ET suctioning, definition, purpose, indication, complications, types, procedure of ET suctioning, post procedure care, documentation, caution

1. Endo TrachealEndo Tracheal
SuctioningSuctioning
Presented by-Presented by-
Jasleen Kaur BrarJasleen Kaur Brar

2. Introduction.....Introduction.....
The patient with an artificialThe patient with an artificial
airway is not capable of effectivelyairway is not capable of effectively
coughing, the mobilization ofcoughing, the mobilization of
secretions from the trachea mustsecretions from the trachea must
be facilitated by aspiration. This isbe facilitated by aspiration. This is
called suctioning.called suctioning.

3. WHAT IS SUCTIONING?WHAT IS SUCTIONING?
Endotracheal suctioningEndotracheal suctioning
is the removal ofis the removal of
secretions fromsecretions from
tracheobroncheal treetracheobroncheal tree
through anthrough an
endotracheal tube withendotracheal tube with
the help of mechanicalthe help of mechanical
suction device.suction device.

4. PURPOSESPURPOSES
 To maintain a patent airway by removingTo maintain a patent airway by removing
retained tracheobroncheal secretions.retained tracheobroncheal secretions.
 To prevent lower respiratory tractTo prevent lower respiratory tract
infection from retained secretions.infection from retained secretions.
 To provide effective ventilation.To provide effective ventilation.
 To stimulate coughing.To stimulate coughing.

5. INDICATIONINDICATION
Therapeutic Diagnostic

6. Therapeutic:Therapeutic:
 Noisy breathingNoisy breathing
 Visible secretions in the airwayVisible secretions in the airway
 Decreased SpODecreased SpO22 in the pulse oximeter &in the pulse oximeter &
Deterioration of arterial blood gas valuesDeterioration of arterial blood gas values
 Patient’s inability to generate an effectivePatient’s inability to generate an effective
spontaneous coughspontaneous cough
 Presence of pulmonary atelectasis or consolidation,Presence of pulmonary atelectasis or consolidation,
presumed to be associated with secretion retentionpresumed to be associated with secretion retention
 During special procedures like Bronchoscopy &During special procedures like Bronchoscopy &
EndoscopyEndoscopy

7. Diagnostic:Diagnostic:
 The need to obtain a sputum specimen / ETAThe need to obtain a sputum specimen / ETA
(Endo Tracheal Aspiration) for investigations.(Endo Tracheal Aspiration) for investigations.

8. COMPLICATIONSCOMPLICATIONS
HypoxiaHypoxia
Tracheal or bronchial mucosal traumaTracheal or bronchial mucosal trauma
Cardiac or respiratory arrestCardiac or respiratory arrest
Pulmonary hemorrhage / bleedingPulmonary hemorrhage / bleeding
Cardiac dysrhythmiasCardiac dysrhythmias
Pulmonary atelectasisPulmonary atelectasis
BronchospasmBronchospasm
Hypotension / hypertensionHypotension / hypertension
Elevated ICPElevated ICP

9. TYPES OF ET SUCTIONINGTYPES OF ET SUCTIONING
OPEN SUCTION CLOSED SUCTION

10. ASSESSMENTASSESSMENT
PREPARATION OF PATIENT & ARTICLESPREPARATION OF PATIENT & ARTICLES
IMPLEMENTATIONIMPLEMENTATION
EVALUATIONEVALUATION

11. ASSESSMENTASSESSMENT
Patient should be monitored prior to, during &Patient should be monitored prior to, during &
after the procedure for following :after the procedure for following :
 Breath soundsBreath sounds
 Oxygen saturationOxygen saturation
 Respiratory Rate & patternRespiratory Rate & pattern
 Hemodynamic parameters (pulse rate, Blood pressure)Hemodynamic parameters (pulse rate, Blood pressure)
 Cough effortCough effort
 ICP (If indicated and available)ICP (If indicated and available)
 Sputum characteristics (color, volume, consistency &Sputum characteristics (color, volume, consistency &
odor)odor)
 Ventilator parameters (PIP, Vt & FiOVentilator parameters (PIP, Vt & FiO22))

12. ASSESSMENT….ASSESSMENT….
Assess theAssess the depth anddepth and
rate of respiration,rate of respiration,
auscultate breath sounds.auscultate breath sounds.
Assess for wheeze orAssess for wheeze or
rattling sound in chest:rattling sound in chest:
a harsh sound caused bya harsh sound caused by
partial obstruction of thepartial obstruction of the
airwaysairways

13. Patient PreparationPatient Preparation
 Explain the procedure to the patient ifExplain the procedure to the patient if
conscious.conscious.
 The patient should receive hyperThe patient should receive hyper
oxygenation by the delivery of 100%oxygenation by the delivery of 100%
oxygen for >30 seconds prior to theoxygen for >30 seconds prior to the
suctioningsuctioning
 Position the patient in supine position.Position the patient in supine position.
 Auscultate the breath sounds.Auscultate the breath sounds.

