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Medication Administration Intravenous Procedures Urinary Catheterization Wound Care Gastrointestinal Tube Traceostomy MEDICATION ADMINISTRATION IM or SQ injection 1. Wash Hands 2. Compare MAR with MD Orders: Client, Time, Drug, Dose, Route 3. Check Patient chart for allergies to medications or latex drugs 4. Take MAR to med cart 5. I am going to perform my three checks: As I am taking med out of med cart Before withdrawing med After withdrawing med 6. Pull med from cart, checks with MAR 7. Which needle size to use for IM injection: 19-23 gauge, 1½ in. SQ injection: 25-27 gauge, 5/8 in. 8. Perform 2nd check before withdrawing med 9. Withdraw med: Take off vial cap Alcohol swab the top Maintain sterile needle Inject air into vial With draw med w/ no bubbles Recap using sweep method Label needle 10. Perform the 3rd check after withdrawing medication 11. Go into patient room and introduce self and id patient; ask about allergies 12. Wash hands/Gloves 13. Tell patient you are going to give him an IM injection, which puts the medication into the muscle. Explain what the med does and how it is useful. 14. Put the patient in the correct position to relax muscle and minimize discomfort 15. Checks one last time.
16. Select site and Perform assessment: Inflammation Erythema Make sure rotating site from last injection Lesions Tenderness Swelling Hardness Bruising 17. Alcohol swab the site 18. Pull skin to the side for Z-track method 19. Hold syringe like a dart, push in quickly 20. Stabilize with non dominant hand, aspirate for 5 seconds and look for air If no air appears inject med slowly and pull needle out. 21. Properly dispose of needle- do not recap 22. Document: On MAR: med and signature Pre-administration assessment findings Site utilized normal Adverse effects IM Injection sites 1. Ventrogluteal: Place heel of hand on greater trochanter(right hand for left hip) Point fingers to the head Make a triangle with index finger on anterior superior iliac spine and middle finger on iliac crest Position: Side lying with knee bent towards chest 2. Vastus Lateralis: Middle third of the thigh Position: Back lying or sitting 3. Dorsogluteal: Palpate posterior superior iliac spine Draw imaginary line to greater trochanter Site lateral and superior to the line Position: Prone with toes inward 4. Deltoid: 3 fingers below acromion process no more than 1 mL of solution SQ Injection Sites Abdomen Lateral anterior arm Upper thigh
Scapular Gluteal Seven Essential Parts to a Medication Order 1. Client’s full name 2. Date and Time order written 3. Drug name 4. Dose of drug 5. Frequency 6. Route 7. Signature of person writing order Ophthalmic Medication 1. Assessment: Lesions Exudates Erythema Swelling Itching Burning Blurred vision OD: right OS: left OU: both 2. Place client in a supine position with head slightly hyperextended 3. Clean eyelids eyelashes with sterile cotton ball moistened with NSwipe inner to outer 4. Place tissue below eyelid 5. Hold eyedropper ½ - ¾ in above eyeball 6. Ointment- discard first bead 7. Rest hand on client’s forehead 8. Tell client to look up 9. Drops into outer 1/3 of lower conjunctival sac 10. Instruct patient to close eyes and move eyes 11. Apply pressure to lacrimal ducts Otic Medication 1. Assessment: Signs of redness Abrasions Discharge 2. Side lying position with affected ear up 3. Clean: use cotton tipped applicators to wipe pinna and auditory meatus 4. Straighten ear canal: Up and out/back 5. Hold dropper ½ in above ear 6. Press firmly on tragus a few times 7. Maintain position for 2-3 min 8. Cotton ball on outermost part of ear
Topical Skin Medication 1. Assessment: 2. Remove old patch 3. Clean site 4. Apply medication Nasal Medication 1. Position patient so they are sitting upright 2. Ask pt to blow nose 3. Inhaler, ask to inhale while spray is administered 4. After- blot nose, but do not blow Rectal 1. Position client in side lying position on left side with upper leg drawn toward the chest 2. Towel or pad under patient 3. Assess external anus 4. Lubricate tip 5. Tell client they will experience a cool sensation and pressure 6. Encourage slow deep breaths 7. Separate buttocks and insert med 8. Wipe anal area Vaginal 1. Ask client to void and help into a back lying position with knees bent and hips rotated laterally 2. Drape client and put towel or pad on bed 3. Assess clean perineal area; Assessment: Inflammation Amount, character, and odor of discharge Complaint of vaginal discomfort-burning, itching 4. Retract labia 5. Insert applicator 2-3 in into the vagina IV PROCEDURES Primary Line 1. Wash Hands 2. Check MD order and MAR: date/time, med/fluid, route, dose/rate, client name 3. Check drug book for compatibility and adverse rexns 4. Calculate drip rate 5. Choose correct fluid and tubing – make sure bag is clear with no precipitates, cloudiness or leaks and check exp date 6. Attach calculation strip to bag: Date, int, start amount, middle, quarter, end Mark how many mL will pass with each hour 7. Label tubing- Date, time, int
