Presentation on theme: "Suctioning and Airway Management"— Presentation transcript:
1Suctioning and Airway Management Module 7Suctioning and Airway Management
2More common causes are: Abnormal increase in respiratory secretions can result from a variety of conditionsMore common causes are:Lung or bronchial infectionsCentral nervous depressionExposure to anesthetic gasesIn newborns saliva & amniotic fluid which babe cannot expectoratePremature babes may have absent or decreased cough reflex
3In a conscious, alert adult the cough reflex is activated and secretions expectorated Others must rely on suctioning to carry out this function
4DefinitionsArtificial airway = inserted to maintain patent air passage for those whose airway has become or may become obstructedLoss of consciousness, facial or oral trauma, copious resp secretions, resp distressMost common:Oropharyngeal, nasopharyngeal, endotracheal and tracheostomy
5Indications for Airways prevent or relieve upper airway obstructiondecrease aspirationfacilitate secretion removalprovide closed system for positive pressure mechanical ventilation
7Oropharyngeal AirwayCurved plastic device inserted through the mouth & positioned in the posterior pharynx to move tongue away from the palate and open the airwayUsually for short term use in unconscious pt. May also be used along with an oral endotracheal tubeNOT USED with recent oral trauma, surgery or loose teethDoes NOT protect against aspiration
11Nasopharyngeal Airway (nasal trumpet) Made of soft rubber or a plastic tubeInserted thru nose into posterior pharynxFacilitates frequent nasopharyngeal suctioningTo be used with EXTREME caution with pts with anticoagulants or bleeding disordersSize should be slightly smaller than diameter of nostril and slightly longer than distance from tip of nose to earlobeCheck nasal mucous for irritation or ulceration
13Endotracheal tubeFlexible tube inserted through mouth or nose into tracheal beyond the vocal cordsThen acts as artificial airwayAllows for deep tracheal suction & removal of secretionsPermits mechanical ventilationInflated balloon seals of trachea so aspiration from GI tract CANNOT occurGenerally inserted in emergencies and by physician or specially trained nurses.Not intended for long term use as maintaining placement difficult
14Orotracheal insertion easiest as done under direct visualization Endotracheal tubeOrotracheal insertion easiest as done under direct visualizationDisadvantages are increased oral secretions, more discomfort, difficulty with tube stabilization & inability of pt to talkNasotracheal is more comfortable to pt & easier to stabilize.Disadvantage is blind insertion required and there is possibility of pressure necrosis of nasal airway, sinusitis & otitis media
16Endotracheal tubeEndotracheal tubes vary according to length, inner diameter, type of cuff & number of lumensUsual sizes = 6.0, & 9.0mmMost cuffs are high volume, low pressure with self sealing inflation valves (or cuff may be of foam rubber)Most are single lumen. But there are dual lumen lumen tubes that can be used to ventilate each lung independently
17Tracheostomy tubeFirm curved artificial airway inserted directly into trachea at level of 2nd or 3rd tracheal through through surgical incisionPermits mechanical ventilationFacilitates secretion removalCan be used long termBypasses the upper airway defenses therefore increases susceptibility to infectionCovered in Next Module
21Mobilization of secretions Goal of airway clearance techniques is to improve clearance secretions thereby decreasing obstruction of airwaysSecretions can be Removed byCoughingSuctioningSuctioning may be necessary if clt has difficulty handling their secretions or when an airway is in place
22SuctioningIs aspirating secretions through a catheter connected either to a suction machine or wall suction outlet.Primary Suctioning Techniques are:OropharyngealNasopharyngealOrotrachealNasotrachealSuction of an artificial airway
23Suction catheters Are either (pic in kozier p. 1288) Open tipped (more effective with thick plugs but can pull at tissues) orWhistle tipped (less irritating to resp tissues)Most have thumb port to control suction (cover to start suction)Catheter attached to tubing which then attaches to collection chamberSuction controlled by a gauge
24Sizes of suction catheters #12 to #18 Fr for adults#8 to #10 Fr for children#5 to #8 Fr for infants
26The YankauerYankauer is a rigid plastic catheter with 1 large & several small eyelets through which mucous enters when suction is appliedUsed for oral suctionPatients themselves can be taught to use this suction method
27Used primarily for oral suctioning Yankauer Used primarily for oral suctioning
28How much pressure? Depends on if wall or portable unit is used… Wall UnitPortable UnitAdult: mm HgAdult: mm HgChild: mm HgChild: mm HgInfant: mm HgInfant: 2-5 mm Hg
