a. Endotracheal suctioning can be accomplished through an endotracheal tube that the physician inserts through the patient's mouth and into the trachea. It can remain in place for several days and, when its cuff is inflated to provide a tight connection, it can be attached to a respirator for controlled ventilation (see Figure 3-8). The inflated cuff also aids in preventing aspiration of blood, vomitus or foreign material into the bronchus.
b. Although endotracheal suctioning is a common procedure, it is one that interferes with arterial oxygenation. The decrease in oxygen in the alveoli is directly proportional to the amount of suction and the length of time the procedure takes. The amount of oxygen in the blood drops suddenly and produces serious hypoxia. It is essential to oxygenate the patient pre- and post-suctioning.
c. Endotracheal suctioning should be done only when necessary to maintain the airway, and then it must be brief. When suctioning is unavoidable, sterile technique (aseptic) must be used.
(6) Provide a clean work area.
(7) Wash your hands.
(8) Open the suction kit and sterile 2 x 2-inch sponges, using the wrapper to create a sterile field.
(9) Pour 30 to 50 cc of sterile normal saline into the sterile solution container using aseptic technique.
(10) Turn on the suction unit and set the desired pressure according to equipment specification or the physician's order.
(11) Put on the sterile gloves.
(12) Attach the sterile suction catheter to the connecting tubing by holding the catheter in your dominant hand (sterile hand) and the connecting tube in you nondominant hand (nonsterile hand).
(13) Moisten the suction catheter tip with the sterile normal saline solution.
(14) Instruct an assistant to hyperoxygenate the patient if ordered by physician.
(a) Patients should be hyperoxygenated prior to suctioning and between suction attempts by means of a ventilator or a manual resuscitator attached to an oxygen flowmeter set at 100% oxygen.
(b) This step limits the hypoxia caused by the suctioning.
(15) Insert the sterile suction catheter gently into the endotracheal tube until resistance is felt, then pull back slightly.
(a) Suction should not be applied during catheter insertion to prevent injury to the mucous membranes.
(b) The depth of suctioning may be determined by the physician's order or by the health care facility's policy.
(16) Place the thumb of your nondominant (nonsterile) hand over the suction control.
(17) Rotate the catheter between the thumb and index fingers of your sterile hand while applying intermittent suction and withdrawing the catheter.
(a) Do not suction for longer than 10 seconds.
(b) Secretions trapped near inflated endotracheal cuffs should be removed at least every 8 hours by deflating the cuff and performing both oropharyngeal and tracheal suctioning using appropriate techniques.
(c) Reinflate the cuff to the minimum occluding volume or according to physician's order.
(18) Rinse the suction catheter in sterile saline.
(19) Instruct an assistant to hyperoxygenate the patient between suction attempts.
(20) Instill 5 cc of sterile normal saline into the trachea if ordered by the physician and, if secretion is thick, wait 5 seconds and suction the patient again.
(a) Thick secretions may be controlled by instilling 5 cc of sterile normal saline into the endotracheal tube immediately prior to suctioning.
(b) Increasing airway humidity will also assist in liquefying secretions.
(21) Repeat the suction procedure until the airway is clear, rinsing the catheter and hyperoxygenating the patient.
(22) Perform oropharyngeal suctioning, if possible.
(23) Shut off the suction machine.
(24) Remove your gloves and place them in the waste receptacle.
(25) Determine the patient's airway patency and vital signs.
(26) Assist the patient to a comfortable position.
(27) Discard the suction kit equipment and return all equipment to the appropriate area.
(28) Wash your hands.
(29) Record procedure and report significant observations to the Charge Nurse.
(a) Time, frequency of the procedure, and name of the person performing the procedure.
(b) Hyperoxygenation procedure and the equipment used.
(c) Specific assessment parameters including color, amount, consistency, odor of the secretions, vital signs, and breath sounds.
(d) Instillation of normal saline during the procedure, if possible.
(e) The patient's reaction to the procedure and the position in bed, if appropriate.
(f) The type of respiratory care equipment attached to the endotracheal tube following the procedure, as appropriate.
(g) Any patient teaching done and the patient's level of understanding.