8. Close clamp on tubing, Remove plastic stopper from IV bag, and insert tubing 9. Fill drip chamber ½ full 10. Prime tubing- Take off cap, open clamp, hold over trash can 11. Prepare syringe with 3mL NS 12. Go to client’s room, Introduce yourself, and Id patient, check allergies 13. Wash hands, gloves 14. Check 5 rights 15. Assess IV site for: Phlebitis, pain, infiltration, inflammation, irritation, edema, warmth, cool 16. Hang bag 17. Clean port with an alcohol swab 18. Flush port with 3 mL NS (if nothing running) or incompatible 19. Connect new bag and tubing to port 20. Open clamp and regulate drip rate within 4 drops 21. Check arm again 22. Document date, time, type of solution, start and end time, drip rate, condition of IV site, client response, signature <100 mL/hr = Microdrip 60 gtts/mL >100 mL/hr = Macro drip 10, 12, 15, 20 gtts/mL Groshong style catheter- do not need to be heparinized because the prevents blood from entering Complications from IV Therapy: 1. Infiltration – Swelling, cool skin, blanching, discomfort, slowed infusion rate 2. Hematona – discoloration, swelling, tenderness 3. Phlebitis – tenderness, redness, heat, edema 4. Tissue Sloughing – tissue necrosis 5. Infection – tenderness, swelling, erythema, induration, purulent discharge Peripheral IVAD: give IVPB 1. Check MD orders with MAR: date/time, drug, strength/dose, route, client 2. Gather materials like med bag and tubing (need primary tubing), tape, marker, alcohol, syringes 3. Label bag and tubing – time, date, flow rate 4. Prime tubing 5. Get syringes ready – 2, 3mL saline syringes 6. 2nd check for medications
7. Calculate flow rate by looking in IV med book and Look up signs for adverse rexns 8. Take into room – med bag w/ tubing, alcohol, 2 flushes, MAR 9. Introduce self, id patient, check allergies to medication 10. Wash hands/gloves 11. Assessment of site 12. Alcohol swab and flush 13. Attach tubing and set flow rate 14. Look at site again, any pain 15. Come back when med is infused, give second flush, assess for adverse rexns Compatible Primary IV infusing: start IVPB Same steps, the difference is in the priming of tubing/ secondary tubing 1. Prime tubing when hooked to primary line on the upper Y port 2. Open all the lines, let the med bag lower than the fluids 3. Set the fluid on a hanger lower than the med bag 4. Set drip rate with fluid bag drip chamber and let med bad wide open 5. Check site again Incompatible Primary IV: start IVPB Need Primary tubing for med bag 1. 3 NS syringes with 3 mL each 2. Close off port by rolling down to lower Y clamp 3. Flush 4. Set up primary tubing at lower port 5. Set flow rate 6. Come back, flush, open clamp and roll back Peripheral IVAD: IV Push 1. Wash hands 2. Check MAR with MD orders 3. 3 checks- a) when taking from med cart b) before withdrawing med c) after withdrawing med 4. Determine med action, SE, rate of administration 5. Calculate med dosage 6. Prepare 3mL NS syringe 7. Introduce self, id patient, determine allergies, explanation 8. Wash hands, clean gloves, 9. Assess insertion site 10. Take client VS 11. Take off port cap 12. Flush lock with 1mL of NS 13. Push med 14. Flush 1mL NS 15. Replace a new sterile cap over the lock
