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1. Define the 3mi SUCTIONING Defining Listening Chart Can you

suctioning. define the
suctioning?
DEFINITION OF SUCTIONING
Suctioning is often required to maintain a patent airway in the patient with
an ETT or tracheostomy tube.

Suctioning is a sterile procedure that is performed only when the patient

needs it and not on a routine schedule.

INDICATIONS FOR SUCTIONING

2. List out of 2 Explaining Listening Chart List out of
the min  Coughing, the
indication  Secretions in the airway, indication of
of  Respiratory distress, suctioning.
suctioning.  Presence of rhonchi on ausculta tion,
 Increased peak airway pressures on the ventilator,
 And decreasing oxygenation saturation.

PRECAUTIONS
3. Enumerate 5 Discussing Listening Chart Give me the
of the min ans
precaution.  Bleeding risk (low platelets, raised INR, raised precautionof
APTT, coagulopathy, warfarin) of
 Haemodynamic instability suctioning?.
 Haemoptysis
 Acute face, neck, or head injury
 Septal deviation and/or prior nasal surgery
 Children
 False teeth
 Recent oral surgery
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4. Specify of 3 SUCTIONING PROTOCOL Explaining Listening Chart Can You

the min Specify of
protocol of A number of protocols regarding suctioning have been developed. Several the protocol
suctioning. practices have been found helpful in limiting the complications of of
suctioning. Hypoxemia can be minimized by giving the patient three suctioning?
hyperoxygenation breaths (breaths at 100% FIO,) with the ventilator before
the procedure begins and again after each pass of the suction catheter.
If the patient exhibits signs of desideration, hyperinflation (breaths at
150% tidal volume) should be added to the procedure.
 "Atelectasis can be avoided by using a suction catheter with an external
diameter of less than one - half of the internal diameter of the ETT.
 Using no greater than 120 mm Hg of suction decreases the chances of
hypoxemia, atelectasis, and airway trauma
 "Limiting the duration of each suction pass to 10 to 15 seconds and the
number of passes to a maximum of three also helps mini mize
hypoxemia, airway trauma, and cardiac dysrhythmias.
 "The process of applying intermittent (instead of continuous) suction
has been shown to be of no benefit.
 " The instillation of normal saline to help remove secretions has not
proved to be of any benefit,
 " and it may actually contribute to the development of hypoxemia, as
well as lower airway colonization, resulting in ventilator-associated
pneumonia (VAP)

5. Explain of 3 ARTICLES Discussing Listening Chart Explain of

the articles min the articles
of  Oxygen source and vacuum with collection container (calibrated) of
suctioning.  Personal protective equipment including gloves, masks, and goggles suctioning?.
(clean and sterile)
 Sterile saline
 Manual resuscitation bag for ventilation
 Monitoring equipment, including a stethoscope and continuous
measurement of pulse oximetry and heart rate.
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 A sterile suction catheter (preferably 2 different sizes, one being

smaller than the appropriate size needed
 Additional medications as needed for comfort

6. Describe of PROCEDURE Discussing Listening Demo Describe of

the 5 nstrati the
procedure min Gather all equipment. on procedure of
of Wash hands and don personal protective equipment. suctioning?
suctioning. Explain procedure and patient's role in assisting with secretion removal
by coughing.
Monitor patient's cardiopulmonary status (e.g. vital signs, SpO, SVO,
Scvo, ECG, level of consciousness) before during, and after the
procedure. ,
Turn on suction and set vacuum to 100-120 mm Hg .
Pause ventilator alarms.
 Set up suction equipment.
 Position patient's head to the side or place in semi - Fowler's position
 Provide suction, as needed, to patients with an artificial airway to
remove any oropharyngeal and subglottic secretions (those secretions
that migrate down the tube and settle on top of the cuff).
 Brush teeth using suction toothbrush and small amounts of water and
alcohol - free antiseptic oral rinse
 Brush for approximately 1 to 2 minutes
 Exert gentle pressure while moving in short horizontal or circular
strokes
 Gently brush surface of tongue
 Use suction swab to clean the teeth and tongue if brushing causes
discomfort or bleeding
 Place swab perpendicular to gum line , applying gentle mechanical
action for 1 to 2 minutes
 Tum swab in clockwise rotation to remove mucus and debris
 Swab mouth with 15 mL of 0.12 % chlorhexidine every 12 hours.
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 Apply mouth moisturizer inside mouth, lip balm, if need.

