2. Introduction.....Introduction..... The patient with an artificialThe patient with an artificial airway is not capable of effectivelyairway is not capable of effectively coughing, the mobilization ofcoughing, the mobilization of secretions from the trachea mustsecretions from the trachea must be facilitated by aspiration. This isbe facilitated by aspiration. This is called suctioning.called suctioning.
3. WHAT IS SUCTIONING?WHAT IS SUCTIONING? Endotracheal suctioningEndotracheal suctioning is the removal ofis the removal of secretions fromsecretions from tracheobroncheal treetracheobroncheal tree through anthrough an endotracheal tube withendotracheal tube with the help of mechanicalthe help of mechanical suction device.suction device.
4. PURPOSESPURPOSES To maintain a patent airway by removingTo maintain a patent airway by removing retained tracheobroncheal secretions.retained tracheobroncheal secretions. To prevent lower respiratory tractTo 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.
5. INDICATIONINDICATION Therapeutic Diagnostic
6. Therapeutic:Therapeutic: 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 valuesDeterioration of arterial blood gas values Patients inability to generate an effectivePatients inability to generate an effective spontaneous coughspontaneous cough Presence of pulmonary atelectasis or consolidation,Presence of pulmonary atelectasis or consolidation, presumed to be associated with secretion retentionpresumed to be associated with secretion retention During special procedures like Bronchoscopy &During special procedures like Bronchoscopy & EndoscopyEndoscopy
7. Diagnostic:Diagnostic: The need to obtain a sputum specimen / ETAThe need to obtain a sputum specimen / ETA (Endo Tracheal Aspiration) for investigations.(Endo Tracheal Aspiration) for investigations.
9. TYPES OF ET SUCTIONINGTYPES OF ET SUCTIONING OPEN SUCTION CLOSED SUCTION
10. ASSESSMENTASSESSMENT PREPARATION OF PATIENT & ARTICLESPREPARATION OF PATIENT & ARTICLES IMPLEMENTATIONIMPLEMENTATION EVALUATIONEVALUATION
11. ASSESSMENTASSESSMENT Patient should be monitored prior to, during &Patient should be monitored prior to, during & after the procedure for following :after the procedure for following : Breath soundsBreath sounds Oxygen saturationOxygen saturation Respiratory Rate & patternRespiratory Rate & pattern Hemodynamic parameters (pulse rate, Blood pressure)Hemodynamic parameters (pulse rate, Blood pressure) Cough effortCough effort ICP (If indicated and available)ICP (If indicated and available) Sputum characteristics (color, volume, consistency &Sputum characteristics (color, volume, consistency & odor)odor) Ventilator parameters (PIP, Vt & FiOVentilator parameters (PIP, Vt & FiO22))
12. ASSESSMENT.ASSESSMENT. Assess theAssess the depth anddepth and rate of respiration,rate of respiration, auscultate breath sounds.auscultate breath sounds. Assess for wheeze orAssess for wheeze or rattling sound in chest:rattling sound in chest: a harsh sound caused bya harsh sound caused by partial obstruction of thepartial obstruction of the airwaysairways
13. Patient PreparationPatient Preparation Explain the procedure to the patient ifExplain the procedure to the patient if conscious.conscious. The patient should receive hyperThe patient should receive hyper oxygenation by the delivery of 100%oxygenation by the delivery of 100% oxygen for >30 seconds prior to theoxygen for >30 seconds prior to the suctioningsuctioning Position the patient in supine position.Position the patient in supine position. Auscultate the breath sounds.Auscultate the breath sounds.
14. COMMUNICATECOMMUNICATE Explain theExplain the procedure to theprocedure to the patient andpatient and importance ofimportance of coughing ifcoughing if conscious.conscious.
15. EQUIPMENT ASSEMBLYINGEQUIPMENT ASSEMBLYING StethoscopeStethoscope Vacuum source with adjustableVacuum source with adjustable regulator suction jarregulator suction jar Sterile glovesSterile gloves Sterile suction catheterSterile suction catheter Protective goggles, apron & maskProtective goggles, apron & mask Sterile normal salineSterile normal saline AMBU bag for pre & postAMBU bag for pre & post oxygenationoxygenation
16. 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.
17. SUCTION PRESSURESUCTION PRESSURE Turn on suction apparatus to appropriate negative pressure for: adults-100-120 mmHg children-50-100 mmHg infants-40-60 mmHg.
18. IMPLEMENTATIONIMPLEMENTATION HAND WASHHAND WASH Perform handPerform hand hygiene, wash hands.hygiene, wash hands. It reducesIt reduces transmission oftransmission of microorganisms.microorganisms.
19. Goggles, mask & apron should beGoggles, mask & apron should be worn to prevent splash fromworn to prevent splash from secretionssecretions Open the end of the suction catheterOpen the end of the suction catheter package & connect it to suctionpackage & connect it to suction tubing (If you are alone)tubing (If you are alone) Wear sterile gloves with sterileWear sterile gloves with sterile techniquetechnique With a help of an assistant openWith a help of an assistant open suction catheter package & connectsuction catheter package & connect it to suction tubingit to suction tubing Continue..
20. Continue..Continue.. With a help of an assistantWith a help of an assistant disconnect the ventilatordisconnect the ventilator Kink the suction tube & insert theKink the suction tube & insert the catheter in to the ETtube untilcatheter in to the ETtube until resistance is feltresistance is felt Resistance is felt when the catheterResistance is felt when the catheter impacts the carina or bronchialimpacts the carina or bronchial mucosa, the suction cathetermucosa, the suction catheter should be withdrawn 2cm outshould be withdrawn 2cm out before applying suctionbefore applying suction
21. Continue.....Continue..... Apply continuous suctionApply continuous suction while rotating the suctionwhile rotating the suction catheter during removalcatheter during removal The duration of eachThe duration of each suctioning should be 10-15sec.suctioning should be 10-15sec. Instill 3 to 5ml of sterileInstill 3 to 5ml of sterile normal saline in to thenormal saline in to the artificial airway, if requiredartificial airway, if required Give four to five manualGive four to five manual breaths with bag or ventilatorbreaths with bag or ventilator
22. Continue..Continue.. Return patient to ventilatorReturn patient to ventilator Flush the catheter with NSFlush the catheter with NS in the suction trayin the suction tray Suction nares & oropharynxSuction nares & oropharynx above the artificial airwayabove the artificial airway Discard used equipmentsDiscard used equipments Flush the suction tube withFlush the suction tube with hot waterhot water Wash handsWash hands
23. POST PROCEDURE CAREPOST PROCEDURE CARE When the procedure isWhen the procedure is completecomplete hyperventilate thehyperventilate the patient again.patient again. When the airwayWhen the airway becomes clear, returnbecomes clear, return the patient tothe patient to ventilator or oxygenventilator or oxygen source.source.
24. DOCUMENTATIONDOCUMENTATION Record the time ofRecord the time of suctioning, nature &suctioning, nature & amount of secretions.amount of secretions. Document indicationsDocument indications for suctioning & anyfor suctioning & any changes in vitals &changes in vitals & patients tolerance.patients tolerance.
25. CAUTION..CAUTION.. Suctioning is potentially anSuctioning is potentially an harmful procedure if carriedharmful procedure if carried out improperly.out improperly. Suctioning should be doneSuctioning should be done when clinically necessarywhen clinically necessary (not routinely).(not routinely). The need for suctioningThe need for suctioning should be assessed at leastshould be assessed at least every 2hrs or moreevery 2hrs or more frequently as need arises.frequently as need arises.