Endotracheal Suctioning

LIMITATIONS FOR PRACTICE: RN who has been instructed and assessed in this procedure.

AIM: To remove secretions from tracheo-bronchial tree.

EQUIPMENT: High wall suction Suction catheter of appropriate size, ie: ETT / Trachy Size Mini-trach 6-7 7-8.5 9-10 Single sterile glove Pulse oximeter to assess O2 saturation (SaO2) Goggles / Face Shields PROCEDURE: 1. Wash hands. 2. Turn suction on, ensure that it is functioning. 3. Pre oxygenate patient if desaturation occurred during previous suctioning by turning the suction option on the ventilator on 4. Open sterile catheter and don glove. 5. Hold suction tubing in ungloved hand and use gloved hand to attached catheter without contaminating catheter or glove. 6. Insert suction catheter into tracheostomy or ET tube without applying suction. Insert catheter until the patient coughs or resistance is felt and withdraw slightly. Suction Catheter Size 8-10fg 10fg 12fg 14fg

The St George Hospital ICU Nursing Procedure Manual

Revised August 2003

7. Apply suction whilst withdrawing catheter. Suctioning should be for no longer than 15 seconds per time. Check SaO2. 8. Curl suction catheter up in your gloved hand and remove glove keeping catheter inside for disposal. 9. Suction oropharynx with Yankeur sucker/suction catheter. 10. Check ventilator observations and air entry to ensure adequate ventilation. 11. Observe patients respiratory status. 12. Document procedure and record amount and type of secretions.

COMPLICATIONS: Infection Trauma to tracheo-bronchial mucosa Hypoxia Aggravation of pulmonary oedema Raised intracranial pressure Decreased lung compliance due to disconnection from ventilator and loss of PEEP

NURSING MANAGEMENT: There is no literature to suggest the correct frequency of Endo trachael suctioning. Clinical assessment of the patient through chest auscultation and the previous amounts of secretion obtained through suctioning should guide our practice. For instance if the patient has copious amounts of secretions every 2nd hour then they require more frequent suctioning. If the patient have scant secretions every 2nd hour then the patient does not require 2nd hourly suctioning. Besides auscultation and secretion quantity there are contraindications for routine suctioning including patients with raised ICP, patients in Pulmonary oedema and patients on 100% oxygen and requiring PEEP level > 10cmsH2O to maintain acceptable SaO2 levels. For these patients ensuring tube patency once per shift will suffice. For this group of patients active humidification with a water bath heater will reduce the risk of air blockage. There is no evidence in the literature supporting the disconnection of patients from a ventilator and using a manual resuscitator bag to Hyperventilate and hyper oxygenate a patient. Current ventilator strategies of the open lung approach suggest that disconnecting a patient from the ventilator and the resultant loss of PEEP is detrimental to patients. Report any difficulty in inserting the suction catheter.

The St George Hospital ICU Nursing Procedure Manual

Revised August 2003

 Report any alteration in the colour of sputum - eg from white to green or blood stained/frothy. A sputum trap is required if a sputum specimen is to be obtained. In-Line suction catheters are used for patients with copious secretions and or infectious secretions: Attach in line suction catheter with single axis swivel connector to ET tube connector. Insert catheter down ET tube without applying suction. Insert catheter until resistance is felt or a cough is stimulated. Apply suction (depress button) whilst withdrawing catheter. Catheters are changed 2nd daily in accordance with the date sticker.

The St George Hospital ICU Nursing Procedure Manual

Revised August 2003