Technique or Treatment
The patient should be educated about the procedure (if awake and interactive) and the possibility of discomfort. Ensure preoxygenation with 100% FiO2 was done with adequate pulse oximetry measurements. Preoxygenation is required because an airway suctioning procedure may be associated with significant hypoxemia.[2] Suctioning of the lower airways should be done in a sterile manner with single-use gloves and suction catheters to prevent contamination and secondary infection.
After preparation with appropriate equipment at the bedside and monitoring continuous heart rate and oxygen saturation (as available), the patient should be suctioned with the appropriately sized equipment for their airway. The catheter should be introduced to a depth no more than the tip of the artificial airway to prevent trauma and bleeding from airway mucosa. Suction pressure should be kept at less than 200 mmHg in adults. It should be set at 80 mmHg to 120 mmHg in neonates.[3] The catheter size used for suction should be less than 50% of the internal diameter of the endotracheal tube. A common conversion is that a 1 mm diameter is equal to a 3 French.
Bạn đang xem: Bookshelf
Xem thêm : What Can Disqualify You From Donating Plasma?
The use of normal saline while suctioning is not recommended by the American Association of Respiratory Care. The duration of suctioning should be less than 15 seconds per suction attempt. Following airway suction, the patient should be allowed to recover for at least 10 to 15 seconds and re-oxygenate as needed before re-suctioning occurs. Standard precautions should be followed while suctioning by the care provider.[1]
Open vs. closed
Xem thêm : What’s the Buzz
Previously the standard of care for intubated patients was open suction, which involved disconnection from the ventilator and the use of a single-use suction catheter. However, for the last two decades, the use of in-line (closed suctioning) is standard practice. In-line suctioning is considered safer and is associated with fewer adverse events. In-line suctioning, as the name implies, includes a suction catheter that is attached as a part of the ventilator circuit connected to the patient. While advantages are seen with the use of in-line suction catheters, it has not been shown to reduce the incidence of ventilator-associated pneumonia.[4]
Superficial vs. deep
Superficial suctioning implies going down with the suction catheter only up to the end of the artificial airway (endotracheal or tracheostomy tube), whereas deep suctioning implies going down with the catheter till resistance is met, which can theoretically be until the carina or primary bronchi are reached. Superficial suctioning is the most advisable to avoid mucosal injury and trauma.[5]
Nguồn: https://buycookiesonline.eu
Danh mục: Info
