Jon Ray R.

Lopez BSN-IIID

SUCTIONING
(NASO/OROPHARYNGEAL)

1. Determine need for suctioning. Administer pain medication before suctioning to postoperative patient.

2. Explain procedure to patient.
3. Assemble equipment.
4. Perform hand hygiene.
5. Adjust bed to comfortable working position. Lower side rail closetto you. Place patient in a semi-Fowler’s position if he or
she is conscious. An unconscious patient should be placed in the lateral position facing you.
6. Place towel or waterproof pad across patient’s chest.
7. Turn suction to appropriate pressure.
a. Wall unit
·        Adult: 100 to 120 cm Hg
·        Child: 95 to 110 cm Hg
·        Infant: 50 to 95 cm Hg
b. Portable unit
·        Adult: 10 to 15 cm Hg
·        Child: 5 to 10 cm Hg
·        Infant: 2 to 5 cm Hg
8. Open sterile suction package. Set up sterile container, touching only the outside surface, and pour sterile saline into it.
9. Don sterile gloves. The dominant hand that will handle catheter must remain sterile, whereas the nondominant hand is
considered clean rather than sterile.
10. With sterile gloves. The dominant hand, pick up sterile catheter and connect to suction tubing held with unsterile hand.
11. Moisten catheter by dipping it into container of sterile saline. Occlude Y-tube to check suction.
12. Estimate the distance form earlobe to nostril and place thumb and forefinger of gloved hand at that point on catheter.
13. Gently insert catheter with suction off by leaving the vent on the Y-connector open. Slip catheter gently along the floor of
an unobstructed nostril toward trachea to suction the nasopharynx. Or insert catheter along side of mouth toward trachea to
suction the oropharynx. Never apply suction as catheter is introduced.
14. Apply suction by according suctioning port with your thumb. Gently rotate catheter as it is being withdraw. Do not allow
suctioning to continue for more than 10 to 15 seconds at a time.
15. Flush the catheter with saline and repeat suctioning as needed and according to patient’s toleration of the procedure.
16. Allow at least a 20- to 30-second interval if additional suctioning is needed. The nares should be alternated when
repeated suctioning required. Do not force the catheter through the nares. Encourage patient to cough and breathe deeply
between suctioning.
17. When suctioning is completed, remove gloves inside out and dispose of gloves, catheter, and container with solution in
proper receptacle. Perform hand hygiene.
18. Use auscultation to listen to chest and breath sounds to assess effectiveness of suctioning.
19. Record time of suctioning and nature and amount of secretions. Also note the character of the patient’s respirations
before and after suctioning.
20. Offer oral hygiene after suctionin
Jon Ray R. Lopez BSN-IIID

SKIN TESTING
1.Ask patient if he/she has had:

a. Positive results to tuberculin skin testing (TST) in the past.

b. Received BCG vaccine in the past. (Bacille Calmette Guenin is a type of TB vaccine).

c. Recent viral disease or immuno-suppression by disease, medications or steroids.

d. If mumps skin test is to be done, ask patient if he/she has an allergy to chicken or eggs.

2. Obtain prescribed antigen(s) from the medication refrigerator or the Pharmacy and draw up into syringe. Be sure to remove all
bubbles so as to avoid “splash reactions” which reduce precision of antigen testing.

3. Obtain a Tuberculin syringe. Grab a sterile water.

4. fill the tuberculin syringe with sterile water up to 0.9 cc and mix 0.1cc of the prescribed medication

5. Cleanse the injection site with alcohol and allow to dry.

6 .Administer the prescribed test as an intradermal injection in the volar or dorsal surface of the arm about four inches below the
elbow. A discrete, pale elevation of the skin (a wheal) 6mm to 10mm in diameter should be produced.

a. If the first test was planted improperly, another test can be given at once, selecting a site at least 5
centimeters away from the original injection.

7. Circle the injection site with an indelible ink pen for later identification.

8. Assess patient for any acute hypersensitivity or anaphylactic reactions.

9. Assess site between 30 and 45 minutes after injection. Measure the diameter of the induration (in millimeters) perpendicularly
to the long axis of the forearm. Assess for redness and itchiness around the injection site. Use a tuberculin skin test gauge for
measurement.
10. Report to the physician if any complications occur.

