Endo tracheal Suctioning

ET suctioning, definition, purpose, indication, complications, types, procedure of ET suctioning, post procedure care, documentation, caution

1. Endo Tracheal Endo Tracheal
SuctioningSuctioning
Presented by-Presented by-
Jasleen Kaur BrarJasleen Kaur Brar

2. Introduction.....Introduction.....
The patient with an artificial The patient with an artificial
airway is not capable of effectively airway is not capable of effectively
coughing, the mobilization of coughing, the mobilization of
secretions from the trachea must secretions from the trachea must
be facilitated by aspiration. This is be facilitated by aspiration. This is
called suctioning.called suctioning.

3. WHAT IS SUCTIONING?WHAT IS SUCTIONING?
Endotracheal suctioning Endotracheal suctioning
is the removal of is the removal of
secretions from secretions from
tracheobroncheal tree tracheobroncheal tree
through an through an
endotracheal tube with endotracheal tube with
the help of mechanical the help of mechanical
suction device.suction device.
  

4. PURPOSESPURPOSES
          To maintain a patent airway by removing To maintain a patent airway by removing
retained tracheobroncheal secretions.retained tracheobroncheal secretions.
          To prevent lower respiratory tract To prevent lower respiratory tract
infection from retained secretions.infection from retained secretions.
          To provide effective ventilation.To provide effective ventilation.
          To stimulate coughing.To stimulate coughing.

5. INDICATIONINDICATION
Therapeutic Diagnostic

6. Therapeutic:Therapeutic:
Noisy breathingNoisy breathing
Visible secretions in the airwayVisible secretions in the airway
Decreased SpODecreased SpO22 in the pulse oximeter & in the pulse oximeter &
Deterioration of arterial blood gas valuesDeterioration of arterial blood gas values
Patient’s inability to generate an effective Patient’s inability to generate an effective
spontaneous coughspontaneous cough
Presence of pulmonary atelectasis or consolidation, Presence of pulmonary atelectasis or consolidation,
presumed to be associated with secretion retentionpresumed to be associated with secretion retention
During special procedures like Bronchoscopy & During special procedures like Bronchoscopy &
EndoscopyEndoscopy

7. Diagnostic:Diagnostic:
 The need to obtain a sputum specimen / ETA The need to obtain a sputum specimen / ETA
(Endo Tracheal Aspiration) for investigations.(Endo Tracheal Aspiration) for investigations.

8. COMPLICATIONS COMPLICATIONS
Hypoxia Hypoxia
Tracheal or bronchial mucosal traumaTracheal or bronchial mucosal trauma
Cardiac or respiratory arrestCardiac or respiratory arrest
Pulmonary hemorrhage / bleedingPulmonary hemorrhage / bleeding
Cardiac dysrhythmiasCardiac dysrhythmias
Pulmonary atelectasisPulmonary atelectasis
BronchospasmBronchospasm
Hypotension / hypertensionHypotension / hypertension
Elevated ICPElevated ICP

9. TYPES OF ET SUCTIONINGTYPES OF ET SUCTIONING
OPEN SUCTION CLOSED SUCTION

10. ASSESSMENTASSESSMENT
PREPARATION OF PATIENT & ARTICLESPREPARATION OF PATIENT & ARTICLES
IMPLEMENTATIONIMPLEMENTATION
EVALUATIONEVALUATION

11. ASSESSMENTASSESSMENT
Patient should be monitored prior to, during & Patient should be monitored prior to, during &
after the procedure for following :after the procedure for following :
Breath soundsBreath sounds
Oxygen saturationOxygen saturation
Respiratory Rate & patternRespiratory Rate & pattern
Hemodynamic parameters (pulse rate, Blood pressure)Hemodynamic parameters (pulse rate, Blood pressure)
Cough effortCough effort
ICP (If indicated and available)ICP (If indicated and available)
Sputum characteristics (color, volume, consistency & Sputum characteristics (color, volume, consistency &
odor)odor)
Ventilator parameters (PIP, Vt & FiOVentilator parameters (PIP, Vt & FiO22))

12. ASSESSMENT….ASSESSMENT….
Assess the Assess the depth and depth and
rate of respiration, rate of respiration,
auscultate breath sounds.auscultate breath sounds.
Assess for wheeze or Assess for wheeze or
rattling sound in chest: rattling sound in chest:
a harsh sound caused by a harsh sound caused by
partial obstruction of the partial obstruction of the
airwaysairways

13. Patient PreparationPatient Preparation
Explain the procedure to the patient if Explain the procedure to the patient if
conscious.conscious.
The patient should receive hyper The patient should receive hyper
oxygenation by the delivery of 100% oxygenation by the delivery of 100%
oxygen for >30 seconds prior to the oxygen for >30 seconds prior to the
suctioningsuctioning
Position the patient in supine position.Position the patient in supine position.
Auscultate the breath sounds. Auscultate the breath sounds.

