Measurement of length to suction is to be predetermined at shift commencement. Length is determined by using the centimetre markings on the ETT; and by adding the length of additional space of the ETT adapter usually Please note, that if you are going to trim an ETT do this prior to attaching closed suction system.
If you need to trim ETT once closed suction system in place, please remove from ETT, replace original adaptor and attach neopuff, trim ETT and then insert closed suction system. There is some evidence that utilizing a closed suction method during mechanical ventilation in neonates will help to reduce the de-recruitment phase of ventilation.
Closed suctioning reduces the risk for contamination with environmental pathogens, reduces viral and bacterial colonisation within the ventilation circuit and it also safely protects nursing and medical staff from exposure to patient bodily fluids.
It therefore appropriate to use this technique when caring for patients with infectious respiratory conditions. Normal saline should not be routinely instilled prior to ETT suction in infants.
It should only be instilled in infants who have thick, tenacious secretions. The amount of normal saline to use is 0. Each infant should be assessed individually regarding whether this is necessary. This should be decreased as soon as possible after suction is complete. Recruitment post-suction should not be routine, however:. If the oxygen saturations are not improving in the two minutes after suction increasing the PEEP by 1 cmH2O should be discussed with the Medical Staff.
Each infant should be assessed individually regarding whether hyperventilation pre-suction is necessary. Hyperventilation pre-suction should not be routine, but:. Using the ventilator setting, rate is increased by breaths above baseline immediately prior to suction, and continues after suction is complete until the infant returns to the pre-suction oxygen saturation and ETT or transcutaneous CO 2 if monitored level. Care should be taken to ensure the rate is reduced to baseline as soon as possible after ETT suction.
It is the responsibility of the clinician caring for the infant requiring ETT suction to ensure that the parents understand the rationale for the procedure, as well as potential complications. Parents can help to support, contain and comfort the neonate while the nurse is carrying out the procedure. Some infants may require a pre-suction bolus of analgesia or sedation where the need is anticipated, however urgent suction should not be deferred. The need for this intervention is based on clinical assessment.
Nursing comfort measures, such as positioning and containment, should also be utilized following the suction procedure. The need for this intervention is not routine, and where appropriate should be ordered by medical staff. This is a two person procedure. For infants on HFOV, mean airway pressure is increased 2cmH2O above baseline for approximately two minutes after suction is complete, or until the infant returns to the pre-suction oxygen saturation level.
Care should be taken to ensure the mean airway pressure is reduced to baseline as soon as possible after ETT suction.
For infants on HFJV, conventional ventilator rate may be increased by breaths above baseline immediately prior to suction, and continues after suction is complete until the infant returns to the pre-suction oxygen saturation and transcutaneous CO 2 if monitored level. When caring for patients on HFJV, ideally the jet ventilator should be put on hold while suctioning and then press the enter button when the procedure is complete.
This step prevents the jet ventilators alarms from shutting down the ventilator during suction. There are, however, occasions where this may not be possible due the instability of the patient you are caring for. There is no need to disconnect from the ventilator as you can suction through the port of the ventilator tubing. Disconnection of a ventilation circuit with iNO therapy should be avoided and so the use of an in-line suction port is most suitable.
Suction of the ETT should be done swiftly to avoid de-recruitment of the lungs. Use aseptic technique and personal protective equipment. Suction catheters should be discarded following each suction event, in order to reduce the risk of introducing infection. Where possible, ETT suction is a two person procedure. Setting levels too high should be avoided and can lead to tissue damage. An endotracheal aspirate procedure can begin after it has been explained to the patient and supplies have been collected.
The use of personal protective equipment including an eye shield is highly recommended and usually required in most facilities. Sterile technique should be used in order to reduce the risk of nosocomial infection. A recent study indicated that the method of hyperoxygenation with FIO2 of 0.
When suctioning through the nose, apply lubricate to the end of the catheter for easier insertion. Insert the catheter through the nose, tracheostomy tube or endotracheal tube. Do not be aggressive when inserting the tube through the nose. Once the catheter has been inserted to the appropriate depth, apply intermittent suction and slowly withdraw the catheter, using a twirling motion as the catheter is withdrawn.
If suctioning more than once, allow the patient time to recover between suctioning attempts. During the procedure, monitor oxygen levels and heart rate to make sure the patient is tolerating the procedure well. Suctioning attempts should be limited to 10 seconds. Suctioning is not entirely without risk. As with all medical interventions, healthcare workers need to use clinical judgment in order to determine if the benefits outweigh the risks.
Various complications such as discomfort, bronchoconstriction, infection, injury to the tracheal mucosa and hemorrhage, atelectasis, cardiac arrhythmias and hemodynamic changes among others could occur.
The most frequently reported complications reported are reduced oxygenation and pulmonary de-recruitment. You need to suction your child's airway because your child needs help to clear secretions that they cannot clear on their own through coughing or blowing their nose.
This will help your child breathe more easily. Most children who need suctioning need to be suctioned at least three or four times a day. In particular, your child needs to be suctioned when:. With nasal suctioning , a catheter or small tip catheter is passed into the nostril.
This is helpful when secretions are visible in the nose or you suspect that secretions are blocking the nasal passage. For oral suctioning , a hard-plastic tip with a handle called a Yankauer is usually used to suction secretions in the mouth. Oral suctioning is useful when your child is unable to remove secretions by coughing for example, they have a weak cough or they are drooling because they cannot swallow.
A suction catheter a thin, clear, soft plastic tube preferably with depth markings on it is inserted to a predetermined depth through the nose nasopharyngeal or mouth oropharyngeal to the back of the throat. This type of suctioning is useful when secretions are pooled at the back of the throat and your child does not have the ability to cough them up or swallow them. This method is usually done with an artificial airway such as a tracheostomy tube.
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