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| What is the rationale for suctioning? | Ineffective airway clearance – client needs help to clear secretions from airway
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| Name three main techniques for clearing the airway. | Oraopharyngeal/Nasopharyngeal; Orotracheal/Nasotracheal; tracheal
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| What kind of catheters are used to perform Oropharyngeal or Nasopharyngeal suctioning? | Yankauer or silicon
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| When is oropharyngeal or nasopharyngeal suctioning indicated? | When the client is able to cough effectively but unable to expectorate or swallow secretions
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| Where is the oropharynx located? What glands are contained in the oropharynx? | extends behind the mouth from the soft palate; contains tonsils
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| Where is the Nasopharynx located? | behind the nose extending to the level of the soft palate
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| When would orotracheal or nasotracheal suctioning be indicated? | The client with pulmonary secretions is unable to cough and does not have an artificial airway.
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| Describe the path of the catheter in Nasotracheal or orotracheal suctioning? | from the nose or mouth to the trachea
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| Which route is preferred, oral or nasal when performing nasotracheal or orotracheal suctioning? Why? | nasal because there is less stimulation of the gag reflex
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| Define tracheal suctioning. | suction catheter is passed through an artificial airway such as an endotracheal tube or tracheostomy tube
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| How many methods are there for tracheal suctioning and what are they? | 2 – open or closed tracheal suction system
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| List three requirements for open tracheal suctioning. Who defines these requirements? | sterile suctioning kit, sterile gloves, practitioner must protect their face per OSHA
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| Describe the catheter used for closed tracheal suctioning. How often is this catheter changed? | multi-use catheter encased in a plastic sheath; usually changed q 24 hrs
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| When is closed tracheal suctioning usually utilized? | with clients who are on a mechanical ventilator
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| What are the potential complications associated with suctioning?(HA TD VA CPLBM VNS IICP I) | Hypoxemia, Atelectasis, Tissue damage, Vomiting, Aspiration, Constriction of pharyngeal, laryngeal , or bronchial muscles; Vagal nerve stimulation, Increased ICP, Infection
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| Why is hypoxemia and Atelectasis a potential complication of suctioning? | Because air and O2 are being suctioned out with secretions
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| What steps should the nurse take to prevent hypoxemia or altelectasis with suctioning? | encourage deep breathes of 100% O2 or provide O2 via ambu bag before procedure
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| What is the cause of tissue damage with suctioning? | trauma from the catheter or too high suction setting
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| What is the appropriate setting for suctioning? | moderate range -80 to -120mmHg
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| When do we suction? | only when needed
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| How is negative pressure applied during suctioning? | intermittently
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| What causes vomiting and aspiration during suctioning? | violent coughing
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| What does the nurse do if the patient develops inspiratory stridor during a suctioning procedure? | Notify MD immediately, ambu bag, oxygen, and possibly Epinephrine may be required
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| What would follow vagal nerve stimulation? | bradycardia, possible arrhythmias such as PVCs
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| What value would indicate that the patient is experiencing an increase in ICP with suctioning? What ICP numbers indicate trouble? What number is critical? | Widening pulse pressure or ICP greater than 15 mmHg (20 mmHg is a critical value)
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| What is pulse pressure? | The difference between systolic and diastolic blood pressure
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| What is a normal pulse pressure in a resting adult? | about 40mmHg
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| What are some causes of widening pulse pressure?(AArgdAAEEFHHTIP) | Aortic stiffness, Aortic regurgitation, fistula, or dissection, Anemia,Anxiety, Endocarditis, Exercise (healthy up to 100mmHg), Fever, Heart block, hyperthyroidism –Thyrotoxicosis, Increased ICP, Pregnancy
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| What is the cushing reflex? | sign of increased ICP – Widening Pulse pressure, Bradycardia, and irregular breathing pattern
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| What is the usual source of infection associated with suctioning? What would the nurse assess for signs of infection? | contaminated equipment; sputum
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| What is the best way to limit complications of suctioning? | limit duration and frequency of suctioning
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| List the steps in order to perform a oropharyngeal suctioning. (C, T, E or S, I, As, Ec, R, R, C, T) | Connect suction device to suction outlet; turn on; elevate HOB or side lying position; insert catheter/yankauer along gum line to pharynx; apply suction; encourage cough; replace O2 mask; rinse catheter (Ns or H2o), clear tubing, turn off suction
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| What are the first things to do when performing nasopharyngeal or nasotracheal suctioning? (3) | Hyperoxygenate client (if needed), auscultate BBS, may need nasal airway (nasal trumpet)
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| Discuss positioning of the client for nasopharyngeal or nasotracheal suctioning. What position facilitates left bronchus? What position facilitates catheter instertion into the right bronchus? | Elevate HOB or position client on side. Turning head to the right facilitates access to the left bronchus and vice versa.
