Sign In
Equipment Tracking
Suctioning Orders The RT will automatically suction orally / nasally as indicated. No orders needed Nasotracheal suctioning should be performed only when absolutely necessary and other methods to remove secretions from the airway have failed Tracheal suctioning will be done as needed for all artificial airways. No order needed Patients should be suctioned on a PRN basis as well as in accordance of the VAP bundle process Cleaning Disposable-change only as needed Indications Maintain a patent airway Remove saliva, pulmonary secretions, blood, vomitus, or foreign material from trachea Chest auscultation of course, gurgling breath sounds, rhonchi or diminished breath sounds Stimulate cough Increased airway pressure Changes in monitored flow and pressure graphics Obtain sputum sample for analysis Contraindications Absolutely contraindicated for epiglottitis / croup Nasal bleeding Coagulopathy or bleeding disorder Laryngospasm Bronchospasm Nasal aspirators (neonares devices/NeoTech Devices) This is a device run on a suction regulator designed to suction the nares / mouth StepsPlace the device into a naris creating a seal around the device Occlude the suction port Do not place too far into the naris as this can cause mucosal damage and bleeding The device should be run at 60-100cmH2O General In mechanically ventilated patients, the artificial airway should be suctioned at least q12 hours Suctioning should last no longer than 10 seconds To know how deep to suction an ETT with an inline ballard suction catheterMeasure depth by lining up a number on the ETT with the same number on the suction catheter then read the color at the window of the saline port Catheter size should not exceed half the inner diameter of the artificial airway (ETT) Suction pressure settingsInfant Pediatric Adolescent Oropharyngealmay be set on the full suction setting for emergent situations such as vomiting If using an ETT of size 6 or greater a subglottic suction ETT should be used unless requested differently by the physician When using a subglottic suction ETT; the suction pressure should be set at 100-150mmHg on the Intermittent setting Outcomes are you looking for after suctioning Improvement in breath sounds Improvement in arterial blood gas values (ABGs) or saturation as reflected by pulse oximetry (SpO2) Removal of secretions Improved work of breathing Patency of the airway Improvement in arterial blood gas values (ABGs) or saturation as reflected by pulse oximetry (SpO2) Improved VentilationDecreased peak inspiratory pressure (PIP) with narrowing of PIP – P plateau (Plateau Pressure) Decreased airway resistance or increased dynamic compliance Increased tidal volume delivery during pressure-limited ventilation Suctioning guidelines for Saline Use Routine suctioning Purpose is to keep the airway clear only Suction airway only Saline used to clean the catheter only Do not place saline down the airway Therapeutic Suctioning to improve lung volume Usually when treatments are ordered or waveform/breath sounds indicate need Suction to the end of the airway only and request that the patient coughFollow up with clearing the catheter only with saline If a patient is unable to cough on request, give therapeutic treatment (ipv,cpt,lung inflation therapy ect.) to stimulate cough. Follow up with clearing the catheter only with saline If patient unable to clear the airway (plug) and unable to stimulate cough Use saline down the airway to stimulate cough or dislodge plugSuction to the end of the airway only Clear catheter with saline Medically paraylized patient or cough not intact Tussive squeeze (if appropriate) if therapy not effective to increase expiratory flow to move secretions Suction to the end of airway Follow up with clearing the catheter only with saline If Tussive squeeze contraindicated, use of saline to aid in clearing secretions allowed