29Gurgling sounds during respirations Procedure 47-4 in Kozier on p Suctioning oropharyngeal & nasopharyngeal cavitiesNote clinical signs indicating need for suctioning:RestlessnessGurgling sounds during respirationsAdventitious breath sounds when chest auscultateChange in mental statusChange in skin colorChange in rate & pattern of respsChange in pulse rate & rhythm
30Oropharyngeal & Nasopharyngeal suctioning Oropharynx = extends behind mouth from the soft palate above the level of the hyoid bone & contains the tonsilsNasopharnyx = is located behind the nose & extends to level of soft palateUsed when clt able to cough effectively but is then unable to clear secretions by expectorating or swallowing secretionsSuctioning done after pt has coughedDone only until pt able to expectorate own secretions
31All of the techniques are based on common principles: Oropharynx & tracheal considered sterile, therefore STERILE technique requiredMouth is considered clean therefore suctioning of oral secretions should be performed AFTER suctioning of the oropharynx & tracheaIf oropharynx & nasopharnyx to be suctioned, use separate sterile catheter for eachFrequency of suctioning determined upon assessment (via auscultation & inspection)
32Overview of procedureDO NOT apply suction during insertion (causes trauma to mucous membranes)While performing the suction, apply finger over port to start suction action. Rotate catheter gentlySuction attempts should last only secondsAllow second intervals between attemptsFlush catheter with sterile water or saline in between attemptsRelubricate (with water soluble) with each attempt
34EvaluationCompare client's respiratory assessments before & after suctioning.Ask client if breathing is easier & if congestion is decreased.Observe client's technique & compliance with suctioning procedures.
35Record and ReportRecord respiratory assessments before and after suctioning.Size of catheter used.Route, amount, consistency, and color of secretions obtained.Frequency of suctioning.Client's response.
36Dangers of suctioningHypoxemia = insufficient oxygen in blood can result if suction maintained without breaks (therefore no longer than 15secs)Vagal nerve stimulation (vagovagal reflex) stimulation of the vagus nerve by reflex in which irritation of the larynx or trachea results in slowing of the pulse reateMucosal damage – using suction while inserting a catheter can cause trauma to the mucousaMicroatelectasis – is an early manifestation of O2 toxicityAspiration – safety for semi conscious (on their side) conscious should in semi fowlers with head turned to sideInfection – follow protocol for sterile proceduremicroatelectasis = Microscopic collapse of alveoli that does not involve the airways and may not appear on radiographic examination. Diffuse microatelectasis, an early manifestation of O2 toxicity and the adult and neonatal respiratory distress syndromes, produces dyspnea; rapid, shallow respirations; arterial hypoxemia; decreased lung compliance; and reduced lung volume. Auscultation of the lungs may be normal, or crackles, rhonchi, or wheezes may be heard. Other manifestations depend on the cause of the acute lung injury and the severity of accompanying hemodynamic and metabolic derangements and organ system failure.Copyright 1997 by F.A.Davis Company
37Deep suctioningTracheal or ‘deep suctioning’ often done by resp therapist, critical care nurseIn tracheal suction the catheter is introduced past the glottis deep into the tracheaNecessary when clt has pulmonary secretions but is unable to cough and does NOT have an artificial airway
38Orotracheal & Nasotracheal Suctioning Catheter passed thru nose or mouth into tracheaNose is preferred route as minimally stimulates gag reflexSimilar to nasopharyngeal except catheter extended further to suction tracheaENTIRE PROCEDURE CANNOT TAKE MORE THAN 15 SECS (no O2 reaches lungs during suctioning)Pt should be allowed to rest (unless in resp distress) between passes of catheter and O2 mask/cannula replaced between passes
39AIRWAY MANAGEMENT: SUCTIONING Verify nursing intervention using physician's order or nursing care plan.Observe for signs and symptoms of excess secretions in the oral cavity and productive cough without expectoration.Assess lung sounds for labored breathing, restlessness/irritability, color, unilateral breath sounds, and oxygen saturation.Assess client's understanding of procedure and feeling of congestion to indicate that the oral cavity or lower airway needs suctioning.
40Preparation for all types of suctioning. Fill basin or cup with approximately 100 ml of sterile water.Connect one end of connecting tubing to suction machine.Check that equipment is functioning properly by suctioning a small amount of water from basin.Turn suction device on. Set regulator to appropriate negative pressure:wall suction, 80 to 120 mm Hg;portable suction, 7 to 15 mm Hg for adults.