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| If the patient has an O2 device when would it be removed? | just before preparing the suctioning kit
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| Describe the process of preparing the suctioning kit and inserting the catheter for nasotracheal suctioning. | Open the kit/ lubricate catheter (NS)/insert with dominant hand into nare, gently and quickly pass the epiglottis while client takes a breath or coughs and continue into trachea
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| About how far is the catheter inserted for nasopharyngeal suctioning? | about 16cm for an adult or from tip of nose to base of ear lobe
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| About how far is the catheter inserted for nasotracheal suctioning? | about 20cm, if you meet resistance (Carina) pull catheter back 1-2 cm before beginning to apply intermittent suction.
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| How much suction is used for nasotracheal suctioning? | moderate -80 to -120 mmHg
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| How is suction applied during nasopharyngeal or nasotracheal suctioning? | intermittently < 15 seconds as the catheter is being withdrawn
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| What steps complete nasopharyngeal or nasotracheal suctioning? | Replace any O2 device, rinse catheter & connective tubing (NS or H2O)
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| What steps should be taken after completion of nasotracheal or nasopharyngeal suctioning? | assess need for repeat suctioning, auscultate BBS, encourage patient to cough, allow adequate time for reventilation/oxygenation before repeating procedure
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| When would the mouth be cleared during nasopharyngeal or nasotracheal suctioning? | After pharynx & trachea are cleared
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| Describe the beginning steps for ETT or tracheal tube suctioning. | assess need for suction, check BBS, Hyperventilate/hyperoxygenate (using manual resuscitation bag to ventilator), Position client, turn on system
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| Describe the steps from kit to suctioning for ETT or tracheal tube suctioning. | Open/prepare kit, sterile gloves; connect to system; irrigation w/ Ns PRN for thick secretions (controversy); lubricate cath w/NS; insert catheter w/dominant hand until resistance met; withdraw 1-2 cm; begin intermittent suction< 10-15 seconds (trach=10)
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| Describe the finishing steps of ETT or tracheal tube suctioning. | administer breaths via ventilator or ambu bag if appropriate, rexoygenate/hyperoxygenate as needed, rinse catheter, assess cardiopulmonary status, repeat suctioning after 1 minute if needed, suction mouth after ETT or tracheal suctioning
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| Define tracheostomy. | artificial opening into trachea to establish an airway (permanent or temporary)
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| Give four reasons a tracheostomy might be employed. | bypass complete upper airway obstruction, facilitate secretion removal & reduce aspiration of abdominal contents, long term mechanical ventilation > 2weeks to reduce damage to nose and pharynx), to decrease the work of breathing by reducing dead space
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| Who inserts trach tubes? | advanced practicioners
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| Name several complications associated with trach surgery. | Laryngeal nerve damage, hemorrhage, Pneumothorax, infection, tube displacement, under/overinflation of cuff, hernation of cuff over end of tube, burst cuff, blockage of tube by secretions, long term: tracheal stenosis, necrosis, tracheoesophageal fistula
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| What changes if observed by the nurse providing suctioning would lead her to stop the procedure and hyperoxygenate the client? | pulse drop more than 20 beats/min, pulse ox below 90% or 5% from baseline, or any deterioration in the patient’s physiological status
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| Complete trach care should be completed per policy. What are the typical guidelines? | ties, disposable cannula change, stoma care, and dressing every 24 hours
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| How often do we clean the inner cannula, clean the stoma, and change dressing? | every shift and prn
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| OSHA wants the nurse to remember to do what while providing trach care? | protect face
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| Who usually checks cuff pressure during trach care? | Respiratory
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| What is the appropriate cuff pressure range? | 15-22mmHg
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| What is the usual amount of air used to inflate the cuff? | 5-10mL of air
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| How do we know that the trach ties are not too tight? | 2 fingers fit between clients neck and trach ties
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| Prevention of infection is crucial to caring for tracheostomy patients. What kind of equipment is preferred to meet this goal? | sterile, disposable whenever possible
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| When must we use sterile technique in provide tracheostomy care? | With a new/recent trach or hospitalized patient, always with suctioning
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| In what situation is good hand washing and clean technique acceptable? | In home or long term care settings with a long standing tracheostomy
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| What emergency equipment should be at the bedside of a trach patient? | an extra trach kit, sterile Kelly clamps/hemostat to open trach stoma if tube become dislodged
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| What alternative remedy may have to be employed if trach becomes disloged and emergency equipment is not available? | reinsert same trach
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| Why is it unsafe to cut stoma ties? | fibers may get in wound
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| Why is it important to suction trach and oropharynx before deflating cuff? | because secretions build up around the cuff
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| What nursing interventions address the tracheostomy’s patients limited ability to communicate when he is in trouble? | careful observation and frequent checks by the nurse and keeping the call button in easy reach
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| When is an artificial airway indicated? | decreased LOC, airway obstruction, mechanical ventilation, removal of secretions
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