Excellent Pulmonary Resources - Page 2

So... is NP suctioning considered a sterile or clean procedure; how about OP suctioning? I've seen nurses I work with do it both ways, and I'm not sure. I try to keep sterile when I do this, but have not always. Seems like the risk for resp. infections would increase if not done w/sterile technique, but that's just my thoughts not backed up w/any kind of research. What do you all think?

NP suction should be sterile or a new sterile catheter used each time because you are moving lower into the respiratory track. OP suction is not sterile because you are going through the mouth and only suctioning into the mouth and upper pharyngeal cavity with yankar.
However, the newer evidence based practice may change that in the near future for pnemonia prevention

I'd suction a nasotracheal tube as a sterile procedure, but just suctioning out the nose, I'd use a suction catheter out of the sterile container and not have it touch anything else but the patient's nose. (The nasal passage is not sterile until you get way up in there, so I don't use sterile gloves - but I don't touch the tip that goes into the nose either). But in my facilily, NP and OP suctioning are not sterile procedures.

If you see it done both ways, I'd check your policy and do it that way.

Blee

oral: clean technique : yanker cath or soft cath for deep posterior pharnyx
nasotracheal: clean technique using sterile catheter

immunocompromised, critically ill, nasal fractures, etc require scrupulous technique compared to patient who is self-suctioning.


maintain aseptic (sterile) technique – since the procedure bypasses many of the normal protective barriers of the body, it is essential that the nurse/respiratory therapist not introduce any microorganisms into the airway during the procedure. each time suctioning is to be done, a new pair of sterile gloves and a new sterile catheter must be used. strict attention to assure the gloves and catheter are essential with suctioning of an artificial airway. for nasotracheal suctioning, it is not possible to maintain sterile technique since the catheter passes through non-sterile areas on the way to the trachea, it is important nothing not already in the patient be introduced during the procedure.
http://www.dmacc.edu/instructors/keg...november10.htm




articles:

inpatient facilities:

nasotracheal suctioning — 2004 revision & update.


adult: procedure: suctioning.endotracheal.tracheostomy.nasotracheal.adult ...

infant + children:
http://www.unchealthcare.org/site/nu...ocedures8.pdf/


critical care:
best-practice interventions: how can you prevent ventilator-associated pneumonia?
http://www.nursingcenter.com/prodev/...asp?tid=627810


homecare:

suctioning of the patient in the home http://www.rcjournal.com/online_reso...otpithcpg.html
care of the child with a chronic tracheostomy: suctioning

suctioning of the patient in the home


great respiratory evidenced based clinical practice guidelines http://www.rcjournal.com/online_reso.../cpg_index.asp

case discussions


don't forget : bronchial hygiene therapy
http://www.meridianhg.com/bronch.html

drugs for asthma

corticosteroids

drugs acting on the upper respiratory tract

teaching correct use of inhaled medications

No more than 15 seconds of continuous suction to the airway. (Unless they changed the rules...). Of course, it may seem alot longer than 15 seconds when you're new at it, and you may think you're gonna suck their lungs right out of 'em - but 15 seconds is generally the rule. Oh yeah, almost forgot to tell ya...that has to be while withdrawing the catheter. Don't apply suction until you are ready to withdraw - that is when your 15 seconds begin. Use KY and it is always good to pre-oxygenate and post-oxygenate the patient when suctioning the lungs. Better to be save than sorry - use sterile technique whenever you suction. Just FYI - Call Respiratory.

Alot of different factors can affect a pox reading but should correlate w/ an abg 2-3%. A continuous accurate reading(correlating w/pts pulse and reading for more than 5 beats and pox displays reading and thats it)is important. Smokers will read higher if just smoked(pts carboxyhemoglobin is whats measured via pox) movement will cause false readings, nail polish (of red/black/purple,false nails)
Perfusion issues(shock/hypovolemia)
Remember to assess the whole picture and the pt. but your pulse ox should be pretty close to the arterial oxygen saturation that results on the arterial gas....

Pulmonary Hypertension

the five p's spell postive outcomes for ards patients

use these evidence-based interventions to avoid the
dangers of ards, its complications, and its therapy

Common Respiratory Disorders