Content That Sun*shine Likes

Content That Sun*shine Likes

Sun*shine 2,542 Views

Joined Jul 23, '07. Posts: 103 (13% Liked) Likes: 13

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  • Feb 4 '13

    I hope to eventually move back to civilization at some point soon.

  • Feb 4 '13

    No,often lung sounds would not be enough, alone, for me to suction. There are times when you can hear that it's needed, but it's not always the case.

  • Feb 4 '13

    Quote from Bortaz, RN
    Especially for our microrottens, my rule of thumb is that we don't suction them unless we see stuff in the ett, or if the baby obviously needs it aeb desatting and other clinical presentations (including sounding crunchy). I watched a nurse deep suction a 23.6 weeker one night ("on schedule")...not five minutes later, blood gushed up into the ETT, and 10 minutes later, I was shrouding the baby for the morgue. This nurse is a 30 year vetern of the NICU, but sometimes they are the last to accept new standards.
    Bortaz, this story freaks me out!! On our unit, we suction routinely every 2-4 hours. It has always either helped the patient by getting rid of all the gunk in there and improving O2 sats or maintained status quo. I've never seen suctioning actually hurt a patient. I've only been in NICU for 7 months though and have only had a handful of micro-preemies.

  • Feb 4 '13

    We stopped routine suctioning years ago. It isn't that good for the kids. RDS is not a secretion producing problem and micronates should only be suctioned when needed as it can cause trauma and increase pressures and cause bleeds, especially in the first 72 hours. We usually only do hands on care with our intubated kids every 6 hours, including suctioning unless they show signs of needing it, desats, increased working, really junky breath sounds.

  • Feb 4 '13

    we don't use inline suction either. We do suctioning 2-3 hours but i prefer doing it 3-4 hours interval unless the baby has desat and i can hear secretions. When I started my orientation at the NICU, the common practice was to use saline flush to loosen secretions. I had to go online for any EB lit on the use of saline to assure myself that I'm not shoving a foreign body to my baby's lungs. Most research i found though does not recommend the use of saline because it increases the risk for infection and a worsening oxygenation esp if the patient doesn't have a cough reflex.
    Over the years, I noticed that most of the saline I instill in the ET I don't get back when i suction. (). Naturally, that makes me nervous. I don't routinely use saline nowadays, but when I do, I use 0.5-1ml. Oh, and btw it is routine in our unit to do CPT with all back tapping, vibration and stuff. I was shocked at first especially since most of the RTs working in our hosp are males and they're quite rough so yeah, even if it's annoying to be doing somebody's job, I'd rather not let those RTs touch my baby.

  • Feb 4 '13

    We use saline for thick and difficult to suction secretions despite being well aware that the evidence is inconclusive. I think the reason we are still willing to do it is because clinically, we see results from it. I am unsure about this practice however this is what more senior nurses think on our unit.

  • Feb 4 '13

    Suctioning is touchy and being gentle and nervous is a good quality honestly. If your suction catheters do not have millimeters/centimeters marked on them and/or your ETTs don't have measurements on them either then I would recommend suggesting this.

    In adults suctioning is pretty cave-man. Jam it in there until you meet resistance, suction on the way out.

    In Neonates suctioning can be pretty touchy. Make sure your suction pressure is low enough (I think 80cmH2O is the recommendation)

    Be gentle, advance the catheter in and "line up" your measurement lines, and then suction on the way out. Slower (in my experience) is better because I can do a single pass and not risk destroying their FRC repeatedly where I'd have to make multiple passes if I went fast. If I don't get anything, I don't do another pass. If I get giant "Boogz" as I like to call secretions, I will do another pass.

    I assess for suctioning Q1 to Q3 but I typically actually suction Q6-Q12, I don't routine suction and we do not allow routine suction orders by providers (MD/NPs)

    I almost never, ever use saline for anything except purging the suction catheter. I cannot remember the last time I lavaged with saline during a suction.

    I tried to find an online education thing but all I can find are bedside sheets to to write down depths for the bedside from the companies that make the in-line catheters.

