SUCTIONING MACHINE and

Suctioning procedures By Group four

Definition
Technological support devise used to clear secretions from the central airway when the cough reflex is impaired or absent. Secretions may contain saliva, dust, gastric contents or blood.

Suctioning procedure
Follows nursing process; Assessment Planning (goal setting) Implementation of the plan Evaluation

Assessment
Assess the clients need for suctioning Observe vital signs for increase in pulse rate and respirations Auscultate breath sounds for presence of adventitious sounds Observe respirations status for tachypnea, shortness of breath and restlessness Observe for signs of hypoxia (low O2)

Indications
Ineffective cough Decreased level of consciousness Thick tenacious mucus Impaired pulmonary function

Reduced O2 saturation.

CONTRAINDICATIONS
Haemoptysis Severe bronchospasms Severe coagulopathies Fracture of the base of the skull (contains the respiratory center) Compromised cardiovascular system e.g. Congestive Cardiac Failure (lead to pulmonary edema)

Planning (Goals)
Provide patent airway Remove secretions Improve ventilation Correct breathing rate Increase tissue oxygenation

Implementation
Three ways; Suctioning using catheter Suctioning using a catheter in sleeve Suctioning with in line closed suction system

1. Suctioning using catheter

Equip Cont.
Sterile saline Receptacle Oxygen source and administration devise Personal protective equipment-gown, goggle and mask Stethoscope

PREPARATION
Check physicians orders and client care plan Gather equipments Recruit an assistant for manual ventilation Wash hands Asses lung sound, heart rate and rhythm Open suction catheter package and open saline flush solution container Set suction control regulator at 80-120mmhg Don protective gown

PROCEDURE
Explain procedure regardless of level of consciousness. Place client in semi fowlers or fowlers position Turn on suction apparatus. Administer 100% oxygen for 1-2 minutes, or have assistant use resuscitator bag with adaptor to hyperoxgenate client. Don sterile gloves, dominant hand will remain sterile while nondominant become clean

Procedure cont.
Using nondominant hand, pour sterile saline into flush solution container.(nondominant hand is no longer sterile at this time) Holding catheter in protective covering with dominant hand, attach to suction tubing (b4 catheter is uncovered) Hold catheter covering with nondominant hand and slip catheter out with dominant hand. Lubricate sterile catheter by dipping it into cup with sterile normal saline.

Procedure cont.
Using dominant hand, insert catheter into client`s airway without applying suction. RATIONALE: suctioning during insertion deprives clients of oxygen and inhibits catheter advancement. Continue to advance catheter quickly until resistance is felt or if the client coughs (notice clients hyperactivity to confirm resistance). RATIONALE: cough is stimulated at the carina (where bronchi divide-dont go beyond this area)

Procedure cont.
Withdraw catheter slightly and slowly,then begin suctioning using a rotating motion as the catheter is withdrawn Suction intermittently by placing and releasing nondominant hand over catheter suction port. RATIONALE: intermintent and continuous application of suctioning may help to reduce injury. Limit suction to no more than 5-10 seconds. Rationale: prevent hypoxemic complication induced by suctioning. Reattach oxygen delivery device and have client take several deep breath, or hyper oxygenate client with lungs with resuscitator bag. Flush suction catheter and tubing with sterile saline.

Procedure cont.
Use same catheter and repeat suctioning procedure one time, if necessary, allow 3 minutes between suctioning attempts for hyperoxygination. Coil suction catheter around hand and deglove over it to discard. Discard glove and catheter Turn off suction source

Procedure cont.
Cover end of suction tubing connecter with sterile gauze. Rationale: this prevent contaminating end that connects to suction catheter. Assess lung sound and heart rate and rhythm for change-if back to normal range. Rationale: suction usually causes tachycardia but hypoxemia and vagal response may cause serious bradycardia or cardiac arrest. Wash hands Empty suction receptacle PRN or at end of every shift, noting characters of secretions

2. Using catheter in sleeve

3. Suctioning with in-line closed suction system

Equip cont.
Clean gloves Note: in line closed system suctioning allows rapid suctioning for intubated clients and does not interrupt ventilator/client interface.

PROCEDURE
Explain procedure and rationale to client regardless of clients level of consciousness. Wash hands and don groves Place client in semi fowlers or fowlers position Turn on suction source Connect oxygen source to side arm of tract tube connector Hyperoxgenate client with 100% oxygen using manual bag or mechanical ventilator

Procedure cont.
Open access valve and advance catheter within plastic sleeve into clients artificial airway using your dominant hand. Rationale: sterility is maintained because catheter is enclosed by plastic cover and slides with it. With nondominant hand, activate suction valve. Intermittently apply suction (no more than 5 to 10 seconds) while rotating withdrawing catheter completely back into plastic sheath. RATIONALE: If not totally out of the airway, the catheter impairs client ventilation.

Procedure cont.
Repeat step this as necessary to clear secretions; allow time between suctioning for hyperoxigation. RATIONALE: repeated suctioning without hyperoxination causes complications like hypoxemia and cardiac dysrrythmias. Attach saline syringe or vial (5-10ml)to catheter irrigation port; inject saline into catheter tip while applying suction to rinse catheter and tubing, then close irrigation port and suction valve. RATIONALE:rinsing prevent catheter occlusion by dried secretion.

Procedure cont.
Remove syringe and turn off suction. Lock mechanism, if appropriate. RATIONALE: locking catheter prevent inadvertent advancement and occlusion of clients airway. Remove gloves and wash hand

COMPLICATIONS
Hypoxemia Dysrhythmiasis Vagal stimulation (bradycardia and hypotension) Bronchospasms Elevated intracranial pressure Atelectasis Tracheal mucosal trauma Bleeding

EVALUATION
Secretions removed without complications Improved ventilation with increased tissue oxygenation Breath sounds clear, no adventitious sounds auscultated

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