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    GTJ 205/4: FON III (IT) Nursing Yr 2 Airway Clearance: Suctioning

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    LimYi
    The document discusses the procedure of suctioning to clear airways. It defines suctioning and describes the indications, contraindications, types, and complications of suctioning. It also outlines the steps nurses should take before, during, and after suctioning including preparing equipment, inserting the catheter, and documenting assessments.

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    GTJ 205/4: FON III (IT) Nursing Yr 2 Airway Clearance: Suctioning

    Uploaded by

    LimYi
    701 views32 pages
    The document discusses the procedure of suctioning to clear airways. It defines suctioning and describes the indications, contraindications, types, and complications of suctioning. It also outlines the steps nurses should take before, during, and after suctioning including preparing equipment, inserting the catheter, and documenting assessments.

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    Suctioning

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    The document discusses the procedure of suctioning to clear airways. It defines suctioning and describes the indications, contraindications, types, and complications of suctioning. It also outlines the steps nurses should take before, during, and after suctioning including preparing equipment, inserting the catheter, and documenting assessments.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    701 views32 pages

    GTJ 205/4: FON III (IT) Nursing Yr 2 Airway Clearance: Suctioning

    Uploaded by

    LimYi
    The document discusses the procedure of suctioning to clear airways. It defines suctioning and describes the indications, contraindications, types, and complications of suctioning. It also outlines the steps nurses should take before, during, and after suctioning including preparing equipment, inserting the catheter, and documenting assessments.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 32

    GTJ 205/4: FON III (IT)

    Nursing Yr 2
    Airway Clearance : Suctioning

    Objectives

    Define suctioning
    Explain indications of suctioning
    Explain contraindications of suctioning
    Explain types of suctioning
    Explain complications of suctioning
    Demonstrate procedure to maintain a secure
    and patent airway: oral/nasal suction
    efficiently
    Appreciate the importance of correct and
    effective suctioning standard in maintaining
    patent airway.
    2

    Definition
    Suctioning = suction = suck = remove
    Suctioning is a procedure using a device
    (catheter) into nose, mouth and throat to
    remove secretions.

    Suctioning should last only 15 seconds after each


    entry. ...
    3

    Indications
    Unable to maintain a patent airway Unconscious or comatose
    Nervous system disorder

    Artificial airways- ETT or Tracheostomy


    Extreme age too old or too young (new
    born- need suction to clear up airway)
    4

    Contraindications Nasotracheal suctioning


    o
    o
    o
    o
    o
    o
    o
    o
    o
    o
    o

    Occluded nasal passages


    Nasal bleeding
    Epiglottitis
    Croup
    Acute head, facial, neck injury
    Coagulopathy
    Bleeding disorder
    Laryngospasm
    Bronchospasm
    Gastric surgery with high anastomosis
    Mycardial infarction

    Complications
    Infection to respiratory tract
    Trauma oral, trachea or bronchial mucous
    Bleeding from respiratory tract
    Bronchospasm or bronchoconstriction
    Heart failure
    Cardiac dysrhythmias
    Atelectasis
    Hypertension
    Hypotension

    Types of suctioning
    ORAL
    Orophayrngeal
    Orotracheal

    NASAL
    Nasophayrngeal
    Nasotracheal

    Types of suctioning
    Tracheostomy

    Types of suctioning
    Endotracheal tube (ETT) - open method

    Types of suctioning
    Endotrachea tube - closed method

    10

    Types of suction tubing

    Yankauer suction
    catheter

    Suction catheter

    Closed method
    suction catheter

    Suction catheter
    11

    Catheter sizes
    CATHETER
    (Fr)

    WALL
    SUCTION
    (mmHg)

    PORTABLE
    SUCTION
    (kPa)

    Infant

    5-8

    40 - 60

    Child

    10 -12

    60 -100

    5-8

    Adult

    14 -18

    120 -150

    13 -16

    Formula: 1cmH2O = 0.7 mmHg = 0.1kPa

    12

    Nursing responsibilities
    BEFORE:
    Assessment:
    Observe sign respiratory distress
    Auscultate lung sound - coarse sound
    Vital signs
    Length of catheter to insert
    Pre oxygenation or increase oxygen
    supply (if necessary)

    13

    Nursing responsibilities
    During
    Aseptic technique to maintain
    Each suction for 10-15 seconds
    Observe oxygen saturation > 90%
    Prevent trauma correct- negative
    pressure, catheter size and technique
    oxygenation pre and post procedure

    14

    Nursing responsibilities
    After
    Oxygenation post procedure
    Assessment:
    Auscultate lung sound - clear
    Oxygen saturation : normal limits
    Respiratory status: rate and depth normal no sign of respiratory distress
    Records - time and nature and amount of
    secretions. Vital sign.
    Offer oral hygiene
    15