Compatible Primary Line: Give IV Push 1. You don’t need flush because you have a flush running 2. Use the port closest to the patient 3. Alcohol swab it 4. Clamp off the primary line 5. Administer med at recommended rate 6. Unclamp tubing Incompatible Primary Line: Give IV Push 1. Need two syringes for flushes and I syringe with medication 2. Slide clamp down and close off 3. Wash hands/glove 4. Wipe port with alcohol swab 5. Flush with 2-3cc NS 6. Inject med 7. Second flush 8. Set clamp in previous position Central Line Triple Lumen Brown port used for blood withdraws With flush always use a 10cc syringe Protocols tell you how much flush to use Flushing a central catheter: 1. Wash hands, apply gloves 2. Prep 2 syringes – 10cc NS, 5cc Heparin 3. Swab injection cap/catheter hub with p-iodine and alcohol 4. Clamp catheter and remove cap 5. Check for patentcy 6. Attach syringe of NS 7. Release clamp 8. Aspirate heparin solution from catheter 9. Observe for blood return 10. Flush quickly with NS 11. Reclamp 12. Remove empty syringe Attach 5cc heparin syringe 13. Release clamp 14. Flush quickly 15. Reclamp 16. Place a new cap on catheter 17. Tape all tubing connections 18. Attach tubing to client’s clothing 19. Wash hands 20. Document: Condition of catheter, patentcy of catheter(ability to draw blood), and report: occlusion, catheter damage, air embolus Starting a Central Line Infusion 1. If patient has no fluids running, flush with NS (10cc syringe)
Look at protocols Slide clamp should be clamped off Wipe Port, and attach syringe Unclamp sliding clamp, aspirate blood**, infuse NS Before removing syringe, turn clamp off, then remove, and attach tubing 7. Turn fluids on Central Line Dressing 1. Wash hands/ clean gloves 2. Remove old dressing 3. Note drainage on dressing 4. Inspect skin at insertion site for redness, tenderness, swelling 5. Palpate catheter for Darcon cuff and document proper placement 6. Inspect Catheter 7. Remove gloves, wash hands, put on sterile gloves 8. Clean exit site with P-iodine – begin at catheter and move out in a circular motion 9. Apply ointment to exit site 10. Apply sterile gauze dressing with tape 11. Label date and time of dressing change 12. Secure tubing to clothing 13. Document: date, time, type of ointment and dressing, condition of skin, presence of exudates and bleeding WOUND CARE & STERILE TECHNIQUE Surgical Incision – wound created under sterile condition, center of the incision is cleanest 1. Clean down the middle first, go down one side then down the other with clean sponge each time 2. Drains should be cleaned last 3. Closed drain – prevents pocket of blood and bacteria, neg pressure (sanguinous – bloody drainage; serosanguinous – combination of serous and blood) 4. Change every 2 hours, and record amount of drainage Open wound – not surgically created; if it is not extremely dirty with much exudate it is not recommended to clean it bc you may destroy healing fiber 1. If it needs to be cleaned, irrigate or apply a wet-to-dry dressing 2. Center is considered most contaminated Wet-to-dry 1. Physician does not want to surgically close incision so it is left open 2. Physician does not want to close fluid inside
2. 3. 4. 5. 6.
Sterile Field 1. Open away from you and set to side, 1in margin on all sides, You can touch cloth underneath 2. Pouring Solution – Open NS can be kept 24 hrs, if it is already opened, then dump some in the trash, put bowl to the side so you do not have to reach over the sterile field, set cap down facing up 3. Adding ointment – pour some ointment in the field or put on a 4X4 4. Put on sterile gloves last after you set everything up 5. You can use forceps to move things around Sterile Gloving 1. Touch folded area 2. Make adjustments once gloves are on – watch where your fingers are, hold over a sterile area, 3. Do not lower hands below waist 4. Take glove off – dirty-to-dirty, clean-to-clean Dressing Change 1. Check MD orders for type of change, irrigation, or ointment 2. Introduce Self, Id Patient, Explain what you are going to do and why 3. Wash hands/clean gloves/privacy 4. Assessment of old dressing: Appearance and size of wound Amount, character, and odor of exudates Complaints of discomfort Local Infection: Erythema, purulent drainage, swelling, pain, inflammation Signs of systemic infection: fever, diaphoresis, and malaise 5. Determine what supplies you need by assessing the wound – number of gauzes saturated and diameter of drainage, dressing change kit, Sterile NS, tape, Neosporin 6. Remove old dressing – pull tape gently but firmly toward wound 7. Ready to set up sterile field 8. Clean wound from clean to contaminated and clean drain last (Penrose – half circle) 9. Apply new dressing Dry heat – apply 4X4 to the wound, place abd pad on top Moist heat – Wring NS out of 4X4 place on wound, dry external dressing Drain – cleanse area under drain, apply precut 4X4, top w/ 4X4 10. Document: where the wound is, intact, kind of drainage, odor, how many gauze saturated, condition of surrounding skin, presence of drains, type of solutions used for cleaning, type old dressing reapplies, client tolerance
