suction. EC G .pdf

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1. فارشإ تحت
د/ نادمغشاجب
د/هيقفلا ىسوم
د/ دارميسومخلا
بلاطلا دادعإ
نافيص يلع محمد دمحأ

6. RATES OF PACEMAKERS

1. SA node 60 - 100 bpm
2. Atrial cells 55 - 60 bpm
3. AV node 45 - 50 bpm
4. Bundle of His 40 - 45 bpm
5. Bundle branch 40 - 45 bpm
6. Purkinje cells 35 - 40 bpm
7. Myocardial cells 30 - 35 bpm

19. 1- Twelve-lead ECG machine with charged battery .
2-cables and leads, Disposable electrodes (12) .
3- Recording Paper
4-Conduction gel
5-Alcohol swab
6-Pillows .
7-Sheet or drape
8-Towel and washcloth .
9-Disposable razor .

20. 1- preparing the patient before performing the electrocardiogram .
2- Empety whate the patient has of any belonging.
3- Entering patient data according to the requirements of the device .
4- preparing the position of the terminal and chest electrodes .
5- Adjust the the device setting ( speed - signal size ) according to the
patient condition .
6- Ensure that the planning signal is free of any electrical vibration .
7- Choosing the printing order and verifying it befor completing the
planning procedure .
8- Separat the electrodes from the patient .
9- Submitting the planning report to the attending physician

21. •. Perform ECG or begin continuous ECG monitoring as indication. 1
•chest, undress,exposingprivacy and ask patient to Provid. 2
ankles . wirists,and
•. Assist with draping as appropriate. 3
• salf labeled,usingas extremiters. Place leads on chest and 4
adhesive electrodes or water soluble gel or other conductive
material.
• movement,coughing,or still,avoiding. Instruct patient to lie 5
to avoid artifact. recoredingtalking while ECG is
• grounded,andis plugged in and machaine. Make sure ECG 6
operate according to manufacturer's directions.
•patient done,advise. If continuous cardiac monitoring is being 7
on the parameters of mobility as movement may trigger alarms
raedings falesand

24. : atrial depolarization .
• : ventricular depolarization and
repolarization of atria .
: ventricular repolarization (relaxation)
: Small rounded, upright wave following
T wave Most easily seen with a slow HR
Represents repolarization of Purkinje fibers

25. •1 small square = 0.04 sec.
•1 Large square = 0.20 sec.
•5 large square = 1 sec.
•300 large square = 60 sec. ( 1 minute ) = 1500
small square
•1 mv = 2 LS = Standard calibration
• 0.1 mv = SS
•LS = 5 SS
•Note : LS = large square . SS = small square .

38. Thank
you

39. SUCTION
جوﺟﺣﺑ رﺻﺎﻧ ﻲﻠﻋ بوﻘﻌﯾ
بﻟﺎطﻟا دادﻋإ
شﺎﺟﺑ نادﻣﻏ/د
ﻲﺳوﻣﺧ دارﻣ/د
ءﺎﻌﻧﺻ ﺔﻌﻣﺎﺟ
ﺔﯾﺣﺻﻟا موﻠﻌﻟاو بطﻟا ﺔﯾﻠﻛ
ﻲﻟﺎﻌﻟا ضﯾرﻣﺗﻟا مﺳﻗ
ﻊﺑارﻟا ىوﺗﺳﻣﻟا
33: ﺔﻌﻓدﻟا
ﺔﯾﻘﻔﻟا ﻰﺳوﻣ/د
فارﺷإ

40. CONTENTS:

I. Definition.
II. Purposes.
III. Indications.
IV. Types of suction.
V. Types of suction catheters.
VI. Equipment.
VII. medications.
VIII. Procedure.
IX. Post care.
X. Contraindications
XI. Complications.

41. INTRODUCTION
Suctioning:
Closed (In-Line)
Endotracheal tubes (ETs) and tracheostomy tubes (TTs) are artificial
airways inserted to relieve airway obstruction, provide a route for
mechanical ventilation, permit easy access for secretion removal, and
protect the airway from gross aspiration in patients with impaired
cough or gag reflexes. An ET tube is inserted through the nares (nasal
ET tube) or the mouth (oral ET tube) past the epiglottis and vocal cords
into the trachea. The length of time that an ET tube remains in place
is somewhat controversial; however, in most cases a tracheostomy tube
(TT) is inserted if a patient still requires an artificial airway after 2 to
4 weeks

42. Suctioning:
Nasopharyngeal,
Nasotracheal , and
Artificial Airway
Oropharyngeal suctioning removes secretions only from the back of
the throat. Tracheal airway suctioning extends into the lower airway to
remove respiratory secretions and maintain optimum ventilation and
oxygenation in patients who are unable to independently remove these
secretions. When a patient’s oxygen saturation measurement falls below
90%, it is a good indicator of the need for suctioning. Assess patients
to determine frequency and depth of suctioning. Some patients require
suctioning every 1 or 2 hours, whereas others need it only once or twice
a day

INTRODUCTION

43. DEFINITION OF SUCTIONING
Aspiration secretion through a
catheter connected to a suction
machine or wall suction outlet.

44. Suction source

45. PURPOSES
• To maintain patient airway.
• To remove saliva, pulmonary secretions, blood, vomitus, or forging material from the
pharynx.
• To improve oxygenation.
• To prevent respiratory tract infection
• Obtain sputum sample for culture.

