298, ‘Skill Checklists for Taylor's Clinical Nursing Skills: A Nursing Process Approach, 3rdedition | Nome bate | uni, Postion | tnstuctorevattor rostion | | SKILL 148 | eS 2 Suctioning an Endotracheal Tube: OpenSystem B ZF | Goats mepatientexhibitsimproved breathsoundsandaclear a a = _| patent airway. Comments 1. Bring necessary equipmenttto the bedside stand or overbed table. Perform hand hygiene and put on PPE, ifindicated. Identify the patient. 4. Close curtains around bed and elose the door ta the r% possible, 5, Determine the need for suctioning, Verify the suction order in the patients chart. Assess for pain or the potential to cause pain. Administer pain medication, as prescribed, before suctioning. 6. Explain what you are going to do and the reason for doing it to the patient, even ifthe patient does not appear to be alert. Reassure the patient you will interrupt the procedure {the or she indicates respiratory diffculy. 7. Adjust bed to comfortable working position, usualy elbow height of the caregiver (VISN 8 Patient Safety Center, 2009), Lower side ral closest to you. If patient ss conscious, place him or her in a semi-Fowler’s position. Ifpatient is uncon- ‘scious, place him or her in the lateral position, facing you. ‘Move the averbed table clase to your work area and raise I to waist height. £8, Place towel or waterproof pad across patient's chest 9. Turn suction to appropriate pressure. Fora wall une for an adult: 100-120 mm Hg (Roman, 2008); neonates: 60-80 mm Hg; infants: 80-100 mm tgs children; 80-100 mm Hg: adolescents: 80-120 mm Hy (ireton, 2007). For a portable unit for an adult: 10-15 em Hg; neonates: 6-8 cm Hg; infants 8-10 om Hg; children 8-10 em Hg; adolescents: #10 em Hg. 10. Put ona disposable, clean glove and occlude the end of the ‘connecting tubing to check suction pressure. Pace the con- necting tubing in a convenient location. Place the resuscita- tion bag connected to oxygen within convenient reach, if using ‘pyigt 2201 yesh pint Ws Wiis Shc orfoers Calan299 SKILL 14-8 Suctioning an Endotracheal Tube: Open System (Continued) Satisfactory Needs Practice Excellent Comments —— — —| 12 open sterite suetion package using aseptic technique, The open wrapper becomes a storile field to hold other supplies. Carefully remove the sterile container, touching ‘only the outside surface. Sot it up on the work surface and pour sterile saline into i 12, Pat on-ace shiold or goggles and mask: Puton sterle-— gloves. The dominant hand will manipulate the eatheter| ‘and must remain sterile. The nondominant hand is ‘considered clean rather than sterile and will control the suction valve (Y-port) on the catheter, —— — —_| 15.With dominant gloved hand, pick up sterile catheter. Pick ‘up the connecting tubing with the nondominant hand and connect the tubing and suction catheter. —— —— —_ | 14 Moisten the catheter by dipping it into the container of sterile saline, unless itis silicone catheter. Occlude V-tube tocheck suction, —— —— —_ | 15-Hyperventitate the patient using your nondominant hand and a manual resuscitation bag and delivering three to shxbreaths or use the sigh mechanism on a mechanical ventilator. —— — —__| 16 open the adapter on the mechanical ventilator tubing or ‘remove themanual resuscitation bag with your nondotn nanthand, —— —— — | 17.Using your dominant hand, gently and quickly insert the ‘catheter into the trachea. Advance the catheter to the pre- determined length. Do not occlude Y-port when inserting ‘the catheter. —— — —_ | 18 Appiy suction by intermittently occluding the Y-port on the catheter with the thumb of your nondominant hand, and gently rotate the catheter as itis belng withdrawn. Do not suction for more than 10 to 15 seconds ata time. —— —— —_ | 19. Hypervenuiate the patient using your nondominant hand ‘and a manual resuscitation bag and delivering three to six breaths. Replace the oxygen delivery device, applicable, using your nondominant hand and have the patient take several deep breaths. the patient is mechanically rentilated, close the adapter on the mechanical ventilator — mee bing orrepl jatortubingandusethesig ‘mechanism on a mechanical ventilator ‘ope 020i octetewer Hath Upc Wes Wine Su hector T inl igi ‘Anu Ps Acc et Stan bP yore300, SKILL 14-8 Suctioning an Endotracheal Tube: Open System (Continued) Excellent Satisfactory Needs Practice Comments 20. lush catheter with saline. Assess the effectiveness of ‘suctioning and repeat, as needed, and according to patient’ tolerance. Wrap the suction catheter around yout dominant hand between attempts. 21. Allow at least a:30-second to I-minute interval additional ‘suctioning Is needed. No more than three suction passes should be made per suctioning episade. Suction the orophar- yynx after suctioning the trachea. Do not reinsertin the endo- tracheal tube after suctioning the mouth 22. When suctioning is completed, remove gloves from dom nnant hand over the coiled catheter, pulling it off inside-out, Remove glove from nondominant hand and dispose of ‘loves, catheter, and container with solution in the appro- prlate receptacle. Assist patient to confortable postion, Raise bed ral and place bed in the lowest postion. 23. Turn off suction, Remove face shield or goggles and mask Perform hand hygiene. —— —— ___ | 24.offer oral hygiene after suctioning. 25, Reassess patient's respiratory status, including respiratory rate, effort, oxygen saturation, and lung sounds. 26. Remove additional PPE, (fused. Perform hand hyglene spigh a012byWotersioneet | lacs illan is Schecter i "rig Poe: ppech Sraeton by Fels tn nda aon