Suction Devices in the Hospital

Myths and Facts

FOCUS FallBally’s Las VegasOct. 1-3, 2013

Andy Brown RRT-NPSClinical Product Manager

Precision Medical Inc. Northampton, PA

Welcome

Disclosure I am the Clinical Product Manager for Precision

Medical Precision Medical manufactures suction

equipment Home Hospitals

I have no other conflicts of interest

A Brief History Of Suction Airway suction was once described as a

“surprisingly simple technique” (Thompson, 1936) .

In 1959, Boba et al studied the effects of endotracheal suctioning in paralysed patients. They reported that severe hypoxia resulted from suctioning for one minute.

Shumacker et al (1951), Keown (1960) and Marx et al (1968) reported cardiac arrest associated with endotracheal suction.

A Brief History Of Suction Rosen and Hillard (1962) stated that deaths

during suctioning procedures have not been reported as often as personal inquiries indicate that they happen. “cardiac arrest may arise from the stimulation of

respiratory tract reflexes,” In 1984, Kergin et al., Using oximetry, again

reported reduction in blood oxygen saturation during suctioning.

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Gas System Risk Levels and Requirements

3.3.90 Level 1 Medical Piped Gas and Vacuum Systems.Systems serving occupancies where interruption of the piped medical gas and vacuum system would place patients in imminent danger of morbidity or mortality.

3.3.91 Level 1 Vacuum System. A system consisting of central-vacuum-producing equipment with pressure and operating controls, shutoff valves, alarm warning system, gauges, and a network of piping extending to and terminating with suitable station inlets at locations where patient suction could be required.

3.3.92 Level 2 Medical Piped Gas and Vacuum Systems. Systems serving occupancies where interruption of the piped medical gas and vacuum system would place patientsat manageable risk of morbidity or mortality.

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Gas System Risk Levels and Requirements (Continued) 3.3.93 Level 3 Compressed Air System. A system of

component parts, including, but not limited to, air compressor, motor, receiver, controls, filters, dryers, valves, and piping, that delivers compressed air <1100 kPa (<160 psi gauge) to power devices (hand pieces, syringe, cleaning devices, etc.) as a power source.

3.3.94 Level 3 Piped Gas Systems. Systems serving occupancies where interruption of the piped medical gas would terminate procedures but would not place patients at risk of morbidity or mortality.

3.3.95 Level 3 Piped Vacuum System. A Level 3 vacuum distribution system that can be either a wet system designed to remove liquids, air-gas, or solids from the treated area; or a dry system designed to trap liquid and solids before the service inlet and to accommodate air-gas only through the service inlet.

Medical Vacuum Outlet Table

Pressure versus Flow (Myth 1)

AARC Clinical Practice GuidelinesProper Suctioning Technique

Suction Devices - Aspirators General Classification

Emergency – Portable and usually battery powered Vacuum Regulators – Generally line powered but

may be venturi style Thoracic – Line powered (cmH2O), may be mobile Surgical – Line powered Wound

Suction Devices - Aspirators Purpose

Removal of obstructions from the airway Secretions Vomitous Blood

Removal of blood or fluids from open wounds or from a surgical field

Evacuate air or fluid from the pleural space

Suction Devices – Emergency Aspirator Useful in pre-hospital or within the hospital

where line vacuum is not available

Components Battery powered unit with electrical backup/charger Suction tubing Collection canister Carrying case Catheters

Diaphragm Pump

Rotary-Vane Pump

Vacuum Regulators Typically line powered units (venturi) more

commonly found in institutions used for multiple applications Continuous Continuous/Intermittent Thoracic Surgical

Vacuum Regulators

Continuous Vacuum Regulator Use Used for continuously removing air or fluid

from the patient Continuous suction is the most common form of

suction used on patients Airway Thoracic Pleural Surgical

A client’s condition may warrant special interventions to decompress the gastrointestinal tract. GI intubation is one of these interventions. Paralytic ileus is one of the conditions that would warrant intubation

Conditions may warrant the use of intermittent suction and gastric drainage. Necrotizing enterocolitis (NEC) Obstruction GERD Inflammatory bowel disease Post surgical aspiration prevention Trauma

Intermittent Vacuum Regulator Use

Facilitating Tube DrainageBecause gastric and intestinal fluid must move against gravity to be removed suction is requiredLow SuctionHigh SuctionIntermittent SuctionConstant Suction

Proper functioning