Principles of Sterile Field 1. Tables about the waist 2. Open package in sterile field 3. Don’t put unsterile things in the field(ie. Tape) 4. Don’t turn your back on the sterile field 5. Hands above waist 6. Make sure you open everything before you put your sterile gloves on Irrigating a Wound 1. Check MD orders to determine type of irrigating solution, frequency of irrigation, and temp of the solution 2. Check irrigating solution is at proper temp 3. Introduce self, ID Patient, Explain what you are going to do 4. Wash hands/glove/privacy 5. Position the client so solution will flow into the basin 6. Place waterproof drape over client and bed 7. Discard old dressing and assess wound drainage: Appearance and size of the wound, character of exudates, signs of systemic infection, pain 8. Open sterile dressing set and supplies 9. Position basin below the wound 10. Instill a steady stream of irrigating solution into the wound, all areas 11. Continue irrigating until the solution becomes clear 12. Dry area around the wound 13. Use sterile technique to apply the dressing to the wound 14. Document: Irrigating, Pt response, character of exudates, appearance and size of wound URINARY CATHETERIZATION 1. Check MD orders and size of catheter 2. Gather catheter kit(ensure right size, exp date), drape for pt 3. Introduce self, ID patient, Ask about allergies to latex or iodine, Explain what you are going to do why necessary; Tell patient she it might feel like a voiding or urinating sensation 4. Wash hands/glove/privacy 5. Perform Abdominal Assessment: Inspect: Contour – distended; full bladder Symmetry – Shine light across, symmetrical Umbilicus – midline, no discoloration, inflammation, or hernia(lift head) Skin – smooth and even, no visible peristalsis Pulsation – Pulsations from aorta Demeanor – comfortable, relaxed Auscutate – bowel sounds present in all four quadrants
Percuss – Tympany heard in all 4 quads with dullness noted lower quads(urinary retention)
Palpate(light and deep) – no masses noted, ask for any tenderness 6. Place client in appropriate position and drape exposed areas Man – supine, legs abducted and laterally rotated Woman – Supine, knees bents, legs laterally rotated 7. Stand on the client’s right if you are right-handed 8. Bring bed to waist level 9. Drape patient 10. Open kit- first away, side-to-side, and then front 11. Place waterproof drape under butt 12. Apply sterile gloves 13. Saturate cleaning balls with antiseptic solution 14. Open lubricant 15. Open specimen container and place it nearby with lid loosely on top(if necessary) 16. Test balloon by filling it with sterile water; leave syringe attached 17. Open lubricant and pour in pocket in box 18. Let pt know when you will expose them 19. Place fenestrated drape over penis 20. Clean meatus with nondominant hand Woman: Use nondominant hand to spread labia Pick up cleansing ball with forceps Clean one side of labia majora, then other side; anteriorposterior direction Same for labia minora and use last ball to go over meatus Man: Grasp penis just below glans with nondominant hand Hold it firmly upright with slight tension Wipe center of meatus in a circular motion out 21. Grasp catheter firmly 2-3 in from tip, ask client to take a slow deep breath, and insert the catheter while pt exhaling 22. Advance catheter 2 in further after urine begins to flow 23. Next move nondominant hand to catheter and inflate the balloon with the clean dominant hand 24. Pull gently on the catheter until resistance is felt 25. Change gloves 26. Collect urine specimen(if required): Allow 20-30mL to flow into bottle with out touching the inside of the container 27. Secure catheter with enough slack to the thigh 28. Make sure bag is hung below the level of the bladder 29. Clean perineum and recover
