airway clearance
TRANSCRIPT
Airway Clearance Techniques
Airway Clearance Techniques
• Suctioning - negative pressure applied within the airway– Can be via ET or Trach tube or– Through the nose into the trachea
• This is called NT or naso-tracheal suctioning
• Bronchoscopy– Flexible Fiberoptic bronchoscopy – Rigid tube bronchoscopy
Indications for Suctioning
• Patient has an inability to clear secretions– Ineffective or absent cough with– Evidence of retained secretions in upper airway
• A sample of sputum is to be obtained for lab analysis purposes– Use a sterile “sputum trap” (Lukens trap)
Lukens Trap for Obtained Sputum Sample
Contraindications to NT Suctioning
• Absolute contraindication: evidence of croup or epiglottitis
• Relative contraindications;– Occluded nasal passages– Nasal bleeding– bleeding disorder– Acute facial, head or neck injury
Hazards & Complications of NT Suctioning
• Hypoxia/Hypoxemia
• Trauma to nasal passages, pharynx or trachea
• Cardiac or respiratory arrest
• Cardiac dysrhythmias or bradycardia
• Atelectasis
• Bronchospasm
When do patients need suctioning?
• Listen over anterior chest with stethoscope– Evidence of loud rhonchi?
• Does patient have audible crackles when breathing with their mouth open?
• Place hand on anterior chest– Does patient have tactile fremitus?
• Have patient cough. What is the character of the cough? Loose but non-productive?
Monitoring During Suctioning
• Respiratory rate & pattern
• ECG tracing (if available), Heart rate
• Skin color; SpO2
• Subjective response
• Sputum character; color, consistency, amount and any odor
• Evidence of airway bleeding?
Equipment Used During Suctioning
• Suction Regulator attached to wall OR portable suction unit (see next slide)
• Suction canister to collect secretions
• Suction supply tubing
• Suction kit; sterile (sheathed or unsheathed) catheter, sterile gloves; basin for irrigation water; sterile water; Lubifax or KY Jelly (for NT suctioning)
Suction Regulator
Procedure for Suctioning
• Assess need
• Turn on & set suction pressure on regulator– Adults: negative 100 - 120 mmHg– Children: negative 80 - 100 mmHg– Infants: negative 60 - 80 mmHg
• Prepare patient: Communicate!!!!!!!!!!
• Make sure patient is well oxygenated
Suctioning Procedure Continued
• Open necessary sterile saline or water containers; open lubricating jelly containers
• Open kit and put glove(s) on
• Lubricate catheter (NT suction only)
• Insert catheter slowly
• Apply suction only while withdrawing using rotating motion (10-15 seconds only)
Suctioning Procedure Continued
• Make sure patient is reoxygenated after catheter has been removed
• Monitor patient and assess need for additional suctioning
• Repeat as necessary based upon need and ability for patient to tolerate procedure
Closed-System Multi-Use ET Catheter
Closed-System Multi-Use Trach. Catheter
Unsheathed Sterile Catheter
Sterile Suction Kit
Cath-n-sleeve Catheter
Sizes of Catheters
• When suctioning though an ET tube;– Take ET tube size (I.D.) and multiply by 2– 7.5 mm tube X 2 = 15– Next closest size is 14 French
• Mostly commonly used adult size is 14 F
• Largest current adult size is 14 French
• Other smaller sizes are 12F; 10F; 8F; 6F
Bronchoscopy
• Therapeutic bronchoscopy– To visualize and remove mucus from the
airway– Can be used to intubate in situations where
standard intubation techniques have failed
• Diagnostic bronchoscopy– To visualize tumors and obtain tissue samples
for pathology analysis
Parts of the Fiberoptic Bronchoscope
Picture from Therapeutic Bronch
Picture from Diagnostic Bronch
THE END!