14. COMMUNICATE……COMMUNICATE……
Explain the Explain the
procedure to the procedure to the
patient and patient and
importance of importance of
coughing if coughing if
conscious.conscious.

15. EQUIPMENT ASSEMBLYINGEQUIPMENT ASSEMBLYING
StethoscopeStethoscope
Vacuum source with adjustable Vacuum source with adjustable
regulator suction jarregulator suction jar
Sterile glovesSterile gloves
Sterile suction catheterSterile suction catheter
Protective goggles, apron & maskProtective goggles, apron & mask
Sterile normal salineSterile normal saline
AMBU bag for pre & post AMBU bag for pre & post
oxygenationoxygenation

16. SUCTION CATHETERSUCTION CATHETER

Catheter can be
selected according
to the ET tube size.
Sterile suction
catheter of 12-14 Fr
is used for adults
and for children 8-
10 Fr is used.

17. SUCTION PRESSURESUCTION PRESSURE

Turn on suction apparatus
to appropriate negative
pressure for:
adults-100-120 mmHg
children-50-100 mmHg
infants-40-60 mmHg.

18. IMPLEMENTATIONIMPLEMENTATION
HAND WASHHAND WASH
Perform hand Perform hand
hygiene, wash hands. hygiene, wash hands.
It reduces It reduces
transmission of transmission of
microorganisms.microorganisms.

19. Goggles, mask & apron should be Goggles, mask & apron should be
worn to prevent splash from worn to prevent splash from
secretionssecretions
Open the end of the suction catheter Open the end of the suction catheter
package & connect it to suction package & connect it to suction
tubing (If you are alone)tubing (If you are alone)
Wear sterile gloves with sterile Wear sterile gloves with sterile
techniquetechnique
With a help of an assistant open With a help of an assistant open
suction catheter package & connect suction catheter package & connect
it to suction tubingit to suction tubing
Continue…..

20. Continue…..Continue…..
With a help of an assistant With a help of an assistant
disconnect the ventilatordisconnect the ventilator
Kink the suction tube & insert the Kink the suction tube & insert the
catheter in to the ETtube until catheter in to the ETtube until
resistance is feltresistance is felt
Resistance is felt when the catheter Resistance is felt when the catheter
impacts the carina or bronchial impacts the carina or bronchial
mucosa, the suction catheter mucosa, the suction catheter
should be withdrawn 2cm out should be withdrawn 2cm out
before applying suctionbefore applying suction

21. Continue.....Continue.....
Apply continuous suction Apply continuous suction
while rotating the suction while rotating the suction
catheter during removalcatheter during removal
The duration of each The duration of each
suctioning should be 10-15sec.suctioning should be 10-15sec.
Instill 3 to 5ml of sterile Instill 3 to 5ml of sterile
normal saline in to the normal saline in to the
artificial airway, if requiredartificial airway, if required
Give four to five manual Give four to five manual
breaths with bag or ventilatorbreaths with bag or ventilator

22. Continue…..Continue…..
Return patient to ventilatorReturn patient to ventilator
Flush the catheter with NS Flush the catheter with NS
in the suction trayin the suction tray
Suction nares & oropharynx Suction nares & oropharynx
above the artificial airwayabove the artificial airway
Discard used equipmentsDiscard used equipments
Flush the suction tube with Flush the suction tube with
hot waterhot water
Wash handsWash hands

23. POST PROCEDURE CARE…POST PROCEDURE CARE…
    
When the procedure is When the procedure is
complete complete
hyperventilate the hyperventilate the
patient again.patient again.
When the airway When the airway
becomes clear, return becomes clear, return
the patient to the patient to
ventilator or oxygen ventilator or oxygen
source.source.

24. DOCUMENTATION…DOCUMENTATION…
Record the time of Record the time of
suctioning, nature & suctioning, nature &
amount of secretions.amount of secretions.
Document indications Document indications
for suctioning & any for suctioning & any
changes in vitals & changes in vitals &
patient’s tolerance.patient’s tolerance.

25. CAUTION..CAUTION..
Suctioning is potentially an Suctioning is potentially an
harmful procedure if carried harmful procedure if carried
out improperly.out improperly.
Suctioning should be done Suctioning should be done
when clinically necessary when clinically necessary
(not routinely).(not routinely).
The need for suctioning The need for suctioning
should be assessed at least should be assessed at least
every 2hrs or more every 2hrs or more
frequently as need arises.frequently as need arises.

26. Thank youThank you