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QuestionAnswer
Whistle tip cathetertip is cut at an angle and has one or more eyes or ports cut in the side.
What is the advantage of an eye or port in a catheterkeeps vacuum from biopsying mucosal during suctioning
Coude tiphas a bend or angle at the distal end, allows for directional entry into right or left mainstem bronchi
Argyle aeroflow catheterdonut shaped tip with multiple port holes
Closed suction systemcatheter in sealed plastic for protection, distal end is attached to modified aerosol T proximal to control valve, replace ea 24 hrs, used on vent
Besides convenience, why is a closed suction system usedprimary is to keep pt VT, FIO2 and PEEP up, secondary is convenient, cheap, less contamination, good for 24 hrs
What is a rigid tonsillar aka yankauershard plastic catheter specifically for oropharynx suctioning
Oropharyngeal airwaycurved shaped device that separates the tongue from the posterior wall of the pharynx to relieve obstructions in unconscious pt
How is a oropharyngeal airway insertedwith tip up, rotate 180 degrees as it goes in
Why and how is correct sizing important in oropharyngeal airwayto small and soft tissue may still obstruct, to large may push epiglottis against larynx closing airway, correct is at base of tongue, measure from middle ear to tip of nose
Why is oropharyngeal airway not tolerated by conscious ptgag reflex may be strongly stimulated, may result in vomiting and aspiration
What is a nasopharyngeal airwaysoft rubber tube placed in one of the nares, used in a conscious and semiconscious pt when tongue or soft tissue is causing obstruction
What is a nasal trumpetnasopharyngeal airway
What size nasal trumpet is bestlargest diameter that can easily pass with minimal force or trauma, length should be from the ear tragus (middle pointy on cheek) to the end of the nose.
If the nasal trumpet is not sized correctly what problems may occurto small may not correct airway obstruction, proper fit should rest at base of tongue, to large may cause larynex to block airway
What is a suction regulatorreduces the high negative pressure to a manageable and safe physiological level, single stage, 0-200 mmhg (neg)
What is the suction pressure for adults-100 to -120
What is the suction pressure for Peds-80 to -100
What is the suction pressure for neonates-60 to -80
Indication for suction areprimary is to remove secretions, maintain a patent airway in the presence of evidence of secretions audible and physical ie: crackles, rhonchi, diminished BS, obstruction, CSR with opacity, tachycardia, tactile fremitis, spo2
Contraindications of suctioning areocclude nasal passages, nasal bleeding, Epiglottitis or croup, acute head face or neck injury, bleeding disorder, laryngospasm, irritable airway, upper resp tract infection
What is a Lukens trapspecimen trap that can be placed in a vacuum circuit to collect sputum
What is the only suction catheter that can go down the left bronchicoude tip
What is the biggest hazard of suctioninghypoxia or hypoxemia
Hazards of suctioning aremechanical trauma-pharynx perf, laceration of nasal turbinate, bleeding, tracheitis, hypoxemia, cardiac dysrhythmia bradycardia, hyper or hypotention, resp arrest, uncontrolled cough, gag, vomit, laryngospasm, bronchospasm, pain, infection, atelectasis
How can suctioning cause atelectasiscatheter to big or suction press to high
Assessment of need for suctioningauscultation, effectiveness of cough
Why can suctioning cause bradycardiatouching the corina with the catheter can stimulate the vagal nerve
Assessment of outcomeimproved breath sounds, removed secretions
Pt monitoring during suctioning should includeBS, skin color, breathing pattern and rte, pulse, rhythm, sputum, bleeding or evidence of trauma, pt subjective response, cough, spo2, ICP if available
Manual resuscitator flow should be set at what prior to suctioning10 to 15
Suction kit includessterile catheter, gloves and basin
Equipment preparation for suctioning includesmanual resuscitator, suction kit, goggles or face mask, sterile normal saline, sterile distilled water, vacuum regulator, suction trap if needed, ky jelly
Sterile distilled water needs replaced how oftenevery 72 hours, be sure to date when opening
What is position of pt for suctioningsemi fowler sniffing or supine if unable to semi fowler
How do we prevent hypoxemia in suctioningpreoxygenate pt at 100 percent O2 for 1 to 2 minutes
Why do we hyperinflate pt prior to suctioninghelps to avoid hypoxemia and vagal stimulation in vented pts
How far does RTT insert catheter8 to 10 inches or until pt coughs
How long do we suction a pt forapplication of vacuum should be no longer than 15 seconds
Artificial airway aspirationdirect passage below the larynx
How much saline is instilled in artificial airway if secretions are thick3 cc
How often do we oxygenate pts when suctioning artificial airwaysbetween each pass
How do you estimate the size of a suction catheter2 x ET tube size and then down one size , so ET tube of 6 is 12 so catheter is 10 french
RTT ready to suction pt but no suction, what might be problemleak at suction trap or vacuum line, canister may be full, suction not turned on
pt has PVC’s during suction, what should RTT dostop, give 100 % O2, once stable continue suction
how does RTT reduce trauma to mucosa during suctioningrotate catheter, do not exede reconmended pressure, use largest cath possible with out going over 1/2
QuestionAnswer
Absolute contraindication for suctioningepiglottitis and croup
How to tell if suction workedDecrease WOB, BS, got something out