42 Oropharyngeal suctioning Attach suction catheter to connecting tubing. Remove oxygen mask if present.Insert catheter into client's mouth (no suction).With suction applied, move catheter around mouth, including pharynx and gum line, until secretions are cleared.Encourage client to cough, and repeat suctioning if needed.Replace oxygen mask if used.
43Oropharyngeal suctioning …cont’d Suction water from basin through catheter until catheter is cleared of secretions.Place catheter in a clean, dry area for reuse with suction turned off or within client's reach, with suction on, if client is capable of suctioning self.Discard water if not used by client. Clean basin or dispose of cup.Remove gloves and dispose.
44Video on Suctioning covers: OropharyngealNasopharyngealNasotracheal
45Nasotracheal suctioning Prepare suction catheter.Open suction kit or catheter using aseptic technique. If sterile drape is available, place it across client's chest. Do table. Be careful not to touch inside of sterile basin not allow suction catheter to touch any nonsterile surfaces.Unwrap or open sterile basin and place on bedside. Fill with about 100 ml sterile normal saline (NS).
46Nasotracheal suctioning… Apply sterile glove to each hand (or nonsterile glove to nondominant hand & sterile glove to dominant hand)Attach nonsterile suction tubing to sterile catheter, keeping hand holding catheter sterile.Secure catheter to tubing aseptically. Coat distal 6 to 8 cm (2 to 3 inches) of catheter with water-soluble lubricants.Remove oxygen delivery device, if present, with nondominant hand.Use dominant hand to insert catheter into nares during inspiration without applying suction .Do not force catheter.
47Nasotracheal suctioning… Insert catheter approximately 16 cm (6½ inches) in adults.Apply intermittent suction by placing and releasing nondominant thumb over vent of catheter. Slowly withdraw catheter while rotating it back and forth with suction on for as long as 10 to 15 seconds. Replace oxygen device, if applicable.Rinse catheter and connecting tubing by suctioning water from the basin until tubing is clear. Dispose of catheter and remaining saline in basin.
48Endotracheal or tracheostomy tube suctioning Prepare suction catheter.Aseptically open suction kit or catheter. If sterile drape is available, place it across client's chest.Unwrap or open sterile basin and place on bedside table. Be careful not to touch inside of sterile basin. Fill with about 100 ml sterile NS.
49Endotracheal or tracheostomy tube suctioning Apply sterile glove to each hand (or apply nonsterile glove to nondominant hand & sterile glove to dominant hand). Attach nonsterile suction tubing to sterile catheter, keeping hand holding catheter sterile.Check that equipment is functioning properly by suctioning small amounts of saline from basin.Hyperinflate and/or hyperoxygenate client before suctioning, using manual resuscitation bag or sigh mechanism on mechanical ventilator.Open swivel adapter, or, if necessary, remove oxygen or humidity delivery device with nondominant hand.
50Endotracheal or tracheostomy tube suctioning Without applying suction and using dominant thumb and forefinger, gently but quickly insert catheter into artificial airway (best to time catheter insertion with inspiration) until resistance is met or client coughs, then pull back 1 cm.Apply intermittent suction by placing and releasing nondominant thumb over vent of catheter, and slowly withdraw catheter while rotating it back and forth between dominant thumb and forefinger. The maximum time catheter may remain in airway is 10 seconds. Encourage client to cough.
51Endotracheal or tracheostomy tube suctioning Close swivel adapter or replace oxygen delivery device. Encourage client to deep breathe. Some clients respond well to several manual breaths from the mechanical ventilator or resuscitation bag.Rinse catheter and connecting tube with NS until clear. Use continuous suction.Assess client's cardiopulmonary status for secretion clearance and complications. Repeat secretions. Allow adequate time (at least 1 full minute) between suction passes for ventilation and reoxygenation.
52Endotracheal or tracheostomy tube suctioning Perform nasopharyngeal and oropharyngeal suctioning to clear upper airway of secretions. After these suctionings are performed, catheter is contaminated; do not reinsert into endotracheal tube (ET) or tracheostomy tube.Disconnect catheter from connecting tube. Roll catheter around fingers of dominant hand. Pull glove off inside out so that catheter remains in glove. Pull off other glove in same way. Discard into appropriate receptacle. Turn off suction device.Place unopened suction kit on suction machine or at head of bed.