En Do Tracheal Suctioning

Endotracheal Suctioning
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ET TUBES
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ET Insertion
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|atient with ET tube
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Endotracheal Suctioning of Mechanically Ventilated Adults and
Children with Artificial Airways
Endotracheal suctioning
is a component of bronchial hygiene
therapy and mechanical ventilation
involves the mechanical aspiration of
pulmonary secretions from a patient with
an artificial airway in place
The procedure includes patient
preparation, the suctioning event(s), and
follow-up care
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|atient |reparation
0 Gyperoxygenate patient by the delivery of

100% oxygen for > 30 seconds prior to the
suctioning event
0 may be accomplished by any of the
following:
0 by adjusting the FIO2 setting on the mechanical
ventilator.
0 by use of a temporary oxygen-enrichment program

available on many microprocessor ventilators.
by manually ventilating the

patient with an increased FIO2.
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|atient |reparation
r A closed-suction system may be used to facilitate

continuous mechanical ventilation and oxygenation
during the suctioning event.
r A patient may be placed on a pulse oximeter to

assess oxygenation during and following the
procedure.
r A patient may receive normal saline by instillation

through the artificial airway to dilute and mobilize
pulmonary secretions.
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The Suctioning Event
0 The placement of a suction catheter through

the artificial airway into the trachea and the
application of negative pressure as the
catheter is being withdrawn
0 Sterile technique should be employed
0 Each pass of the suction catheter into the
artificial airway is considered a suctioning
event
0 Duration : 10-15 seconds
0 Suction pressure should be set as low as
possible and yet effectively clear secretions.
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Follow-Up Care
å the patient should be hyperoxygenated by delivery

of 100% oxygen for > or = 1 minute
å the patient may be hyperventilated by increasing

the respiratory rate and/or tidal volume
å the patient should be monitored for adverse

reactions.
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ET INDICATIONS
å The need to remove accumulated pulmonary
secretions as evidenced by one of the
following:
r Coarse breath sounds by auscultation or 'noisy'
breathing
r Increased peak inspiratory pressures during
volume-controlled mechanical ventilation or

decreased tidal volume during pressure-
controlled ventilation.
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ET INDICATIONS
r |atient's inability to generate an effective
spontaneous cough.
r Visible secretions in the airway
r Changes in monitored flow and pressure graphics
r Suspected aspiration of gastric or upper airway

secretions
r Clinically apparent increased work of breathing
r Deterioration of arterial blood gas values
r Radiologic changes consistent with retention of
pulmonary secretions
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ET INDICATIONS
å The need to obtain a sputum specimen to rule out or
identify pneumonia or other pulmonary infection or for
sputum cytology
å The need to maintain the patency and integrity of the
artificial airway
å The need to stimulate a patient cough in patients unable to
cough effectively secondary to changes in mental status or
the influence of medication
å |resence of pulmonary atelectasis or consolidation,
presumed to be associated with secretion retention
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ETS CONTRAINDICATIONS:
r Endotracheal suctioning is a necessary procedure for

patients with artificial airways
r Most contraindications are relative to the patient's risk of
developing adverse reactions or worsening clinical
condition as result of the procedure
r When indicated, there is no absolute contraindication to
endotracheal suctioning because the decision to abstain
from suctioning in order to avoid a possible adverse
reaction may, in fact, be lethal.
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ETS GAZARDS/COM| ICATIONS
0 Gypoxia/hypoxemia
0 Tissue trauma to the tracheal and/or bronchial mucosa
0 Cardiac arrest
0 Respiratory arrest
0 Cardiac dysrhythmias
0 Pulmonary atelectasis
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ETS GAZARDS/COM| ICATIONS
0 jronchoconstriction/bronchospasm
0 Infection (patient and/or caregiver)
0 Pulmonary hemorrhage/bleeding
0 Elevated intracranial pressure
0 Interruption of mechanical ventilation
0 Gypertension
0 Gypotension
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ETS ASSESSMENT OFOUTCOME
å Improvement in breath sounds

å Decreased peak inspiratory pressure (|I| with
narrowing of |I| - |plateau; decreased airway
resistance or increased dynamic compliance;
increased tidal volume delivery during pressure-
limited ventilation
å Improvement in arterial blood gas values (ABGs or
saturation as reflected by pulse oximetry (SpO2
å Removal of pulmonary secretions
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Necessary Equipment
r Vacuum source
r Calibrated, adjustable regulator
r Collection bottle and connecting tubing
r Sterile disposable gloves
r Sterile suction catheter of appropriate caliber
r Diameter of the suction catheter should not exceed
more than one half of the internal diameter of the

artificial airway. For selective main-stem
suctioning, a curved-tip catheter may be helpful.
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Necessary Equipment
r Sterile water and cup

r Sterile normal saline, if instillation is desirable
r Goggles, mask, and other appropriate equipment for

