Artificial Airway: Suctioning
01/07/2013
Equipment水煮牛肉的家常做法
个人艺术照欣赏
Open suction :
• Checked and operational Suction Regulator / and Suction t
• Suction tubing
• Sterile suction catheters: the size of the suction catheter should occlude no more than half of the internal diameter of the artificial airway to avoid greater negative pressures in the airway and to potentially minimize falls in PaO2
馆员
• Suction trolley
• Yankeur sucker
• Sterile water or saline
• Sterile gloves (two person suction advid)
• Hand ventilating bag
• Oxygen
• Spare face mask of appropriate size for individual patient
• Protective eyewear and face mask (as required)
Clod-suction system:
• Checked and operational suction Regulator / and Suction t
• Suction tubing
• Yankeur sucker
• Clean gloves
• Sterile water or saline
• Hand ventilating bag
• Oxygen
• Protective eyewear and facemask (as required)
Recommended Practice
NOTE:
• This intervention does not address concerns specific to patients with cerebral injury
• Two person suction is advid to ensure airway integrity
• Asss whether patient requires suctioning. Possible indications FOR suctioning:
• Coar breath sounds on auscultation
• Reduced/abnt breath sounds on auscultation
• Spontaneous coughing
• Audible or visible cretions in the airway
• Incread respiratory effort
• Worning oxygen saturation or blood gas results
• Maintenance of airway patency
• Collection of sputum specimens
• Stimulation of the cough reflex in unconscious patients
• Increasing airway pressures
NOTE:
• If the patient is able to cough up their own cretions, they should be encouraged to do so. POTENTIAL COMPLICATION OF SUCTIONING:
• Hypoxia
• Cardiac arrhythmias
• Trauma to tracheal mucosa
• Accidental extubation/decannulation
• Tube migration
• Patient anxiety
NOTE:
• Repetition of suctioning, vigour of inrtion, level of suction applied, and continuous or intermittent suction may all contribute to tracheal tissue damage. Increasing suction pressure and duration of suctioning has been shown to increa tracheal trauma and lung volume loss / atelectasis.
KEY POINTS:
• Ensure suction tubing is accessible and suction is functioning. Using “occlude to t”method lect appropriate negative pressure on the suction regulator and confirm its function ( a pressure of 80 to 100 mm Hg. is recommended for pediatric cas and up to 150mm Hg in the adult patient)
• Throughout procedure monitor;
• SaO2 (where oximetry available)
• Respiratory status (i.e. patient’s colour, chest expansion and inspiration)
• Haemodynamic status (where continuous monitoring insitu)
柠檬的作用与功效
• A maximum of two pass is recommended
• A maximum of 10-15 conds is recommended
OPEN-SUCTION
• Preoxygenate patient (u ventilator, if patient is ventilated )
• Open sterile gloves and suction catheter packages
• Perform hand hygiene, don sterile gloves古埃及壁画
• Maintain aptic technique (with hand designated for suction) throughout the procedure • Pick up suction catheter, connect to suction tubing
• Detach endotracheal/tracheal mount or tracheostomy mask and place on disposable towel.• Inrt suction catheter gently down tracheal tube until about 2cm beyond the end of the ET tube or tracheostomy. Do not apply suction while inrting catheter
• Withdraw catheter gently (whilst applying suction) ensuring the whole procedure lasts less then 10-15 conds
• Reconnect endotracheal/tracheal mount or mask. Ensure patient has sufficient rest between each suction episode, as clinically indicated
• Following procedure, document amount, colour and viscosity of cretions.