11. Document findings to the form.

Jon Ray R. Lopez BSN-IIID

Electro Cardiogram(ECG) Procedure

Procedure:

A. Assess patient and monitor cardiac status.

B. Administer oxygen per patient condition as tolerated.
C. If patient is unstable, definitive treatment is the priority. If the patient is stable or stabilized after treatment, perform a 12-lead
ECG.
D. Prepare ECG monitor and pre-cordial lead cables.
E. Enter patient demographic data.
F. Expose the chest and prep as necessary. Modesty should be considered.
G. Apply chest leads and limb leads as follows:
I. RA----right arm
II. LA----left arm
III. RL----right leg
IV. LL----left leg
V. V1----4th intercostal space at right sternal border
VI. V2----4th intercostal space at left sternal border
VII. V3----Directly between V2 and V4
VIII. V4----5th intercostal space at midclavicular line
IX. V5----Level with V4 at the left anterior axillary line
X. V6----Level with V5 at the left midaxillary line
H. Instruct patient to remain still.
I. Press the 12 lead acquisition button on the monitor.
J. If the monitor detects a problem, such as loose leads, bad connection, noisy data, the monitor will alarm. The EMT-P should
address the problem.
K. Once acquired, transmit to the appropriate receiving facility.
L. Contact the receiving facility to notify them of the patient and the incoming 12-lead.
M. Monitor and reassess the patient enroute and continue treatment protocol.
N. Attach a copy of the 12-lead with the patient’s record at the hospital.
O. Document the procedure, time, results and findings on the ACR.
Jon Ray R. Lopez BSN-IIID

Adult basic life support sequence

Basic life support consists of the following sequence of actions:

1. Make sure the victim, any bystanders, and you are safe.

2. Check the victim for a response.

 Gently shake his shoulders and ask loudly, ‘Are you all right?’

3A. If he responds:

 Leave him in the position in which you find him provided there is no furtherdanger.
 Try to find out what is wrong with him and get help if needed.
 Reassess him regularly.

3B. If he does not respond:

 Shout for help.

 Turn the victim onto his back and then open the airway using head tilt and chin lift:
 Place your hand on his forehead and gently tilt his head back.
 With your fingertips under the point of the victim's chin, lift the chin to open the airway.

4. Keeping the airway open, look, listen, and feel for normal breathing.

 Look for chest movement.

 Listen at the victim's mouth for breath sounds.
 Feel for air on your cheek.

In the first few minutes after cardiac arrest, a victim may be barely breathing, or taking infrequent, noisy, gasps. This is often termed
agonal breathing and must not be confused with normal breathing.

Look, listen, and feel for no more than 10 s to determine if the victim is breathing normally. If you have any doubt whether breathing
is normal, act as if it is not normal.

5A. If he is breathing normally:

 Turn him into the recovery position (see below).

 Summon help from the ambulance service by mobile phone. If this is not possible, send a bystander. Leave the victim
only if no other way of obtaining help is possible.
 Continue to assess that breathing remains normal. If there is any doubt about the presence of normal breathing, start
CPR (5B).

5B. If he is not breathing normally:

 Ask someone to call for an ambulance and bring an AED if available. If you are on your own, use your mobile phone to
call for an ambulance. Leave the victim only when no other option exists for getting help.
Jon Ray R. Lopez BSN-IIID

Start chest compression as follows:

 Kneel by the side of the victim.

 Place the heel of one hand in the centre of the victim’s chest (which is the lower half of the victim’s sternum
(breastbone)).
 Place the heel of your other hand on top of the first hand.
 Interlock the fingers of your hands and ensure that pressure is not applied over the victim's ribs. Do not apply any
pressure over the upper abdomen or the bottom end of the sternum.
 Position yourself vertically above the victim's chest and, with your arms straight, press down on the sternum 5 - 6 cm.
 After each compression, release all the pressure on the chest without losing contact between your hands and the
sternum. Repeat at a rate of 100 - 120 min-1.
 Compression and release should take an equal amount of time.

