Do u install saline when u do endotracheal suctioning??
Let's discover what evidence say about it...
Stay tuned 💜
Let's discover what evidence say about it...
Stay tuned 💜
Airway suctioning is one of the most common interventions for patients with respiratory disorders and having adequate knowledge in implementing this technique is quite crucial for nurses.
First:- Why we need suction:
Suctioning secretions from the airway or ETT maintains patency, prevents aspiration, assists an ineffective cough, and can be used to obtain specimens for diagnostic purposes.
Suctioning secretions from the airway or ETT maintains patency, prevents aspiration, assists an ineffective cough, and can be used to obtain specimens for diagnostic purposes.
Second:- When to be use?
It is not a benign procedure, recognizing when it is or is not indicated is important.
1- auscultating decreased breath sounds; implicating a possible mucous plug
2- difficulty during mechanical ventilation, possibly resulting from ETT occlusion
تابع..
It is not a benign procedure, recognizing when it is or is not indicated is important.
1- auscultating decreased breath sounds; implicating a possible mucous plug
2- difficulty during mechanical ventilation, possibly resulting from ETT occlusion
تابع..
3- decreasing oxygen saturation
4- visible presence of secretions.
4- visible presence of secretions.
There is 2 types of endotracheal suctioning:
1- open
2- close system
But close suction is more preferable
Why closed suction is overweight open suction??
See the pictures 🌷🌷
1- open
2- close system
But close suction is more preferable
Why closed suction is overweight open suction??
See the pictures 🌷🌷
During open endotracheal suctioning (OES), the patient is temporarily removed from the ventilator to breathe freely, or manually ventilated, while ETS is performed. Some studies have shown that there is more secretion removal with OES.
Conversely??!
Conversely??!
closed system suctioning (CSS), the patient remains attached to the ventilator, or their supplemental breathing device, and a reusable inline (enclosed) catheter is used for ETS. Remaining connected to the ventilator helps prevent the loss of pressure and the loss of lung volume.
1-In infants, CSS has been shown to be physiologically better tolerated by the patient because of much less desaturation and less incidence and length of bradycardia.
2- The use of CSS may prevent hypoxia and decreases in lung volume for both pediatric and adult patients.
2- The use of CSS may prevent hypoxia and decreases in lung volume for both pediatric and adult patients.
Using CSS also has the potential for lessening the spread of infection to patients and staff. Most clinical staff prefer CSS for the ease of use, less time involved, and better patient toleration.
Some studies have shown no significant difference in ventilator-associated pneumonia (VAP) occurrence between open or closed ETS.
By the way close system is expensive and not available in all institutions
By the way close system is expensive and not available in all institutions
There are10 Considerations for Endotracheal Suctioning which are mostly studied. I will explain one by one and what evidence say about them..
Awareness and application of evidence-based knowledge practices in respiratory therapy is ideal, because it demonstrates to patients and peers that procedures are being performed according to scientifically proven methods.
Put in ur mind
#nursing_intern
Put in ur mind
#nursing_intern
First:-1. Frequency of Suctioning:-
there has been a very limited number of studies regarding a scheduled frequency of performing ETS every 1, 3, 4, 6, 8, or even 12 hours,
تابع شوه الايفدنس اوصى...
there has been a very limited number of studies regarding a scheduled frequency of performing ETS every 1, 3, 4, 6, 8, or even 12 hours,
تابع شوه الايفدنس اوصى...
the recommendation is to suction only as indicated (as needed) because there is considerable risk with using “routine” suctioning.
بعدها دراسه قالت ETS better performed at least every 8 hrs to slow the formation of the secretion within the lumen of the ET. وهذه المفضله معي
بعدها دراسه قالت ETS better performed at least every 8 hrs to slow the formation of the secretion within the lumen of the ET. وهذه المفضله معي
فأنت اقرا الافيدنس المتعارض واختار ما يتناسب المؤسسه وحاله المريض
Second:- Preoxygenation
In general, studies have not yet shown the optimal level or duration for the use of preoxygenation for ETS.
In adults, the common practice is to preoxygenate with 100% oxygen before, during, and for some period after performing ETS.
تابع نفس النقطه
In general, studies have not yet shown the optimal level or duration for the use of preoxygenation for ETS.
In adults, the common practice is to preoxygenate with 100% oxygen before, during, and for some period after performing ETS.
تابع نفس النقطه
However,Prolonged hyperoxia may lead to free-radical tissue damage, absorption atelectasis (nitrogen washout), and loss of lung volume.
In preterm infants, the practice of using 100% o2 is avoided because of the possible deleterious effects of hyperoxia ..تابع
In preterm infants, the practice of using 100% o2 is avoided because of the possible deleterious effects of hyperoxia ..تابع
that can cause ROP. Also the level of brain oxygenation decreases in parallel with the drop in oxygen saturation, Also in infants there is a possibility of bradycardia and apnea when preoxygenation is not provided.Therefore, many (NICUs) have a protocol تابع...
Better the O2is increased by 10% to 20% before ETS. Another concern is providing hyperoxia to patients in cardiac units who have cyanotic heart disease, since the hyperoxiacause pulmonary vascular dilation and decreased preload to the left heart result in systemic hypotension.