  • Jan 27 '13

    Especially for our microrottens, my rule of thumb is that we don't suction them unless we see stuff in the ett, or if the baby obviously needs it aeb desatting and other clinical presentations (including sounding crunchy). I watched a nurse deep suction a 23.6 weeker one night ("on schedule")...not five minutes later, blood gushed up into the ETT, and 10 minutes later, I was shrouding the baby for the morgue. This nurse is a 30 year vetern of the NICU, but sometimes they are the last to accept new standards.

  • Jan 27 '13

    Wow! We have a whole protocol just for suctioning. We only suction as needed, use inline (and even if we use the adapter with a regular suction Cath we don't disconnect, you do lose volume, no matter what anyone says, and bagging changes ICP pressures which can lead to bleeds. We don't use saline, that was a hard habit to break. Our RT's are great, they actually helped write the protocols and implement them.

  • Jan 27 '13

    As long as we're discussing sx and rt staff...I swear, I'm going to body slam the next rt that comes into my micropremies room, cranks open the bed, and tries to suction my baby while I'm steady telling them "THIS BABY DOESN'T NEED TO BE SX! Quit before I break your arm! No, I will never again let you sx my preemie just because you're a worker bee and have no critical thinking skills. No, I won't let you sx just because 'its time' to sx. Quit being so task directed. AND UNLESS YOU CAN ASSURE ME YOU GET OUT THE SAME AMOUNT OF NS THAT YOU FLUSH IN, I will not let you use that bullet."

    yes, I feel strongly about this...and someone's about get get a knot yanked in their tail. Carry on!

  • Jan 27 '13

    Quote from NicuGal
    you shouldn't be taking them off the vent to suction, you lose pressures.
    It's actually not the disconnection from the vent that causes loss of pressure/derecruitment. That is a result of suctioning itself (i.e. because you're occluding the airway -- the ETT -- with the suction catheter for the purpose of suction.)

    In my unit we use a suction port on the ETT/vent circuit connection. So, we don't use in-line, but we don't have to disconnect. However we find the process is often fiddly and difficult because passing a catheter through the one way valve of the suction port is difficult and you don't tend to get as many secretions as you do when you disconnect the vent and suction.

    A number of nurses on my unit recently went to a high frequency ventilation conference and attended a seminar purely on suctioning whilst kiddo is on the vent. Numerous things that they heard in this seminar were applicable to conventional ventilation. They were shown two images of lungs following suction and asked to chose which patient had been disconnected during suction and which had not. Everyone chose the worse looking, more de-recuited pair of lungs as being disconnected for suction. In fact, the opposite was true.

    Suction itself causes de-recruitment, not disconnection.

  • Jan 27 '13

    Ask for help if you don't feel comfortable. I agree with another poster that said ask for help, but YOU do the do the suctioning ..... the other person will be there for assistance and answering any questions you have. Don't feel embarrassed asking for help. Before long you'll be the one others will be coming to with questions ...... just give it time

    Is it typical for units not to use inline suction? We use two man suction on the jets, but that's it.

  • Jan 25 '13

    Quote from Sun*shine
    Hello. I'm really new to neonates and I'm loving it so far. My main concern is I'm underconfident when it comes to suctioning a Et tube.

    I know how to do it, but I struggle with when to do it, if I should use saline, how many times I should do go down etc. I ask for help every time I need to suction a baby but our unit is really busy and at times no one is available. I'm also aware that the more I ask for help, the more I'm finding myself never wanting to do it on my own.

    Does anyone know of any resources online that are helpful in this topic?
    I know how you feel. My fear was putting NG tubes in patients. I always grabbed one of my colleagues to come help me. My colleague would do everything while I handed her what she needed. I knew how to do it, I just didn't have the confidence to do it, until one day. I was sent to another floor where I didn't know anyone and came face to face with an order to put in a NG tube for Gastrointestinal decompression. I had to do it and once I did it, I was fine, confidence surrounded me. My patient didn't even vomit once. When you're good, you're good. Please muscle up the courage to do it. Don't get stuck like me, when you're on a floor with no familiar faces there to help. Now I volunteer when ever there is a NG tube placement, I go and do it. That's the only way to conquer your fear, is to just do it.

  • Jan 25 '13

    Are you using in-line catheters?

  • Jan 25 '13

    do you have an educator that can run you through the process..............tell her that you are not 100% confident and want a refresher or ask her to assess your technique


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