6A. Combine chest compression with rescue breaths:

 After 30 compressions open the airway again using head tilt and chin lift.
 Pinch the soft part of the victim’s nose closed, using the index finger and thumb of your hand on his forehead.
 Take a normal breath and place your lips around his mouth, making sure that you have a good seal.
 Blow steadily into his mouth whilst watching for his chest to rise; take about one second to make his chest rise as in
normal breathing; this is an effective rescue breath.
 Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest to fall as air comes out.
 Take another normal breath and blow into the victim’s mouth once more to give a total of two effective rescue breaths.
The two breaths should not take more than 5 s. Then return your hands without delay to the correct position on the
sternum and give a further 30 chest compressions.
 Continue with chest compressions and rescue breaths in a ratio of 30:2.
 Stop to recheck the victim only if he starts to show signs of regaining consciousness, such as coughing, opening his eyes,
speaking, or moving purposefully and starts to breathe normally; otherwise do not interrupt resuscitation.

If the initial rescue breath of each sequence does not make the chest rise as in normal breathing, then, before your next attempt:

 Check the victim's mouth and remove any visible obstruction.

 Recheck that there is adequate head tilt and chin lift.
 Do not attempt more than two breaths each time before returning to chest compressions.
 If there is more than one rescuer present, another should take over CPR about every 1-2 min to prevent fatigue. Ensure
the minimum of delay during the changeover of rescuers, and do not interrupt chest compressions.

6B. Compression-only CPR

 If chest compressions only are given, these should be continuous at a rate of 100 - 120 min-1.
 Stop to recheck the victim only if he starts to show signs of regaining consciousness, such as coughing, opening his eyes,
speaking, or moving purposefully and starts to breathe normally; otherwise do not interrupt resuscitation.

7. Continue resuscitation until:

 qualified help arrives and takes over,

Jon Ray R. Lopez BSN-IIID

 the victim starts to show signs of regaining consciousness, such as coughing, opening his eyes, speaking, or moving
purposefully and starts to breathe normally, OR
 you become exhausted.

Nasogastric Tube (NGT) Insertion

1. Gather equipment
2. Don sterile gloves
3. Explain the procedure to the patient and show equipment
4. If possible, sit patient upright for optimal neck/stomach alignment
5. Examine nostrils for deformity/obstructions to determine best side for insertion
6. Measure tubing from bridge of nose to earlobe, then to the point halfway between the end of the sternum and the navel
7. Mark measured length with a marker or note the distance
8. Lubricate 2-4 inches of tube with lubricant (preferably 2% Xylocaine). This procedure is very uncomfortable for many patients,
so a squirt of Xylocaine jelly in the nostril, and a spray of Xylocaine to the back of the throat will help alleviate the discomfort.
9. Pass tube via either nare posteriorly, past the pharynx into the esophagus and then the stomach.
10. Instruct the patient to swallow (you may offer ice chips/water) and advance the tube as the patient swallows. Swallowing of
small sips of water may enhance passage of tube into esophagus.
11. If resistance is met, rotate tube slowly with downward advancement toward closes ear. Do not force.
12. Withdraw tube immediately if changes occur in patient's respiratory status, if tube coils in mouth, if the patient begins to cough
or turns pretty colours
13. Advance tube until mark is reached
14. Check for placement by attaching syringe to free end of the tube, aspirate sample of gastric contents. Do not inject an air
bolus, as the best practice is to test the pH of the aspirated contents to ensure that the contents are acidic. The pH should be
below 6. Obtain an x-ray to verify placement before instilling any feedings/medications or if you have concerns about the
placement of the tube.
15. Secure tube with tape or commercially prepared tube holder
16. If for suction, remove syringe from free end of tube; connect to suction; set machine on type of suction and pressure as
prescribed.
17. Document the reason for the tube insertion, type & size of tube, the nature and amount of aspirate, the type of suction and
pressure setting if for suction, the nature and amount of drainage, and the effectiveness of the intervention