30. Documentation: date/time, name, amount and description of urine, Catheter size and results, assessment findings, amount of water instilled into balloon Obtain a Sterile Specimen 1. Explain procedure 2. Wash hands/ gloves 3. Clamp foley until urine is seen 4. Wipe port with alcohol swab 5. Remove lid from ua bottle 6. insert needle, bevel up, and pull off 10cc 7. Put urine into cup w/out touching sides of cup 8. Discard sharps 9. Put lid back on bottle 10. Provide comfort 11. Clean up/remove gloves/wash hands 12. Documentation: Sterile specimen obtained, sent to lab, side rails up, call light within reach Draping Woman: 1. Put drape in a triangle before you put legs up 2. The point of the triangle between her legs 3. Flex knees with feet flat on the bed and spread 4. Wrap tails around legs and when you are ready, open them Male: 1. Lift gown until you see penis 2. Use bottom cover or bath blanket in between their legs GASTROINTESTINAL TUBES NG Tube Insertion 1. Check MD orders for type and size of tube 2. Gather supplies: Tube Solution basin filled with warm water Tape Lubricant Tissue Glass of water w/ straw 20-50mL syringe w/ adapter pH strips Stethoscope Towel Pen light Tongue depressor Safety pin
3. Introduce self, id patient, explain what you are going to do: it is not painful, but it may be uncomfortable bc gag reflex is activated, ask if the client has any allergies or has dentures 4. Establish a method for the client to indicate distress 5. Wash hand/ privacy 6. Abdominal Assessment: Inspect: Symmetrical, umbilicus midline without discoloration, skin smooth and even, warm to touch Pulsation: Aortal pulsation, no visible peristaltic waves Auscultate: bowel soundsX4 Percuss: Tympanyx4 Palpate: No masses, tenderness 7. Nose Assessment: Use pen light to check intactness of tissues-irritations, abrasions Examine for obstruction or deformity by asking to breath through nostril while occluding the other 8. Determine how far to insert the tube – tip of nose to tip of ear lobe to tip of xiphoid 9. Tear the tapes, one for measurement, other as trousers 10. Check patentcy of the tube 11. Gloves 12. Lubricate tip of tube well, insert tube with natural curve – Ask client to hyperextend the neck 13. Direct tube along floor of nostril 14. As tube reached the throat ask client to lean head forward and take sips of water, Which closes epiglottis 15. Ascertain correct placement by aspirating stomach contents and checking ph, auscultating air, or X-ray 16. Clamp tube, Tape tube to client’s nose and secure to gown 17. Document: Insertion of tube, means by which correct placement was checked and client response Salem slump used for suctioning and Levine for feeding Irrigation of NG Tube 1. Check MD orders 2. Gather Supplies: NS Irrigation Set Towel Stethoscope 3. Emesis Basin 4. Introduce self, ID patient, explain procedure
5. Wash hands, privacy, gloves 6. Abdominal Assessment 7. Place towel under patient 8. Semi-fowlers Position 9. If on suction disconnect tube from suction 10. Check Placement 11. Inject 20-30 cc NS into tube 12. Pull back on syringe and empty into basin 13. Instill and withdraw until tube is patent 14. Reestablish suction 15. Document: Tube patent, any problems and pt rexn, how many mLs irrigated with, and how much pulled back, color and consistency of drainage, amount and type of irrigating solution, time suction started and pressure established Intermittent Tube Feeding 1. Check MD order 2. Gather supplies: Feeding Solution Irrigation set Cup with water Emesis basin PH strip 3. Introduce self, id patient, explain procedure, ask about allergies to any food 4. Wash hands, glove 5. Abdominal Assessment 6. Verify tube placement 7. Check residual 8. Attach syringe to NG tube and fill with a small amount of contents and hold about 6 in about tube insertion 9. Fill syringe with feeding and allow to slowly flow 10. Flush with 30cc water 11. Clamp NG tube 12. Document: time of tube feeding, amount and what feeding, tube placement verified, Assessment findings, Amount of residual Continuous Feeding 1. Check MD orders, Order is give for cc/hr, do not put more than 4 hours of feeding into the bag 2. Check placement and residual 3. Prime tubing and connect to NG tube 4. Turn on pump Medication through NG tube 1. Liquid med or crushable tab that dissolves in water 2. Ensure 3 checks w/ 5 right
