Question

Endotracheal and Tracheostomy Suctioning

1.Make a table and indicate ‘When To Perform Suction and in Whom’, then the other column would include ‘When NOT To Perform Suction.’

2. Watch the following videos:

a.https://www.youtube.com/watch?v=jOkO2lfny5A

b.https://www.youtube.com/watch?v=ern1Z77DUVo

Make a reflection about these two procedures by writing a minimum of 200-300 words essay.

Answer 1

when and in whom to perform endotracheal and tracheal suctioing

when to not perform endotracheal and tracheal suctioning

saw tooth pattern of flow over the screen and crackles in the trachea shows retained pulmonary secretions, increased peak inspiratory pressure in volume controlled ventilation and decreased tidal volume in pressure controlled ventilation, deterioration of oxygen saturation and arterial blood gas, visible secretions in the airway, patient's inability to make an effective cough, suspected aspiration of upper airway secretions

adequate oxygen saturation normal breathing pattern with no crackles patient able to make effective coughing normal peep

video 1: endotracheal suctioning

• when a patient is on endotracheal tube, there is chance of loss of peep and oxygen desaturation.
• micoorganisms enter into the respiratory system when suctioing through an open catheter
• there is chance of cross infection when the patient cough back while suctioning
• closed suction system helps to maintain peep and breathing system stable, reduce the chance of use of ventilators and thereby helps in faster recovery
• in order to use a trachseal, check the internal diameter of endotracheal tube
• carefully review the instructions before opening the trachseal pack
• take out the clip and attach to the patient's bedding
• connectvtrachseal with the endotracheal tube with a push twist manner and without giving pressure to the cuff
• catheter mount may be used to connect the trach seal and breathing system
• attach the day sticker to the tube to check the day of changing the trach seal
• saw tooth pattern of flow over the screen and crackles in the trachea shows retained pulmonary secretions, increased peak inspiratory pressure in volume controlled ventilation and decreased tidal volume in pressure controlled ventilation, deterioration of oxygen saturation and arterial blood gas, visible secretions in the airway, patient's inability to make an effective cough, suspected aspiration of upper airway secretions are indications of suctioning
• in order to start suctioning, regulate the vaccum, initiate the sucton unit
• a vaccum pressure of 80-100 mmhg in neonates and less than 150mm of hg in adults is recommended
• attach the suction tubing with the vaccum source
• negative pressure must be checked by occluding the suction tube before attching
• ensure that suction valve lock is functioing
• administration of 100% oxygen is mandatory before suctioning event in both pediatrics and adults for 30-60 seconds
• when the numbers of the et tube and suction catheter allign, it means that catheter is located at the distal end of the endotracheal tube
• extend two centimeters more to clear the murphy's eyes to start suctioing
• press down the suction valve and withdraw the suction catheter
• suctioing must not exceed 15 seconds each time
• when the suction cather fully withdrawn, a black mark appears as indicator
• close the isolation valve, if using a 72 hours version
• by using a syringe or ampule of saline, irrigate the closed suction catheter
• close the irrigation port and lock the suction valve
• in order to remive the trach seal, slide the disconnection wedge between trach seal and et tube and then remove the trach seal
• reconnect the breathing system with the endotracheal tube

2. video 2: tracheal suctioning

• traheal suctioing must be perfomed every 12 hours as per instructions
• artcles inclde, a drape, suction catheter, hemostat, bandage scissiors, extra pair of sterile gloves, trach care kit(cleaning solution, trach tie, gauze), pulse oximeter
• address the patient by name and explain the procedure to the patient
• wash hands and put on the gloves
• perform auscultation to check for any crackles
• raise the bed level to easy work
• ask for any discomfort to the patient
• confirm patient identity with name and date of birth
• check the oxygen levels using the pulse oximeter
• start suctioing, grab the suction catheter and maintain the enough suction pressure
• check for negative pressure
• drape the patient
• prepare the sterile field with the tracheal kit and wear the sterile gloves
• 50 percent of the saline and 50 percent hydrogen peroxide must be mixed in the large bowl
• another 50 percent of the saline solution must be divided and poured into two different bowls
• remove the inner cannula and connect the oxygen into the outer cannula
• keep the inner cannula in the 50-50 solution
• make sure to keep dominant hand sterile and must hold the suction catheter
• non dominant hand must be clean and must hold the suction tube
• prime the suction catheter with the normal saline
• insert he cather straight and do not apply any suctioing while inserting
• while feeling resistance, withdraw back in a rotatory manner while suctioing at the same time
• clear the catheter
• clean and dry the inner cannula and reinsert it
• remove the gloves
• clean the area around the tracheal tube using the normal saline
• apply new tracheal tie and then remove the old tracheal ties.
• perform reassessment with ausculation and pulse oxymetery
• reposition the bed
• clean the area and wash hands and record procedure