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Flashcards in Nsg: Suctioning Deck (15)
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1
Q

What is suctioning?

A

Bronchial hygiene involving the mechanical aspiration of secretions from the:
Nasopharynx
Oropharynx
Trachea

2
Q

Determine the need for suctioning.

A
  • Pt rate, depth, and ease of breathing.
  • Pt inability to remove own secretions by couging.
  • Presence of wet loose cough
  • Presence of excessive and/or thick secretion and noisy breathing.
  • Signs of Hypoxia ( Cyanosis), restlessness, agitation, tachycardia.
  • Signs of resp distress (Nasal flaring), accessory muscles, tachypnea, SOB, decr. SaO2.
3
Q

Can suctioning irritate mucous membranes and increae seretion if performed too often?

A

Yes, so suctioning is based on clinical need, not schedule.

4
Q

What are the Routes for Suctioning?

OONNE

A

1) Oral: Mouth
2) Oropharyngeal: into oropharynx through mouth
3) Nasopharyngeal: into nasopharynx though nose
4) Nasotracheal: To the level of the laryngopharnx+ trach
5) Enchotracheal + Tracheostomy: For pts who need Artificial ventilaton.

5
Q

potential problems of suctioning

A

1) Pt distress
2) Hypoxia (obstruction w/ catheter, duration of procedue, suction flow and pressure and size of catheter)
3) Soft tissue damange/bloody aspirate
4) Stridor (Narrowing airway usually heard on inspiration), bronchospasm
5) Gagging/voming, then aspiration.
6) Vasovagal stimulation causing bradycardia + hypotension
7) arrhythmias/HTN
8) Infection (by septic tools that weren’t cleaned)
9) Raised ICP for pt’s w/ traumatic brain injury)

6
Q

Contraindication of suctioning

A

1) Severe bronchospasm, irritable airways
2) stridor (narrow airway = cannot breathe)
3) Basal Skull fracture
4) Severe epitaxis = could aspirate blood
5) Leakage of CSF
6) Coagulopathy + bleeding disorders = suctioning could cause tissue damage and lead to bloody aspirate
7) jaw fractures (cannot open mouth to suction)
8) Loose teeth (could dislodge teeth and be swalloed/ choking hazard)

7
Q

Catheter suction size selection.

A

Oropharyngeal: 12FG
Nasopharngeal: 10-12FG
Child: 8-10FG

8
Q

Vacuum pressure selection.

A

The greater the pressure with the suction catheter, the greater the degree of muscosal drainage b/c pulling on mucosa lining.

Adult: 80-120mmHg
Child:70-100mmHg

9
Q

What do you need for suctioning?

A

1) Suctiong Unit
2) Recptacle
3) Connection tubing
4) Yankur suction (Tonsil tip)
5) Water soluble lubricant
6) 0.9% NS
7) Suction catheters w/ correct size
8) Resuscitation equipment in area if needed b/c of resp distress.
9) sterille gloves to maintain sterility of catheter

10
Q

Nasopharyngeal Insertion

pg. 1351K

A

(sterile technique)
Measure from Tip of nose to Ear lobe
-Elevate tip of nose
-Tubing in non dominant hand
-catheter in dominant hand
-If right handed, be on pts right side.
-dip catheter tip in lubricant
-gently insert with inclination till slight resistance
-Rotate catheter till resistance is overcome (helps dislidge secretions)
-Advance catherer 5”-6” untill pool of secretions or pt coughs

11
Q

Oropharyngeal Insertion

A

(Doesn’t need to be sterile, but is better)
-Moisten Yankauer or suction catheter w/ sterile water/saline to reduce frictoin.
(measure catheter from Tip of nose to Ear lobe)
-Insert in pt mouth
-advance 3”-4” along side of pt mouth till pool of secretions or pt cough.
-Watch for stimulation of gag relflex while inserting
-Suction both sids of mouth
-Intermittent suction, withdraw with rotaing motion
-***If secretions are thick, clear lumen by dipping in in NS + apply suction.
-Repeat till sounds stop/breathing is quiet.
-Flush connecting tube when done.

Listen to lungs for Adventicious sounds.

12
Q

While suctioning, what are some special considerations?

A
  • Alternate b/w nostrils
  • Do not go bw nostril and mouth (bring extra catheters)
  • If excessive oral secretions, consider tonsil tip catheter
  • Is s/s of hypoxia occur, stop suctioning and apply O2.
  • Do not suction for longe than 10 seconds.
  • Do not suction while inserting catheter into pt mouth-
  • Allow intervals b/w suctioning to see how pt is tolerating and if it is working. 30sec-1min
13
Q

Post suctioning

A

Assess:

  • RR
  • HR and rhythm
  • Skin colour
  • SaO2
  • Lung sounds

Place suction accessible to pt.
Assist pt to position that helps O2 and comfort.

14
Q

What are some signs that suctioning has worked?

A
  • Decr. breathing effort
  • Decr. RR
  • Visible evidence of removal of secretions
  • Absence of audible secretions in large airways
  • Pt colour improves
15
Q

What to document?

A

-Amount and characteristics of secretions
-If specimen was obtained and what tests were requested.
-Pt tolerance during procedure.
-Note condition before and after, and any adverse effects
-Comunicate observations and recommendations for further interventions to promote continuity of care
-Notify MD of any abnormal findings
(If pt has ventolin, suction first (if needed) so ventolin has a clear airway to work on)