ENDOTRACHEAL/ TRACHEAL SUCTIONING PROCEDURE ‘oBlECTIVES: ‘The nurse performs endotracheal & tracheot 1, Maintain a patent airway 2. Improve oxygenation and reduce the work of breathing 3, Remove accumulated tracheobronchi ara ronchial secretio q . 4. Stimulate the cough renee jal secretions using sterile technique. 5. Prevent pulmonary aspiration of 6. Prevent infection and atelectasis tomy suctioning to : ‘blood and gastric fluids EQUIPMENT: sterile normal saline - Xo Suction source ‘Oe ‘Ambu bag connected to 100% 02 -N = pa un WA Clear protective googles/mask or face shield coh expe : sterile gloves for open suction Clean gloves for (in-line) closed suction Stull el sterile catheter with intermittent suction control in het ort or in-line suction catheter i gecrersed DE PROCEDURE: Lanypoxte 1. Wash hands. Reduces transmission of microorganisms Ly train damage, 2. Access the need for suctioning. Since endotracheal can be hazardous and causes discomfort, it is not recommend in the absence of apparent need RUIWPIE GTN FAHUrE - Coarse breathe sounds Coughing; increased respirations pie Ke increased PIP on ventilator 3. Don goggles and mask or faced shield. Potential for contamination 4, Tum on suction apparatus and set vacuum regulator to appropriate negative pressure. Recommend 80-120 mm HG; adjust lower for children and elderly. Significant hypoxia and damage tracheal mucosa can result from excessive negative pressure. 5. Prepare suction apparatus. Secure one and of connecting tube to suction machine, and place other end in a convenient location within reach. 6. Use inline suction catheter or open sterile package (catheter size not exceeding one half the inner diameter of the airway) on a clean surface, using the inside of the wrapping as a sterile filed. 7. Prepares catheter and prevents transmission of microorganisms. Catheters exceeding one- half of the diameter increases possibilty of suction induce hypoxia and atelectasis. 8 Prepare catheter flushed solution with in-lined catheter used sterile saline bullets to flush catheter. With regular suctioning set up sterile solution container and being careful not to touch the inside of the container fill with enough sterile saline or water to flush catheter 9. With in-line suction catheter use clean gloves. With regular suction, done sterile gloves. Maintain sterility. Universal precautions. Irregular suction the dominant hand must remain sterile throughout the procedure. 40. Pick up suction catheter, being careful to avoid touching non sterile surfaces. With non dominant hand, pick up connecting tubing. Secure suction catheter to connecting tubing. ‘Maintains catheter sterility. Connects suction catheter and connecting tubing.11, Insures equipment function. Check equipment for proper functioning by suction a small amount of sterile by suctioning a small amount of sterile saline from the container, ( skip this step in in- line suction) 12, Removed or open oxygen or humidity device to the patient with non dominant hand (skip this step wit = suctioning) opens artificial airway for catheter entrance, Have second person assist when indicated to avoid unintentional extubation. 13. Replace 02 delivery device or reconnect patient to the ventilator, Hyperoxygenate and hyperventiate via three breaths by giving patient addtional manual breaths on the ventilator before suction. Hyperonygenation with 100% 02 is used to offset hypoxemia during interrupted eee lation. Pre oxygenation offsets volume and 02 loss with suctioning. 4. Without applying ould be suctioned through an adapter on the closed suction system : u ‘out applying gently but quickly insert catheter with dominant hand. Inspiration until resistance is met; then pull back 2 to 2 centimeter. Catheter is now in tracheobronchial tree. Application of suction pressure upon insertion increases hypoxia and results in damage to the tracheal mucosa, 45. Apply intermittent suetion by placing and releasing dominant thumb over the control vent of the catheter. Rotate the catheter between the dominant thumb and forefinger as you slowly withdraw the catheter. With intine suction, apply continuous suction by depressing suction valve and pull catheter straight back, Time should not exceed 10-15 seconds. Intermittent Suction and catheter rotation prevent tracheal mucosa when using regular suctioning methods. Unable to rotate with closed-suction method. Replace oxygen delivery device, Hyperoxygenate between passes of catheter and following suctioning procedure. Replenishes 02. Recovery to base. PaO? takes 1 to 5 minute. Reduces incidents of hypoxemia and atelectasis, 16. 