ET Tube suction. - page 2
by Sun*shine 4,694 Views | 26 Comments
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... Read More
- 2Jan 26, '13 by imaginationsQuote from NicuGalIt'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.)you shouldn't be taking them off the vent to suction, you lose pressures.
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.
- 1Jan 26, '13 by RainDreamerAsk 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.
- 2Jan 26, '13 by Bortaz, RNAs 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!
- 1Jan 26, '13 by NicuGalWow! 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.
- 0Jan 27, '13 by Sun*shineThank you all for making me feel better about asking for help with suctioning. I felt like by now I should be able to do such a basic thing as this on my own. Reading your comments has helped me realise that suction is neither basic nor straightforward.
I couldn't fathom why we didn't have in-line suction but when I asked around the nurses said that in-line suction doesn't work as well as disconnecting the vent. I've never used inline so I wouldn't know.
Nicugal I'd love to read through a protocol like that.
I don't have that clinical judgement yet as to when not to suction if I'm asked to. Generally every time a baby has a bad gas the first intervention the doctors would like is suction. I've known them to want it doing even if it was only done recently "just to see what's there". So I can see where you're coming from Bortaz.
When I ask people if I should be suctioning or not they often tell me 'have a listen to their chest.' Fair enough if anything clinically has changed or if they sounds particularly bad then I'd suction them. But if their ventilation and Fi02 hasn't changed and Sp02 is steady away...then do you suction just because you can hear secretions? I think that in some babies you can always hear them, especially when they've got bad RDS. Do you wait until the secretions become a problem?
- 1Especially 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.