14. COMMUNICATE……COMMUNICATE……
Explain theExplain the
procedure to theprocedure to the
patient andpatient and
importance ofimportance of
coughing ifcoughing if
conscious.conscious.

15. EQUIPMENT ASSEMBLYINGEQUIPMENT ASSEMBLYING
StethoscopeStethoscope
Vacuum source with adjustableVacuum source with adjustable
regulator suction jarregulator suction jar
Sterile glovesSterile gloves
Sterile suction catheterSterile suction catheter
Protective goggles, apron & maskProtective goggles, apron & mask
Sterile normal salineSterile normal saline
AMBU bag for pre & postAMBU bag for pre & post
oxygenationoxygenation

16. SUCTION CATHETERSUCTION CATHETER
Catheter can be
selected according
to the ET tube size.
Sterile suction
catheter of 12-14 Fr
is used for adults
and for children 8-
10 Fr is used.

17. SUCTION PRESSURESUCTION PRESSURE
Turn on suction apparatus
to appropriate negative
pressure for:
adults-100-120 mmHg
children-50-100 mmHg
infants-40-60 mmHg.

18. IMPLEMENTATIONIMPLEMENTATION
HAND WASHHAND WASH
Perform handPerform hand
hygiene, wash hands.hygiene, wash hands.
It reducesIt reduces
transmission oftransmission of
microorganisms.microorganisms.

19. Goggles, mask & apron should beGoggles, mask & apron should be
worn to prevent splash fromworn to prevent splash from
secretionssecretions
Open the end of the suction catheterOpen the end of the suction catheter
package & connect it to suctionpackage & connect it to suction
tubing (If you are alone)tubing (If you are alone)
Wear sterile gloves with sterileWear sterile gloves with sterile
techniquetechnique
With a help of an assistant openWith a help of an assistant open
suction catheter package & connectsuction catheter package & connect
it to suction tubingit to suction tubing
Continue…..

20. Continue…..Continue…..
With a help of an assistantWith a help of an assistant
disconnect the ventilatordisconnect the ventilator
Kink the suction tube & insert theKink the suction tube & insert the
catheter in to the ETtube untilcatheter in to the ETtube until
resistance is feltresistance is felt
Resistance is felt when the catheterResistance is felt when the catheter
impacts the carina or bronchialimpacts the carina or bronchial
mucosa, the suction cathetermucosa, the suction catheter
should be withdrawn 2cm outshould be withdrawn 2cm out
before applying suctionbefore applying suction

21. Continue.....Continue.....
Apply continuous suctionApply continuous suction
while rotating the suctionwhile rotating the suction
catheter during removalcatheter during removal
The duration of eachThe duration of each
suctioning should be 10-15sec.suctioning should be 10-15sec.
Instill 3 to 5ml of sterileInstill 3 to 5ml of sterile
normal saline in to thenormal saline in to the
artificial airway, if requiredartificial airway, if required
Give four to five manualGive four to five manual
breaths with bag or ventilatorbreaths with bag or ventilator

22. Continue…..Continue…..
Return patient to ventilatorReturn patient to ventilator
Flush the catheter with NSFlush the catheter with NS
in the suction trayin the suction tray
Suction nares & oropharynxSuction nares & oropharynx
above the artificial airwayabove the artificial airway
Discard used equipmentsDiscard used equipments
Flush the suction tube withFlush the suction tube with
hot waterhot water
Wash handsWash hands

23. POST PROCEDURE CARE…POST PROCEDURE CARE…
When the procedure isWhen the procedure is
completecomplete
hyperventilate thehyperventilate the
patient again.patient again.
When the airwayWhen the airway
becomes clear, returnbecomes clear, return
the patient tothe patient to
ventilator or oxygenventilator or oxygen
source.source.

24. DOCUMENTATION…DOCUMENTATION…
Record the time ofRecord the time of
suctioning, nature &suctioning, nature &
amount of secretions.amount of secretions.
Document indicationsDocument indications
for suctioning & anyfor suctioning & any
changes in vitals &changes in vitals &
patient’s tolerance.patient’s tolerance.

25. CAUTION..CAUTION..
Suctioning is potentially anSuctioning is potentially an
harmful procedure if carriedharmful procedure if carried
out improperly.out improperly.
Suctioning should be doneSuctioning should be done
when clinically necessarywhen clinically necessary
(not routinely).(not routinely).
The need for suctioningThe need for suctioning
should be assessed at leastshould be assessed at least
every 2hrs or moreevery 2hrs or more
frequently as need arises.frequently as need arises.

26. Thank youThank you