A nurse is trying to determine whether or not a patients artificial airway should be suctioned
ALERTSuction airways during mechanical ventilation only when clinically indicated and not as a routine, fixed-schedule treatment. Show
If the patient develops respiratory distress or cardiac decompensation during the suctioning procedure, immediately withdraw the catheter, supply additional oxygen, and deliver manual breaths as needed. Suctioning can cause elevations in intracranial pressure (ICP) in patients with head injuries. Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions. OVERVIEWEndotracheal (ET) and tracheostomy tubes are used to maintain a patent airway and to facilitate mechanical ventilation. ET or tracheostomy tube suctioning is performed to maintain the patency of the artificial airway and to improve gas exchange, decrease airway resistance, and reduce infection risk by removing secretions from the trachea and mainstem bronchi. Suctioning also may be performed to obtain samples of tracheal secretions for laboratory analysis. ET and tracheostomy tubes prevent effective coughing and natural secretion removal, which necessitates the need for periodic suctioning to remove pulmonary secretions. In acute care situations, suctioning is always performed as a sterile procedure to prevent hospital-acquired pneumonia. Indications for suctioning include:
There are two basic methods of suctioning. In the open-suction technique, after disconnection of the ET or tracheostomy tube from any ventilatory circuit or oxygen sources, a sterile single-use suction catheter is inserted into the open end of the tube. In the closed-suction technique, also referred to as “in-line suctioning,” a multiuse suction catheter inside a sterile plastic sleeve is inserted through a special diaphragm attached to the end of the ET or tracheostomy tube (Figure 1). The closed-suction technique allows for the maintenance of oxygenation and ventilation support, which may be beneficial in patients with moderate to severe pulmonary insufficiency. In addition, the closed-suction technique decreases the risk for aerosolization of tracheal secretions during suction-induced coughing. Use of the closed-suction technique should be considered in patients who develop cardiopulmonary instability during suctioning with the open-suction technique; in patients who have high levels of positive end-expiratory pressure (PEEP), inspired oxygen, or both; or in patients who have grossly bloody pulmonary secretions or in whom airborne transmission of disease, such as active pulmonary tuberculosis, is suspected. 100% oxygen should always be provided before and after each pass of the suction catheter into the ET tube, whether suctioning is done with the open- or the closed-suction method.undefined#ref3">3 The suction catheter should not be any larger than one half of the internal diameter of the ET or tracheostomy tube.3 Closed or in-line suction catheters are available in two lengths: a longer one for ET tubes and a shorter one for tracheostomy tubes. Adequate systemic hydration and supplemental humidification of inspired gases help thin secretions for easier aspiration from airways. Instillation of a bolus of sterile 0.9% sodium chloride solution is not a recommended routine practice.2 Complications associated with artificial airway suctioning during mechanical ventilation include:
Tracheal mucosal damage (e.g., epithelial denudement, hyperemia, loss of cilia, edema) occurs during suctioning when tissue is pulled into the catheter-tip holes. These areas of damage increase the risk of infection and bleeding. Suctioning is a necessary procedure for patients with artificial airways. No absolute contraindication to suctioning exists when clinical indicators point to the need for it. EDUCATION
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*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice. Elsevier Skills Levels of Evidence
How do you know if a patient needs suctioning?When to suction. Any time the patient feels or hears mucus rattling in the tube or airway.. In the morning when the patient first wakes up.. When there is an increased respiratory rate (working hard to breathe). Before meals.. Before going outdoors.. Before going to sleep.. When should you not suction a patient?Prolonged suctioning increases the risk of hypoxia and other complications. Never suction a patient for longer than 15 seconds. Rather than prolonged suctioning, withdraw the catheter, re-oxygenate the patient, and suction again.
What indicates that a patient with a tracheostomy needs suctioning?Tracheal suctioning is indicated with noisy respirations, decreased O2 sats, anxiousness, restlessness, increased respirations or work of breathing, change in skin colour, or wheezing or gurgling sounds. These are signs and symptoms of respiratory distress, and the patient should be suctioned immediately.
Which of the following is an indication for suctioning a tracheostomy quizlet?Signs and symptoms that indicate that a tracheostomy may need suctioning include coughing, wheezes, gurgling, crackles on inspiration and/or expiration, restlessness/anxiety, cyanosis, mucus draining from the tracheostomy tube, and pulse oximetry values below 90%.
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