7. Discuss of TYPE OF SUCTION Explaining Listening Chart Give me the

the type 3 ans of the
suctioning. min type
1. OPEN SUCTION TECHNIQUE:
suctioning?
In this technique ventilator is disconnected from the patient and
hyperoxygenation is given for the patient for 30 seconds and suction is
done.
 Open sterile catheter package using the inside of the package as a
sterile field.
 Fill the sterile solution container with sterile normal saline or water .
 Don sterile gloves.
 Pick up sterile suction catheter with dominant hand .
 Using nondominant hand , secure the connecting tube ( to suction ) to
the suction catheter .
 Check equipment for proper functioning by suctioning a small volume
of sterile saline solution from the container.

2. CLOSED - SUCTION TECHNIQUE:

The CST uses a suction catheter that is enclosed in a plastic sleeve
connected directly to the patient - ventilator circuit.
 In this oxygenation and ventilation are maintained during suctioning,
and exposure to the patient's secretions is reduced.
 The CST should be considered for patients who require high levels of
positive end - expiratory pressure (PEEP ) ( > 7 to 8 cm H 2O ), who
. have bloody or infected pulmonary secretions, who require frequent
suctioning
 And Who Experience Clinical Instability clinical instability with the
OST Connect the suction tubing to the closed suction port.
 Hyperoxygenate the patient for 30 seconds using one of the following
methods :
 Activate the suction hyperoxygenation setting on the ventilator using
nondominant hand.
 Increase FIO, to 100%.
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Note: FIO must be returned to baseline level at the completion of the

procedure. Describing Listening Chart

Disconnect the ventilator tubing from the ET tube and manually ventilate
the patient with 100% O, using a bag valve - mask (BVM) device.
Administer 5-6 breaths over 30 seconds.
Note: Use of a second person to deliver the manual breaths will
significantly increase the tidal volume delivered.
With suction off, gently and quickly insert the catheter using the dominant
hand.

When resistance is met, pull back 1½ inches. - Apply continuous

Administer 5-6 breaths over 30 seconds.
Note: Use of a second person to deliver the manual breaths will
significantly increase the tidal volume delivered. With suction off , gently
and quickly insert the catheter using the dominant hand .

When resistance is met, pull back 1½ inches.

Apply continuous or intermittent suction using the nondominant thumb.
Rotate the catheter between the dominant thumb and forefinger and
withdraw the catheter over 10 seconds or less. Hyperoxygenate for 30
second. If secretions remain and the patient has tolerated the procedure,
two to three suction passes.
Note: Rinse the suction catheter with sterile saline solution between
suctioning passes as needed.

Reconnect patient to ventilator (open-suction technique).

At the completion of suctioning, rinse the catheter and connecting tubing
with the sterile saline solution.
Reset FIO, (if necessary) and ventilator alarms. Reassess patient for signs
of effective suctioning.
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CHANGING TRACHEOTOMY DRESSINGS. Explaining Listening Chart

 It is very important to change tracheotomy dressings as soon as they

become soiled.
 While changing the tracheotomy ties or holders, one nurse holds the
tube in place while the other removes the old ties or holders and
replaces them with new.
 Never tie tracheotomy ties with a bow.
 Ties should always be tied with a square knot.

SKIN CARE

The care of the skin around the stoma site should be considered one of the
more important procedures in the care of the tracheostomy patient. The
new surgical site needs to be cleaned and dressed frequently as it heals. As
the incision heals, the frequency will decrease. Reassess patient for signs
of effective suctioning
8. Point out of Discussing Listening Chart
the 2 COMPLICATIONS OF SUCTIONING Point out of
complicatio min the
n.  Hemorrhage complicatio
 Wound infection n?
 Tracheitis.
 Pneumonia
 Subglottic edema
 Tracheal stenosis
 Hypoxemia,
 Atelectasis,
 Broncho spasms,
 Dysrhythmias,
 Increased intracranial pressure,
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 And airway trauma.