Third:-Vacuum Pressure Level
the general recommendation is to use between 80 and 100 mm Hg is used with the appropriate suction catheter size. One interesting thing to note about ETS is that negative pressure is created inside of the lungs only while air flows out of the suction
the general recommendation is to use between 80 and 100 mm Hg is used with the appropriate suction catheter size. One interesting thing to note about ETS is that negative pressure is created inside of the lungs only while air flows out of the suction
Fourth:- Suction Catheter Size
If a suction catheter is too large for the ETT, andthere is too much vacuum pressure, massive atelectasis may occur. the general recommendation is to use a suction catheter that has an external diameter less than 50% of the size of the ETT inner di
If a suction catheter is too large for the ETT, andthere is too much vacuum pressure, massive atelectasis may occur. the general recommendation is to use a suction catheter that has an external diameter less than 50% of the size of the ETT inner di
Fifth:- Depth of Catheter Insertion
The appropriate catheter length is determined by measuring the length of the ETT against the suction catheter. The proper length should pass the end of the tube but not touch the carina.
The appropriate catheter length is determined by measuring the length of the ETT against the suction catheter. The proper length should pass the end of the tube but not touch the carina.
6_Duration of Suctioning
Considering what was previously presented about vacuum pressure, it should be clear that a longer duration of suction can increase the negative pressure within the lungs and reduce lung volumes. Recommended duration of 10 to 15s for adult and 5s pediatr
Considering what was previously presented about vacuum pressure, it should be clear that a longer duration of suction can increase the negative pressure within the lungs and reduce lung volumes. Recommended duration of 10 to 15s for adult and 5s pediatr
انجي الجزئية المهمه insulation of normal saline during suction
#nursing_intern
There is a general belief that normal saline instillation (NSI) lubricates the ETT so that the suction catheter will pass more easily and dilutes secretions and helps to stimulate cough.
تابع
#nursing_intern
There is a general belief that normal saline instillation (NSI) lubricates the ETT so that the suction catheter will pass more easily and dilutes secretions and helps to stimulate cough.
تابع
بس Research, however, has shown that normal saline and mucus are immiscible and maintain their separate phases, even after
vigorous shaking
يعني لو خلطوهم بالقوه ما يجتمعو
vigorous shaking
يعني لو خلطوهم بالقوه ما يجتمعو
Since saline and mucus do not mix together, there is some doubt that NSI thins or loosens secretions and improves secretion return.
The common concern in the use of NSI is that it can cause desaturation and bradycardia, and may increase airway infection.
The common concern in the use of NSI is that it can cause desaturation and bradycardia, and may increase airway infection.
Some studies comparing ETS with and without NSI showed that both have the same effect upon heart rate, oxygenation, and blood pressure.
Another concern is that NSI may cause cough-dispersion of secretions into other areas of the lungs, or possibly lung contamination
تابع...
Another concern is that NSI may cause cough-dispersion of secretions into other areas of the lungs, or possibly lung contamination
تابع...
recent study by Caruso et al in which 8 ml of normal saline was instilled before ETS demonstrated that saline can effectively decrease the microbiologically proven incidence of VAP more so than ETS without NSI.
In infants with a size 2.5 mm ETT, the use of NSI helps keep the lumen of the tube open.
Morrow and Argent stated that NSI should not be routinely used with ETS, but adequate airway humidification is essential, which is a good general recommendation.
Morrow and Argent stated that NSI should not be routinely used with ETS, but adequate airway humidification is essential, which is a good general recommendation.
If saline is to be used with suctioning, the clinician must remember there are potentially significant differences in the neonatal and adult airway chemistry. the antimicrobial component of airway mucus in the neonate is significantly different compared with an adult.
Saline instillation after suctioning remains a controversial topic in pediatrics. Catheter insertion alone may dislodge thousands of bacteria located within the lumen of the ETT; a saline flush serves as a vehicle and potentially contributes to the distribution of bacteria
شخصيا تجربتي انه اعمل مثل لافاج ونفس التوقيت اعمل سكشن.. نبغي دراسه تثبت فاعليتها....وراح أسرد قصه.. لما كنت بالعملي ايام الدراسه.. الممرضات الي يشتغلو بالقسم كانو يتخوفو منا ع اساس احنا راح نجادلهم بالفيدنس.. كان الطفل معه pulmonary bleed بس already was stopped.. تابعو القصه
البيبي باديه معه اعراض انه خلاص et متسكر ومبين ابدا ما مرتاح...وهي تدخل السكشن تيوب وما يطلع شي.. اتاريه old blood يابس ومسكر ع الفتحه....وهي متخوفه. قلت لها اعملي سلاين.. ونفس التوقيت اسحبي. طلع لنا قول مال ٢٠ ملي old blood متيبس والطفل ارتاح مباشره بعد ما سحبناه عنه
لذلك حابه انوه انه evidence doesn't mean its evidence لكن انت كممرض مجبور انه تقرا وتعرف المناسب لمريضك وتسلح نفسك بالعلم..
Knowing is power
Knowing is power
@Rattibha
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