3. Check placement 4. Give med and follow with water Connecting NG tube to suction 1. Low-intermittent suction, watch for tube patentcy 2. Do abdominal assessment 3. Keep up with I&O Initiating Suction: 1. Semi-fowlers 2. Check Placement 3. Intermittent Suction set at 80-100 4. Check suction level by occluding drainage tube Salem sump tube(double lumen) – connect larger lumen to NG tube, smaller tube provides a continuous flow of atmospheric air to prevent excessive suction force, should always keep air vent tube higher than the stomach to prevent reflux of stomach contents and keep drainage collection chamber below the client’s stomach Levine – single lumen NG tube, smaller so it is usually for feedings 5. Coil and pin tubing so that is does not go below the suction bottle 6. Assess drainage – amount, color, odor, consistency Maintaining suction: 1. After initiating suction assess client q30min until running regularly, then q2hr 2. Assess for complains of fullness, nausea, epigastric pain, and make sure there are flow of secretions 3. Inspect for patentcy or tightness of connections 4. Relieve blockages, reposition client, rotate NG tube 5. Irrigate NG tube 6. Apply mouth care q2-4hr 7. Empty drainage receptacle: clamp NG tube, turn off suction, note amount, assess drainage, replace, turn on suction and unclamp tube TRACHEOSTOMY Trach Care 1. Check MD orders 2. Gather equipment: Stethoscope, sterile drape, sterile NS and HP, sterile 4x4 gauze, dressing 3. Introduce self, ID patient, explain what you are going to do, Tell them to raise a hand or finger to signal distress 4. Wash hands 5. Semi-fowlers position 6. Chest assessment: Inspect: Color, condition, lesions, rate, rhythm, and depth of airway Palpate: Symmetric chest expansion
Percuss: Hear resonance Auscultate: clear or crackles 7. Place towel on chest 8. Clean gloves/throw away old trach dressing 9. Wash hands 10. Establish sterile field; open and organize supplies, check exp dates 11. Pour NS and 2 HP into separate containers, 2 soaked gauze with NS, 2 soaked gauze with HP 12. Sterile gloves 13. Unlock inner cannula with nondominant hand and pull it towards you in line with curvature and place it in 14. HP solution for 2-3 min, clean with a brush and place in NS, clean 15. Insert inner cannula and lock it into place 16. Clean insertion site/stoma and tube flange, wipe once with NS gauze and discard 17. Clean faceplate first with HP gauze, next w/ NS gauge, next with dry 18. Rinse and dry area thoroughly 19. Apply sterile dressing, use commertailly prepared or open and refold 4x4 gauze to create V-shape 20. Apply dressing under flange but make sure it is supported 21. Change tracheostomy ties; enough to fit person’s neck plus 6 in 22. Discard equipment, client comfort, bed rails up, lower bed, call light 23. Wash hands 24. Document: Describe color, amount, and odor of secretions, size and type of tracheostomy in place, describe the condition of the stoma including presence of secretions, color, edema, skin breakdown Trach Suctioning Whistle tip – less irritating to tissues Open tip – more effective at removing thick mucous plugs Yankauer – Used to suction oral cavity Symptoms that indicate need for suctioning: dyspnea, bubbling, rattling breath sounds, cyanosis, decreased Sa02, inability to move secretions 1. Check MD orders 2. Gather equipment: Ambu bag, suctioning equipment, sterile drape and gloves, stethoscope(assessment), 3. Introduce self, id patient, explain what you are going to do 4. Wash hands/privacy 5. Semifowlers position/analgesic before suctioning
6. Assess patient, ant and post assessment: Inspect: skin color, conditions, and respirations Auscultate: anterior and posterior respirations Palpate: symmetric expansion of the chest, tenderness, lumps, masses Percuss: anterior/posterior 7. Attach ambu bag to O2 source 8. Open sterile supplies 9. Place sterile drape across client’s chest 10. 100-120 pressure for suction 11. Pour sterile NS in sterile container 12. Put on sterile gloves 13. Hold catheter in dominant hand and connector in nondominant hand attach suction catheter to suction tubing 14. Flush and lubricate the catheter, place catheter tip in sterile saline solution and with thumb of nondominant hand occlude the thumb control and suction a small amount of NS into the catheter 15. Hyperventilate lungs before suctioning, turn on 02 to 1215L/min, compress ambu bag 3-5 times (adequacy of ventilation is assessed by rise and fall of the chest 16. Insert catheter (w/out suction) 5 in or until cough or resistance 17. Apply intermittent suction for 5-10s, rotate catheter by rolling it between the finger and thumb 18. Withdraw completely 19. Hyperventilate and suction again 20. Encourage client to breath deeply and cough between suctioning 21. Allow 2-3 min between suctioning 22. Documentation: time/date, Findings of respiratory assessment(pre and post suctioning), description of secretions – color, amount, viscosity, odor, number of time suction catheter inserted
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