    Assessment
    Patient:
    1. General condition
    2. Assess vital signs
    3. Length of catheter insert
    Equipment:
    1. Identify type of suction device use: functioning
    2. Select appropriate catheter size
    3. Identify catheter parts, proximal end - 2 lumen (1 suction tubing; thumb control). The distal and sides patent lumens
    4. Identify equipment or addition equipment necessary
    (resuscitation bag connected to oxygen supply)
    appropriate, safe to use
    16

    Assessment
    Environment:
    1. Working space comfortable and safe
    2. Enough space to move
    3. Clean
    4. Appropriate lighting
    5. Suitable bed height
    6. Lock the bed
    7. Electrical source (if necessary)
    17

    Planning
    Equipments :
    1. Sterile suction set (1 short & 1 long tubing)
    2. Normal saline 0.9% or distill water
    3. Suction catheter appropriate size
    4. 1 pair sterile glove (latex or polymer)
    5. Water soluble lubricant
    6. Receiver kidney dish
    7. Tissue towel
    8. Face mask
    9. Oxygen mask connected to oxygen supply (if
    necessary)
    18

    Composite skills
    1. Prepare suction tubing
    2. Remove suction catheter from wrapper
    3. Measure the depth to which to insert the suction
    catheter:
    a. Oropharyngeal suctioning:
    Measure the distance between the edge of the
    patients mouth and the tip of the patients ear
    lobe.
    b. Nasopharyngeal suctioning:
    Measure the distance between the tip of the
    patients nose and the tip of the patients ear
    lobe.
    4.Discard the suction catheter
    19

    Preparation of suction tubing


    1. Hand hygiene
    2. Unwrap wrapper
    3. Connect one end of connecting tubing
    to suction machine
    4. Place other end in convenient location
    near client
    5. Turn suction device on (if portable) and
    6. Set vacuum regulator to appropriate
    negative pressure
    20

    Adjusting wall suction

    Portable suction

    21

    Preparation of suction catheter


    1. Tear suction catheter wrapper or unwrap
    suction catheter wrapping (ensure sterility
    - do not touch nonsterile surface or
    object)
    2. Attach catheter to the suction tubing
    3. Hand hygiene and put on gloves
    4. Hold catheter wrapping with non
    dominant hand
    5. Place closed end of the wrapping in
    between the lateral side of the body and
    the arm
    22

    Remove suction catheter from wrapper


    1. Hold suction tubing with non dominant
    hand, pull out slowing - expose the
    catheter (ensure sterility)
    2. Hold the proximal end of the catheter
    with dominant hand pull out slowing
    (ensure sterility)

    23

    Insertion of suction catheter


    1.
    2.
    3.
    4.

    Wet catheter end into distill water


    Withdraw small amount of distill water
    Apply no pressure during inserting catheter
    Apply negative pressure once reached desired
    area to suck mucus
    5. Rotate tube while withdrawing at 10-12 sec.
    *Remove oxygen mask, if present (nasal
    cannula may remain in place)
    Keep oxygen mask near client face

    24

    Discard of suction catheter


    1. Roll catheter around fingers of dominant hand
    2. Pull out catheter from suction tubing
    3. Pull glove off inside out so that catheter remains
    coiled in glove
    4. Pull off other glove over first glove in same way
    to seal in contaminants.
    5. Discard in appropriate receptacle

    25

    26

    Insertion of suction catheter via nasal

    27

    Insertion of suction catheter: Yaunker


    1. Hand hygiene and put on glove
    2. Unwrap Yankauer suction catheter wrapping
    3. Insert Yankauer suction catheter into client
    mouth (along gum line) to pharynx.
    4. Move Yankauer suction catheter to withdraw
    mucus
    5. Pull catheter while rotating

    28

    Evaluation
    Compare cardiopulmonary assessment
    finding before and after procedure : vital
    sign blood pressure, pulse rate, respiration
    rhythm, rate and depth, and oxygenation
    status
    Auscultate chest and airway: no secretion

    29

    Documentation
    Patient general condition before and after
    procedure
    Secretions
    Colour (yellowish, red),
    Type (mucoid, blood stain & purulent)
    Amount (small, moderate & large)

    30

    Nursing Diagnosis
    Actual Diagnosis

    Potential Diagnosis

    31

    Summary
    Very crucial to prevent hypoxic episode
    Promote comfort
    Nurses knowledgeable to
    - catheter size, vacuum measurement
    - catheter depth measurement
    - correct technique of applying pressure
    - maintaining ASEPTIC TECHNIQUE

    32

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