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TL Suctioning


What is the rationale for suctioning? Ineffective airway clearance – client needs help to clear secretions from airway
Name three main techniques for clearing the airway. Oraopharyngeal/Nasopharyngeal; Orotracheal/Nasotracheal; tracheal
What kind of catheters are used to perform Oropharyngeal or Nasopharyngeal suctioning? Yankauer or silicon
When is oropharyngeal or nasopharyngeal suctioning indicated? When the client is able to cough effectively but unable to expectorate or swallow secretions
Where is the oropharynx located? What glands are contained in the oropharynx? extends behind the mouth from the soft palate; contains tonsils
Where is the Nasopharynx located? behind the nose extending to the level of the soft palate
When would orotracheal or nasotracheal suctioning be indicated? The client with pulmonary secretions is unable to cough and does not have an artificial airway.
Describe the path of the catheter in Nasotracheal or orotracheal suctioning? from the nose or mouth to the trachea
Which route is preferred, oral or nasal when performing nasotracheal or orotracheal suctioning? Why? nasal because there is less stimulation of the gag reflex
Define tracheal suctioning. suction catheter is passed through an artificial airway such as an endotracheal tube or tracheostomy tube
How many methods are there for tracheal suctioning and what are they? 2 – open or closed tracheal suction system
List three requirements for open tracheal suctioning. Who defines these requirements? sterile suctioning kit, sterile gloves, practitioner must protect their face per OSHA
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
When is closed tracheal suctioning usually utilized? with clients who are on a mechanical ventilator
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
Why is hypoxemia and Atelectasis a potential complication of suctioning? Because air and O2 are being suctioned out with secretions
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
What is the cause of tissue damage with suctioning? trauma from the catheter or too high suction setting
What is the appropriate setting for suctioning? moderate range -80 to -120mmHg
When do we suction? only when needed
How is negative pressure applied during suctioning? intermittently
What causes vomiting and aspiration during suctioning? violent coughing
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
What would follow vagal nerve stimulation? bradycardia, possible arrhythmias such as PVCs
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)
What is pulse pressure? The difference between systolic and diastolic blood pressure
What is a normal pulse pressure in a resting adult? about 40mmHg
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
What is the cushing reflex? sign of increased ICP – Widening Pulse pressure, Bradycardia, and irregular breathing pattern
What is the usual source of infection associated with suctioning? What would the nurse assess for signs of infection? contaminated equipment; sputum
What is the best way to limit complications of suctioning? limit duration and frequency of suctioning
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
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)
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.
If the patient has an O2 device when would it be removed? just before preparing the suctioning kit
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
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
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.
How much suction is used for nasotracheal suctioning? moderate -80 to -120 mmHg
How is suction applied during nasopharyngeal or nasotracheal suctioning? intermittently < 15 seconds as the catheter is being withdrawn
What steps complete nasopharyngeal or nasotracheal suctioning? Replace any O2 device, rinse catheter & connective tubing (NS or H2O)
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
When would the mouth be cleared during nasopharyngeal or nasotracheal suctioning? After pharynx & trachea are cleared
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
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)
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
Define tracheostomy. artificial opening into trachea to establish an airway (permanent or temporary)
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
Who inserts trach tubes? advanced practicioners
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
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
Complete trach care should be completed per policy. What are the typical guidelines? ties, disposable cannula change, stoma care, and dressing every 24 hours
How often do we clean the inner cannula, clean the stoma, and change dressing? every shift and prn
OSHA wants the nurse to remember to do what while providing trach care? protect face
Who usually checks cuff pressure during trach care? Respiratory
What is the appropriate cuff pressure range? 15-22mmHg
What is the usual amount of air used to inflate the cuff? 5-10mL of air
How do we know that the trach ties are not too tight? 2 fingers fit between clients neck and trach ties
Prevention of infection is crucial to caring for tracheostomy patients. What kind of equipment is preferred to meet this goal? sterile, disposable whenever possible
When must we use sterile technique in provide tracheostomy care? With a new/recent trach or hospitalized patient, always with suctioning
In what situation is good hand washing and clean technique acceptable? In home or long term care settings with a long standing tracheostomy
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
What alternative remedy may have to be employed if trach becomes disloged and emergency equipment is not available? reinsert same trach
Why is it unsafe to cut stoma ties? fibers may get in wound
Why is it important to suction trach and oropharynx before deflating cuff? because secretions build up around the cuff
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
When is an artificial airway indicated? decreased LOC, airway obstruction, mechanical ventilation, removal of secretions