Question Answer
Whistle tip catheter tip 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 catheter keeps vacuum from biopsying mucosal during suctioning
Coude tip has a bend or angle at the distal end, allows for directional entry into right or left mainstem bronchi
Argyle aeroflow catheter donut shaped tip with multiple port holes
Closed suction system catheter 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 used primary 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 yankauers hard plastic catheter specifically for oropharynx suctioning
Oropharyngeal airway curved shaped device that separates the tongue from the posterior wall of the pharynx to relieve obstructions in unconscious pt
How is a oropharyngeal airway inserted with tip up, rotate 180 degrees as it goes in
Why and how is correct sizing important in oropharyngeal airway to 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 pt gag reflex may be strongly stimulated, may result in vomiting and aspiration
What is a nasopharyngeal airway soft 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 trumpet nasopharyngeal airway
What size nasal trumpet is best largest 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 occur to 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 regulator reduces 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 are primary 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 are occlude 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 trap specimen trap that can be placed in a vacuum circuit to collect sputum
What is the only suction catheter that can go down the left bronchi coude tip
What is the biggest hazard of suctioning hypoxia or hypoxemia
Hazards of suctioning are mechanical 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 atelectasis catheter to big or suction press to high
Assessment of need for suctioning auscultation, effectiveness of cough
Why can suctioning cause bradycardia touching the corina with the catheter can stimulate the vagal nerve
Assessment of outcome improved breath sounds, removed secretions
Pt monitoring during suctioning should include BS, 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 suctioning 10 to 15
Suction kit includes sterile catheter, gloves and basin
Equipment preparation for suctioning includes manual 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 often every 72 hours, be sure to date when opening
What is position of pt for suctioning semi fowler sniffing or supine if unable to semi fowler
How do we prevent hypoxemia in suctioning preoxygenate pt at 100 percent O2 for 1 to 2 minutes
Why do we hyperinflate pt prior to suctioning helps to avoid hypoxemia and vagal stimulation in vented pts
How far does RTT insert catheter 8 to 10 inches or until pt coughs
How long do we suction a pt for application of vacuum should be no longer than 15 seconds
Artificial airway aspiration direct passage below the larynx
How much saline is instilled in artificial airway if secretions are thick 3 cc
How often do we oxygenate pts when suctioning artificial airways between each pass
How do you estimate the size of a suction catheter 2 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 problem leak at suction trap or vacuum line, canister may be full, suction not turned on
pt has PVC’s during suction, what should RTT do stop, give 100 % O2, once stable continue suction
how does RTT reduce trauma to mucosa during suctioning rotate catheter, do not exede reconmended pressure, use largest cath possible with out going over 1/2
Question Answer
Absolute contraindication for suctioning epiglottitis and croup
How to tell if suction worked Decrease WOB, BS, got something out
When to suction When needed, when patient requests
Safe range for adult pressure 120-150
Safe range for child pressure 100-120
safe range for infant pressure 80-100
How to look for leaks when not vacumming look in connection
What kind of catheter for left main stem bronchi directional or Coude
What to do for collection of sputum attach leuken tube and suction
What kinds of lavages are there normal saline, mucomyst, and Na Bicarb
What are some complications for suctioning bronchospasm, vagal stimulation (bradycardia)
How to prevent complications correct 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
Question Answer
Purpose of suctioning Maintain a patent airway by removing secretions, blood, or foreign material
When is suctioning performed only when needed, visible secretions or audible gurgling, sudden increase in RR
Retention of secretions can cause increased WOB, atelectasis, hypoxemia, hypercapnia, pulmonary infection, increased airway resistance
What happens when you cough large inspiration, glottis closed, diaphragm moves up, pressure builds up in thorax, glottis opens, secretions move out
Indications for suctioning prolonged coughing, patientes request, patients with artificial airways
Patients that require suctioning Nervous system depression (intoxicated, sedated), abnormal pulmonary mechanics, thick secretions, pain, post surgical
Upper airway suction device oroharynx; clean (not sterile) yaunker, flexible plastic or rubber catheter
Lower airway suction device trachea and bronchi; open airway (remove pt from O2), closed airway (pt remains connected to O2)
Pressure save zone for adult 120-150 mmHg
Pressure save zone for child 100-120 mmHg
Pressure save zone for infant 80-100 mmHg
Formula to find right size catheter (ID of ET tube X 3 (factor))/ 2
When do you instill lavage Only after you are completely compared to begin insertion and suction
What to monitor during suction BS, O2 sat, RR, PR, BP, ABG, cough effor and ICP (internal cranial pressure)
Complications of suctioning Hypoxia,vagal stimulation, trauma, dysrhythmias, hemoptysis, atelectasis, bronchospasm,
What does high peep pressure help with helps with decrease FRC, it causes large drop in oxygenation,
Contraindications for suctioning epiglotitis because the glottis protects trachea, and Croup
Indication for closed suction catheter use PEEP 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 home make sure it is clean as possible, Catheter can be used up to 24 hours, equipment washed in vinegar 9:1, and boil if permitted.
Question Answer
Determine correct size of suction catheter when given endotracheal or trach tube size ID of ET x 3 (factor) = /2
Amount of vacumm suction needed for adults 120-150 mmHg
Amount of vacumm suction needed for children 100-120 mmHg
Amount of vacumm suction needed for infants 80-100 mmHg
Purpose of the Coude catheter curved directional tip catheter which may help in guiding it into either the left mainstem bronchi
Purpose of sputum trap for sputum collection
Purpose of tracheal suctioning Maintain a patent airway removing secretions, blood, or foreign material and facilitate pulmonary hygiene
Indications for tracheal suctioning visible 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 cough large 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 suctioning hypoxia, vagal stimulation, trauma, dsyhythmias, hemoptysis, atelectasis, bronchospasm
Contraindications to nasotracheal suctioning epiglottitis, and croup
Methods to minimize or prevent problems associated with suctioning hyperoxygenate, do it only as needed, do it in a quick efficient way (less than 15 seconds)
Suctioning in home care setting get 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 trap attach 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 reactions BS, vital signs, appearance…… stop treatment notify nurse or doctor
cause of expiratory wheezing after suctioning bronchospasm; 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 kit intermittent
What kind of suctioning for when getting a sputum trap depending on what it is. closed or not
When is lavage needed to break up hard thick mucus
Types of solution used for lavage normal saline, mucomyst, Na Bicarb
Advantages of lavage breaks up thich mucus
Disadvantages of lavage if 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 lavage right before suctioning
Indications for use of closed suction techniques PEEP > 10, insp time > 1.5 seconds, FiO2 > 60, MAP > 20 , resp infections
Factors that indicate the outcome of suctioning was beneficial to the patient decrease WOB, you got sputum out, HR went close to normal, and RR went down