• Aspirate or suction oral pharyngeal airway cretions
• Rin suction tubing with water, sterile water or saline
• Perform mouth care
CLOSED-SUCTION SYSTEM
• Preoxygenate patient ( u ventilator, if patient is ventilated)
• Perform hand hygiene and don clean, non-sterile gloves
• Aspirate or suction oral pharyngeal airway cretions and remove any above cuff aspirates • Remove protective hub on end of clod-suction system
• Attach suction tubing to clod-suction system
• Inrt suction catheter gently down tube until approximately 2 cm beyond the end of the ET tube or tracheostomy. Or, if performing deep endotracheal suctioning, until resistance is felt. Do not apply suction while inrting the catheter
• Withdraw catheter gently (whilst applying suction) ensuring the whole procedure lasts less then 10-15 conds
• Using sterile water or saline, attach to port on clod-suction system and clean suction tubing
• Ensure patient has sufficient rest between each suction episode, as clinically indicated.• Following procedure document amount, colour and viscosity of cretions
• Aspirate or suction oral pharyngeal airway cretions
国庆节图片儿童画
• Perform mouth care
• Rin suction tubing with water, sterile water or saline
References
Evidence Summary: Endotracheal Suctioning: Clinician Information
2016
Author
Wing Hong Chu BHSc (Hons), PhD Candidate
Summary
Question
What is the best available evidence in regard to endotracheal suctioning in adult patients? Clinical Bottom Line
Endotracheal suctioning (ET suctioning) is an important activity in reducing the risk of consolidation and atelectasis that may lead to inadequate ventilation.1 The procedure is associated with complications and risks including bleeding, infection, atelectasis, hypoxemia, cardiovascular instability, elevated intracranial pressure, and may also cau lesions in the tracheal mucosa.1
• A prospective randomized study demonstrated that prn (administered as needed) suctioning was associated with fewer adver effects.2 (Level 1)
• It is recommended that endotracheal suctioning should be performed only when cretions are prent, and not routinely.1,5 (Level 5)
• A number of studies show that the internal lumen of endotracheal tubes decreas significantly after a few days of intubation, sometimes only after 8 h, due to formation of biofilm and the adherenc
e of cretions on the surface.1 (Level 5)
槙岛圣护• There is connsus in the literature that suction catheters should be as small as possible, yet large enough to facilitate cretion removal. It is generally recommended that the suction catheter should occlude less than half of the internal lumen of the endotracheal tube.1,5 (Level 5)
• A meta-analysis demonstrated that a suction pressure of 80-120mmHg was ud in more than 50% of the studies of endotracheal suctioning examined.3 (Level 3)
• A number of studies recommend the u of the lowest possible suction pressure to reduce the risk of atelectasis, hypoxia and damage to the tracheal mucosa. As high pressure is more effective in removing cretions, a pressure of 200-300mmHg may be applied when using the appropriate catheter size.1 (Level 5)
• A number of studies recommend that the suction catheter should be inrted to the carina and retracted 1-2 cm before applying suction.1 (Level 5)
• A prospective randomized study concluded that deep suctioning may be necessary in patients with large amounts of cretions in the lower airways.2 (Level 1)
• There is no conclusive evidence to indicate that instilling saline prior to suctioning adults with an artificial airway increas the removal of respiratory cretions.1,4 (Level 1)
• The potential for multiple bacteria to enter the lower airway during repeated suctioning procedures, contributing to lower airway tract colonization and nosocomial pneumonia has been highlighted, particularly if saline instillation is routinely ud as part of the procedure.4 (Level 1)
• Literature highly recommended to maintain aptic technique, including hand washing and
u of gloves, becau ET suctioning is an invasive procedure that may lead to contamination of the lower airways.1 (Level 5)
• There is minimal rearch to guide practice in relation to optimal suction duration times. Expert opinion and literature suggest suction duration times of < 10 -15 conds.1,4,5 (Level 5)
• A meta-analysis concluded that pre-oxygenation with 100% oxygen, reduces the occurrence of suct
ion-induced hypoxemia by 32%.3 (Level 3)说明文标题的作用
• A clinical guideline recommended that pre-oxygenation be considered if the patient has a clinically important reduction in oxygen saturation with suctioning.5 (Level 5)
• The rearch suggested that hyperoxygenation and hyperinflation prior to suctioning can potentially minimize suctioning-induced hypoxemia.4 (Level 1)
• There is little evidence to support that clod or open suction system is superior to the other in terms of oxygen saturation, cardiovascular instability, cretion removal, environmental contamination, and cost.1 (Level 5)
• A prospective crossover study found that clod suction systems failed to reduce
cross-transmission and acquisition rates of the most relevant Gram-negative bacteria in intensive care unit patients.6 (Level 2)
• A prospective, before and after study that examined adver effects of endotracheal suctioning found that the procedure frequently induces adver effects. The authors cite technique, frequency of suctioning and high PEEP are risk factors for complications but suggest this incidence can be red
uced by the implementation of practice guidelines.7 (Level 2)
• In some ICU ttings, clod endotracheal suctioning (CES) may be advantageous in reducing the incidence of ventilator-associated pneumonia (VAP), particularly late-ont VAP.8 (Level 1)
• A randomized controlled trial (RCT) found that endotracheal tube (ETT) with polyurethane (PU) material resulted in less ventilator-associated pneumonia as compared to ETT with polyvinyl chloride (PVC) cuff). Even in PU tubes Taperguard has less incidence of ventilator-associated pneumonia compared to Sealguard tubes.9 (Level 1)
• In an obrvational study it was found that upper facial expression were frequently activated during pain respon in non-communicative critically ill adult patients.10 (Level 3)• A prospective, before and after study that examined the effect of ketamine on the adver effects of endotracheal suctioning (ETS) found that ketamine did not induce any significant variation in cerebral and systemic parameters. After ETS , it maintained cerebral hemodynamics without changes in cerebral perfusion pressure (CPP), jugular oxygen saturation (SjO2) and cerebral blood flow velocity (mVMCA), and prevented cough reflex.11 (Level 3)
Characteristics of the Evidence