Universal |recautions
r Oxygen source with a calibrated metering device
r Manual resuscitation bag equipped with an oxygen

enrichment device
r Stethoscope
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Optional Equipment
r EKG monitor
r |ulse oximeter
r Sterile sputum trap for culture
specimen
r Closed suction system
r Oxygen insufflation device
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RES|ONSIBI ITIES
The RN responsible for

performing Endotracheal
suctioning should demonstrate
the following :
1. Knowledge of proper use and assembly of all equipment used

2. Ability to recognize abnormal breath sounds by auscultation
3. Knowledge and understanding of the patient's history, disease
process, and goals of treatment
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RES|ONSIBI ITIES
. Knowledge and understanding of basic

physiology and pathophysiology
5. Knowledge and understanding of

ventilation, mechanical ventilators, and
their alarm systems
6. Knowledge and understanding of all

artificial airways and adjuncts used
7. Ability to monitor vital signs, assess the

patient's condition, and appropriately
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respond to complications or adverse
reactions to the procedure
RES|ONSIBI ITIES
U. Ability to modify techniques and equipment in response to
complications or adverse reactions
9. Knowledge of basic EKG interpretation
10. Ability to assess the need for and

provide cardiopulmonary resuscitation
11.Ability to evaluate and document the

effectiveness and patient response to
the procedure
12.Knowledge and |understanding of the

CDC guidelines for Universal |recautions
RES|ONSIBI ITIES
13. Knowledge of signs and symptoms

of decreased cardiac output,
oxygenation, and perfusion

patient response to the procedure
15. Ability to perform the proper

suctioning technique

patient response to the procedure
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ETS MONITORING
r The following should be monitored prior to,

during, and after the procedure:
1. jreath sounds
2. Oxygen saturation
a. Skin color
b. Pulse oximeter, if available
3. Respiratory rate and pattern
4. Gemodynamic parameters
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ETS MONITORING
Î. Pulse rate
6. jlood pressure
7. EKG
8. Sputum characteristics
a. Color
b. Volume
c. Consistency
d. Odor
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ETS MONITORING
9. Cough effort
10. Intracranial pressure,
11. Ventilator parameters
a. Peak inspiratory pressure
and plateau pressure
b. Tidal volume
c. Pressure, flow, and volume
graphics
d. FIO2
e. Arterial blood gases
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ETS FREQUENCY
r Endotracheal suctioning should be performed

whenever clinically indicated, with special
consideration for the potential complications
associated with the procedure
r Endotracheal suctioning may be required at
some minimum frequency in order to maintain
the patency of the artificial airway used
ETS INFECTION CONTRO
å CDC Guidelines for Universal Precautions
should be adhered to.
å All equipment and supplies should be
appropriately disposed of or disinfected.
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En Do Tracheal Suctioning

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Endotracheal Suctioning

0 Gyperoxygenate patient by the delivery of

0 by use of a temporary oxygen-enrichment program

by manually ventilating the

r A closed-suction system may be used to facilitate

r A patient may be placed on a pulse oximeter to

r A patient may receive normal saline by instillation

0 The placement of a suction catheter through

å the patient should be hyperoxygenated by delivery

å the patient may be hyperventilated by increasing

å the patient should be monitored for adverse

volume-controlled mechanical ventilation or

r Changes in monitored flow and pressure graphics

r Suspected aspiration of gastric or upper airway

r Deterioration of arterial blood gas values

r Radiologic changes consistent with retention of

r Endotracheal suctioning is a necessary procedure for

å Improvement in breath sounds

r Collection bottle and connecting tubing

r Sterile disposable gloves

r Sterile suction catheter of appropriate caliber

r Diameter of the suction catheter should not exceed

more than one half of the internal diameter of the

r Sterile water and cup

r Goggles, mask, and other appropriate equipment for

r Manual resuscitation bag equipped with an oxygen

r Sterile sputum trap for culture

r Oxygen insufflation device

The RN responsible for

1. Knowledge of proper use and assembly of all equipment used

. Knowledge and understanding of basic

5. Knowledge and understanding of

6. Knowledge and understanding of all

7. Ability to monitor vital signs, assess the

9. Knowledge of basic EKG interpretation

10. Ability to assess the need for and

11.Ability to evaluate and document the

12.Knowledge and |understanding of the

13. Knowledge of signs and symptoms

1. Ability to assess the need for and

15. Ability to perform the proper

16. Ability to assess the need for and

r The following should be monitored prior to,

r Endotracheal suctioning should be performed

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. Knowledge and understanding of basic

1. Ability to assess the need for and