17. Rinse catheter and connecting tubing with normal saline until clear. Removes catheter secretions. Monitor patient's cardiopulmonary status during and between suction passes. Observe for signs of hypoxemia, e.g. dysrhythmias, cyanosis, anxiety, bronchospasms, and changes in mental status. 18. 19. Once the lower airway has been adequately cleared of secretions, perform nasal and oral pharyngeal or upper airway suctioning. Removes upper airway secretions. The catheter is contaminated after nasal and oral pharyngeal suction and should not be reinserted into the endotracheal or tracheostomy tube. 20. Upon completion of upper airway suctioning, wrap catheter around dominant hand. Pull gloves off inside out. Catheter will remain in glove. Pull off other gloves in same fashion and discard. ‘Tur off suction device. Reduces transmission of microorganisms. Reposition patient. Supports ventilator effort promotes comfort communicates caring attitude. Reassess patient's respiratory status. Indicates patient's response to suctioning. Dispose of suction liners and connecting tubing, sterile saline solution every 24 hours and set up new system. Decreases incidents of organism color contamination. Universal precautions 24. 22. 23. ation and subsequent pulmonary PRECAUTIONS 1. Minimize suctioned-induce atelactasis and hypoxemia 2. Avoid using catheters larger than one half the diameter of the airway. b. Administer one or more post suction hyperinflations, using manual or sigh breaths on the ventilator or ambu bag if not ventilated.= 2, Maintain rigorous sterile technique when suctioning the intubated Patient, Impaired pulmonary defense systems and invasive instrumentation of the pulmonary tract predisposes these patients to colonization and infection. Never use same catheter to suction the trachea after It has been used in the nose or the mouth, 3, Limit the frequency of suctioning and avoid, as much as possible, catheter impaction in the bronchial tree when the patients is anticoagulated or when hemorrhage from suction-induced trauma is evident. 4, Minimize the frequency and duration of suctioning when patient is on positive end-expiratory pressure (PEEP) greater than 5 cm or continuous positive airway pressure (CPAP). Small suctioning-induced changes may have profound effects on these on these marginally oxygenated patients. 5, Maintain awareness of the imitations of ET/tracheal suctioning. Maneuvers and catheter design have been proposed to increase the likelihood of passage into the left bronchus; however, these have been shown to be of limited success. Because the left main stem bronchus emerges from the trachea at the 45-degree angle from the vertical, suction catheters are almost inevitable passed into the right bronchus (when they pass the carina) despite head-turning, etc. 6. The use of saline installations for loosening secretions has been controversial and recent research shows that in fact itis detrimental and poses a greater risk of pneumonia for the patient. RELATED CARE: 1. Include strategies to move secretions through peripheral airways. These measures are: appropriate hydration and adequate humidification of inspired gases (to keep secretions thin); coughing and deep breathing; frequent position changes (may need rotation bed); chest therapy; and bronchodilating agents as ordered. r the patient carefully during ET/tracheal suctioning for ectopic dysrhythmias aggravated by suction-induced hypoxemia and other dysrhythmias, particularly conduction disturbances, related to catheter irritation of vagal receptors within the respiratory tract (requires immediate cessation of suctioning and hyperoxygenation). POTENTIAL COMPLICATIONS: eo syporemia Le ganey ame) io Atelectasis { We Dysrhythmias y Nosocomial pulmonary tract infection l poe Sepsis : ore Mucosal trauma with increase secretions ee 0 a Cardiac arrest py of gre?