24tracheal asp student - amarillo college procedure • suctioning simulation – nasotracheal...
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RSPT 1410 Tracheal Aspiration
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RSPT 1410
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Tracheal Aspiration
• …is the use of ________________ to facilitate the removal of secretions from the respiratory tract.
• Under normal circumstances, patients with normal coughing do not have difficulty in removing secretions.
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Tracheal Aspiration
• Indications – CNS depression – Placement of ________________ – Debilitating diseases – Pain – Anything that decreases the patient’s ability to
_______________ – When there is a overwhelming amount of secretions,
even when patient can cough
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To Promote Cough
• Ask patient • ________________
– Spontaneous – Ambu bag, mask – IPPB – 5% CO2
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To Promote Cough
• Insert sterile ________________ into trachea • Instill sterile ________________ into trachea
through suction catheter, ETT • Suprasternal notch pressure
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Orotracheal Suctioning
• Best done sitting up 45° • Difficult to hit trachea • Causes gagging, vomiting
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Nasotracheal Suctioning
• Better ________________ • Easier to hit trachea • Does not cause gagging, etc.
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Suction Equipment
• Suction source – Portable or piped-in wall outlet
Suction setting"intermittent or"
continuous"
Collecting"bottle"
One-way valve"
Connecting tube"
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Suction Equipment
• Safe suction ranges – Adult: ________ to _______ mmHg – Pediatric: -60 to -80 mmHg – Neonatal: -40 to -60 mmHg
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Suction Equipment
• One-way valve – __________ valve
– __________ valve
• Collection jar – Glass or plastic – Marked in ml to measure – Special containers for sterile samples
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Suction Equipment
• Catheters should not take up more than 50% of airway – Sizes 6-18 Fr. (Fr. = O.D. x 3)
Catheter with"thumb control"
Catheter without"thumb control"
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Suction Equipment
In-Line or Closed "suction catheter"
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Suction Equipment
Yankauer"
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Suction Equipment
• Catheters are designed as ___________ • Procedure should be sterile
– sterile catheter – 2 gloves
• Catheters should have thumb port
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Suction Equipment
• Distal end of catheter is designed to reduce trauma to mucosa – standard or “whistle tip” – ring tip – Coudé tip
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Suction Equipment
Catheter tips
Whistle-tip" Ring-tip"
Coudé"
Bronchitrac"
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Suction Procedure
• Suctioning Simulation – Nasotracheal suctioning – Artificial airway (ETT) suctioning – Closed system suctioning
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Suction Procedure
• Tracheal aspiration is not a __________ procedure and should be performed on a PRN or as needed basis only
• Tracheal aspiration is just that - tracheal • As with any patient procedure, a good
_____________________ is first
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Suction Procedure
• _________________ – patient cooperation depends on it
• _________________ – airway straight and open – semi-Fowler’s is best (head up at least 45°)
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Suction Procedure
• Preoxygenation/hyperinflation – increase _________________
• if patient is on O2, ↑ liter flow • if patient is not on O2, it would be best to set it
up – encourage/assist patient with 5-10 deep breaths
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Suction Procedure
• Catheter insertion – slow, gentle motion – use sterile water-soluble lubricant (e.g. K-Y) – NEVER force advancement - can cause mucosal
damage – DO NOT apply suction on insertion
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Suction Procedure
• Catheter insertion – advance catheter as far as possible, then withdraw
slightly – if suctioning through an artificial airway, catheter
external diameter should be no more than ½ the internal diameter of the airway
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Suction Procedure
• Applying suction – suction should be applied only during
_________________ of catheter – suction should be intermittent, never continuous – _________________ catheter 180° between
fingers during withdrawal
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Suction Procedure
• Applying suction – suction should be applied for no more than
_________________ seconds – total procedure time, insertion to complete
withdrawal, should take no more than 20 seconds
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Suction Procedure
• Applying suction – stop procedure if dysrrhythmias occur (indicates
possible _____________ stimulation or hypoxia) • ventilate as necessary with 100% O2 until vital
signs and cardiac rhythm return to normal
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Suction Procedure
• Reoxygenation/hyperinflation – patient should receive O2 and be encouraged/
assisted with deep breathing following procedure – monitor cardiac _________________ and
_________________ until pre-procedure status returns
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Suction Procedure
• Repetition – procedure may be repeated as necessary – repeat all steps each time
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Suction Procedure
• Documentation – record __________, _________________ and
viscosity of removed secretions – record any problems or adverse effects
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Therapeutic Considerations
• Use largest catheter possible that meets size requirements/limitations
• If possible, suction _____________ the cuff of artificial airways first
• DO NOT ________ disposable catheters • Properly discard all disposable items
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Therapeutic Considerations
• DO NOT apply suction during ________ • Be aware that your patient may have a
deviated septum or obstructed nasal passages
• Be prepared for gagging, retching or vomiting as catheter is passed into the pharynx
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Therapeutic Considerations
• The tongue may be held forward using a gloved hand or sterile 4 X 4
• Instruct patient to breathe deeply and slowly to assist in passing catheter through _________________
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Therapeutic Considerations
• Apply intermittent suction • _______________ catheter • Limit actual suction time to ___________
seconds • Limit procedure to _________ seconds
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Complications/Hazards
• Hypoxia – monitor for ↑ _______________ – limit suction time
• Vagal Stimulation – monitor for ↓ _______________ – perform slow, gentle insertion – limit _______________
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Complications/Hazards
• Atelectasis – Cause
• Suctioning removes ____________________ – Prevention
• _______________
• _______________
• Oxygenate between suction passes
• Use proper size suction catheter
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Complications/Hazards
• Trauma to the airway – Catheter tip contacts mucosa + suction =
• Hemorrhage • Mucosal damage • Local inflammation
– Well documented by autopsy reports: when suction applied, mucosa is elevated into catheter holes - epithelial cells are removed for entire length of suction time
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Complications/Hazards
• Trauma to the airway – Prevention
• Ring-tip catheters • _______________ catheter while withdrawn • Intermittent suction • Limit suction ____________ & pressure
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Complications/Hazards
• Cardiac arrhythmias – Cause
• Usually secondary to _______________ • Also caused by hypoxia + vagal stimulation
– Carina, trachea, pharynx, larynx • Vagal stimulation alone causes bradycardia &
hypotension • Hypoxia can cause _______________
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Premature Ventricular Contraction (PVC)
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Premature Ventricular Contraction (PVC)
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Premature Ventricular Contraction (PVC)
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Premature Ventricular Contraction (PVC)
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Premature Ventricular Contraction (PVC)
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Premature Ventricular Contraction (PVC)
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Complications/Hazards
• Cardiac arrhythmias – Prevention
• ____________ with suction catheter • Short suction times • Well ______________ & ______________
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Complications/Hazards
• Hypotension – Cause
• Bradycardia from ______________ stimulation • Prolonged coughing which interrupts venous
return – Prevention
• Gentle with suction catheter • Short suction times • Well ______________ & ______________
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Complications/Hazards
• Infection – ____________________ & most easily prevented – Cause
• Non-sterile technique • Repeated passes with catheter
– Prevent • ______________ technique with sterile
equipment • ________________________________
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Sterile Sputum Specimens
• Lukens tube • Bottle in-line • All samples labeled,
bagged, sent to lab ASAP – C & S - anytime – AFB - AM x 3 – Cytology