When to suctionWhen needed, when patient requests
Safe range for adult pressure120-150
Safe range for child pressure100-120
safe range for infant pressure80-100
How to look for leakswhen not vacumming look in connection
What kind of catheter for left main stem bronchidirectional or Coude
What to do for collection of sputumattach leuken tube and suction
What kinds of lavages are therenormal saline, mucomyst, and Na Bicarb
What are some complications for suctioningbronchospasm, vagal stimulation (bradycardia)
How to prevent complicationscorrect the pressure set, be gentle, hyperoxygenate, make sure it’s quick (no more than 15 seconds)
When do you suction (in or out)On the way out only
QuestionAnswer
Purpose of suctioningMaintain a patent airway by removing secretions, blood, or foreign material
When is suctioning performedonly when needed, visible secretions or audible gurgling, sudden increase in RR
Retention of secretions can causeincreased WOB, atelectasis, hypoxemia, hypercapnia, pulmonary infection, increased airway resistance
What happens when you coughlarge inspiration, glottis closed, diaphragm moves up, pressure builds up in thorax, glottis opens, secretions move out
Indications for suctioningprolonged coughing, patientes request, patients with artificial airways
Patients that require suctioningNervous system depression (intoxicated, sedated), abnormal pulmonary mechanics, thick secretions, pain, post surgical
Upper airway suction deviceoroharynx; clean (not sterile) yaunker, flexible plastic or rubber catheter
Lower airway suction devicetrachea and bronchi; open airway (remove pt from O2), closed airway (pt remains connected to O2)
Pressure save zone for adult120-150 mmHg
Pressure save zone for child100-120 mmHg
Pressure save zone for infant80-100 mmHg
Formula to find right size catheter(ID of ET tube X 3 (factor))/ 2
When do you instill lavageOnly after you are completely compared to begin insertion and suction
What to monitor during suctionBS, O2 sat, RR, PR, BP, ABG, cough effor and ICP (internal cranial pressure)
Complications of suctioningHypoxia,vagal stimulation, trauma, dysrhythmias, hemoptysis, atelectasis, bronchospasm,
What does high peep pressure help withhelps with decrease FRC, it causes large drop in oxygenation,
Contraindications for suctioningepiglotitis because the glottis protects trachea, and Croup
Indication for closed suction catheter usePEEP greater than 10 cmH20, MAP greater than 20, I time greater than 1.5, FiO2 greater than 60, pt with TB, pt receiving inhaled agents that can’t be interuppted by disconnect for suctioning
Suctioning in the homemake sure it is clean as possible, Catheter can be used up to 24 hours, equipment washed in vinegar 9:1, and boil if permitted.
QuestionAnswer
Determine correct size of suction catheter when given endotracheal or trach tube sizeID of ET x 3 (factor) = /2
Amount of vacumm suction needed for adults120-150 mmHg
Amount of vacumm suction needed for children100-120 mmHg
Amount of vacumm suction needed for infants80-100 mmHg
Purpose of the Coude cathetercurved directional tip catheter which may help in guiding it into either the left mainstem bronchi
Purpose of sputum trapfor sputum collection
Purpose of tracheal suctioningMaintain a patent airway removing secretions, blood, or foreign material and facilitate pulmonary hygiene
Indications for tracheal suctioningvisible secretions in airway or audible gurgling, increased tactile fremitus, sudden increase in resp distress/dyspnea, and increase in pressures require to ventilate with IPPB or mech ventilation, prolonged cough,
physiological steps in a normal coughlarge inspiration (2/3 of vital capacity), glottis is closed, diaphragm moves up, pressure builds in thorax, glottis suddenly opens up, secretions move up and out
Complications associated with tracheal suctioninghypoxia, vagal stimulation, trauma, dsyhythmias, hemoptysis, atelectasis, bronchospasm
Contraindications to nasotracheal suctioningepiglottitis, and croup
Methods to minimize or prevent problems associated with suctioninghyperoxygenate, do it only as needed, do it in a quick efficient way (less than 15 seconds)
Suctioning in home care settingget clean as possible, use boiled or distilled water to rinse catheter, air dry, suction catheter can be used up to 24 hours, only when needed, and clean equipment with vinegar
how to collect a sputum sample with a trapattach leuken tube to suction and to sucker. Suction and close cup
Clinical signs that should be monitored during the suctioning procedure and how to respond to adverse reactionsBS, vital signs, appearance…… stop treatment notify nurse or doctor
cause of expiratory wheezing after suctioningbronchospasm; things get irritated so they tighten up and wheeze gets vibrant
What kind of suctioning for closed system (in line)continous
What kind of suctioning for sterile hand catheter kitintermittent
What kind of suctioning for when getting a sputum trapdepending on what it is. closed or not
When is lavage neededto break up hard thick mucus
Types of solution used for lavagenormal saline, mucomyst, Na Bicarb
Advantages of lavagebreaks up thich mucus
Disadvantages of lavageif need a sputum sample it will have to much saline in it. Also some might get stuck way down and cause infection
Appropriate time to instill lavageright before suctioning
Indications for use of closed suction techniquesPEEP > 10, insp time > 1.5 seconds, FiO2 > 60, MAP > 20 , resp infections
Factors that indicate the outcome of suctioning was beneficial to the patientdecrease WOB, you got sputum out, HR went close to normal, and RR went down