46. INDICATIONS FOR SUCTIONING
• Decreased consciousness
• Abnormal breath sounds(wheezing Crackles or gargling
sounds.)
• Decrease oxygen saturation level.
• Signs of respiratory distress
• Presence of artificial airway:to prevent accumulation of
secretions around the artificial airway

47. INDICATIONS FOR SUCTIONING
• Unable to cough effectively to clear the secretions.
• Abnormal breathing patterns
• Change in patient color (Cyanosis due to inadequate
oxygenation
• visible secretions that obstruct the airflow

48. V. SITE OF SUCTIONING
Endotracheal suctioning
Definition:
Removal of secretion from
tracheobronchial tree through
an endotracheal tube with the
help of mechanical suction
device.
Oropharyngeal suctioning
Definition:
Removal of the secretion from
the oral cavity and pharynx
through the suction.

Nasopharyngeal suctioning
Definition:
Removal of the secretion from
the nasal cavity and pharynx
through the suction.

49. SUCTION TRACHEOSTOMY
Tracheostomy suction refers
to the process of removing
secretions or mucus from the
airway of a patient who has a
tracheostomy tube

50. TYPES OF SUCTION CATHETERS
CLOSED SUCTION CATHETER
• Used only in patient with endotracheal
tube and tracheostomy
• Enable to clear the lungs secretions
while maintaining ventilation.
• Helpful in preventing cross
contamination and infection.
OPEN SUCTION CATHETER
• Used in all types of suctioning.
• Can not maintaining ventilation
during endotracheal suctioning.

52. EQUIPMENT
• Sterile suction catheter.
• Normal saline or sterile water in a
container.
• Sterile gloves.
• Mask, face shield.
• Alcohol swab.
• Stethoscope.

• Sterile bowel.
• Gauze pieces
• Ambo bag
• Drugs

54. MEDICATIONS USED WITH SUCTIONING
• Sodium Bicarbonate, : mucolytic action on the mucous and mucopurulent
secretions
• Asist ( N- Acetylcysteine), Same as Sodium Bicarbonate fluidize the secretions.
• Adrenalin, Prevent the mucosal bleeding if there is mucosal trauma caused by
suctioning.

56. DURATION OF SUCTION : LESS THAN10 SECONDS
Amount of pressure for suctioning:

58. PROCEDURE
1. Assess the patient history for any
contraindications.
2. Auscultate breath sounds.
3. Assess level of consciousness and Note any
drainage from the mouth.
4. Assess vital sigs. .

59. PROCEDURE

5. Maintain patient
privacy.
6. Prepare equipment.

60. PROCEDURE

7. Wash hands.and Wear
disposable gloves.

61. PROCEDURE

8. Explain procedure to the patient.
9. Reassure the patient.
10. Positioning:
 If the patient is conscious place him in simi fowler or high fowler
position.
 Unconscious patient : Lateral position and the patient facing you.

63. PROCEDURE
11. Adjust suction to appropriate negative
pressure.
Adult 120-150mm Hg
Children 80-120mmHg
Infant 50-80 mmHg

64. PROCEDURE


12. Open sterile catheter and connect it to
the connecting tube of suction machine.

65. PROCEDURE
13. Pour normal saline or sterile water into sterile
container.
14 . Hyper-oxygenate the patient.

66. IX. PROCEDURE
15. Wear a sterile glove on your dominant t
hand and clean glove on your non dominant
hand.
16. Suction small amount of sterile saline to.
check the efficacy of yourr suction device and
lubricant the catheter

67. PROCEDURE
17. Insert the catheter gently
• For nasopharyngeal suctioning:
 Advance it approximately 5 to 6 inches to
reach the pharynx.

68. PROCEDURE
• For oropharyngeal Suctioning:
 Advance the catheter 3 to 4 inches
to reach the pharynx.
 Infant:8-14 cm
 Child: 14-20 cm
 Adult: 20-24 cm

69. PROCEDURE
18. Apply suction immediately and gently rotating the catheter gently
during suction
19. Don’t suction for more than 10 to 15 seconds at a time.
20. Hyper-oxygenate between suctions.
21. Flush the catheter between the suctions.
22. Assess the patient's cardiopulmonary status during suction

70. POST CARE

1. Reassess the patient respiratory status.
2. Cleaning
3. Return equipment
4. Remove gloves.
5. Hand washing.
6. Documentation secretions (color amounts consistency time and
any complication during suction

71. CONTRAINDICATION
• a. Bleeding disorders, such as disseminated intravascular
coagulation, thrombocytopenia, leukemia.
b. Laryngeal edema, laryngeal spasm.
c. Esophageal varices.
d. Tracheal surgery.
e. Gastric surgery with high anastomosis.
f. MI
g. Occluded nasal passages or nasal bleeding.
h. Epiglottitis.
i. Head, facial, or neck injury

72. COMPLICATIONS OF SUCTION
• Hypoxia and hypoxemia.
• Atelectasis
• Tracheal damage) bleeding)
• Mucosal trauma
• Cross contamination
• Cardiac arrhythmias
• Bronchoconstriction
• vomiting.
• Misdirection of catheter.
• Bradycardia.
• Increased ICP

73. DECREASE OR MINIMIZE TO TECHNIQUES
COMPLICATIONS THE
-1Suction only as needed.
-2sterile technique.
-3monitor of oxygen saturation
-4Hyperoxygenation.
-5safe catheter size.
-6No saline instillation.
-7Allow 20 to 30 second intervals
between each suction
-8limit suctioning to 5 minutes in total.

74. Thanks for your attention