
  • Sputum trap placed in-line between catheter and
    connecting tubing
  • Irrigation may be necessary - use sterile saline
    without bacteriostatic agent
  • Dont turn trap upside down

52
Connecting Tubing
Suction Catheter
Lukens Sputum Trap
Suction Unit
53
(No Transcript)
54
(No Transcript)
55
Charting after Suctioning
  • Amount, color, thickness
  • How well patient tolerated procedure
  • Breath sounds after suctioning
  • Any complications

56
Summary
  • Avoid hazards when suctioning.
  • Suction when indicated
  • Pre and post oxygenate!
  • If PVCs occur, limit suction time, use closed
    suction system.
  • Premature babies will drop heart rate when
    stressed.

57
Additional References
  • Hyperinflation before and after suctioning
  • McIntosh D, Baun MM, Rogge J. Effects of lung
    hyperinflation and presence of positive
    end-expiratory pressure on arterial and tissue
    oxygenation during endotracheal suctioning. Am J
    Crit Care 19932317-325.
  • 100 O2
  • Goodnough SK. The effects of oxygen and
    hyperinflation on arterial oxygen tension after
    endotracheal suctioning. Heart Lung
    19851411-17.
  • Bronchospasm
  • Guglielminotti J. Desmonts JM. Dureuil B. Effects
    of trache suctioning on respiratory resistances
    in mechnicaly ventilated patients. Chest
    1998113 1335-1338.
  • Nadel JA, Widdicomb JG. Reflex effects of upper
    airway irritation on total lung resistance and
    blood pressure. J Appl Physiol 196217861-865.
  • Intracranial pressure
  • Rudy E, M Baun, K Stone, B Turner. The
    relationship between endotracheal suctioning and
    changes in intracranial pressure A review of the
    literature. Heart Lung. 198615 (5) 488-494.
  • Cardia arrhythmias
  • Shim C, Fine N, Fernanandez R, Williams MH.
    Cardiac arrhythmias resulting from tracheal
    suctioning. Ann Intern Med 1969711149-1153.
  • Trauma
  • Kleiber C, N Krutzfield, E F Rose. Acute
    histologic changes in the tracheobronchial tree
    associated with different suction catheter
    insertion techniques. Heart Lung, 1988 17 (1)
    10-14.
  • Closed suction
  • Johnson KL, PA Kearney, SB Johnson, J B Niblett,
    NL MacMillan, RE McClain.Closed versus open
    endotracheal suctioning Costs and physiologic
    consequences. Crit Care Med 1994 22(4) 658-666.
About PowerShow.com