Student nurse confused about suctioning

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    I'm a student nurse in my second semester of school, and I'm a little stumped on continuous versus intermittent suctioning. I was taught to always use intermittent in class, and the nurses on my unit say to use intermittent, because it decreases the risk of damaging the airway. However, when I used intermittent suctioning in front of a respiratory therapist, she told me to always use continuous because it's more effective, and every other respiratory therapist I've talked to agrees.

    So, now I have to change my method depending on who is watching me!

    I've found two articles on the topic (references below). Glass and Grap say to use continuous, as there's no evidence that intermittent reduces trauma. Czarnik et al. found that both methods were equally damaging to the airways of dog, but they were using suction pressures of 200 mmHg...

    What do you think? Which do you use, and why? Have you found one to be more effective/damaging?

    I'm going to write a paper on this for my theory class, so I'd love to get as many opinions as possible!

    Thank you!

    Glass, C., & Grap, M. (1995). Ten tips for safe suctioning. American Journal of Nursing, 5(5), 51-53.

    Czarnik, R., Stone K., Everhart, Jr. C., and Preusser, B. (1991). Different effects of continuous versus intermittent suction on tracheal tissue. Heart and Lung, 20(2), 144-151.
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  3. 14 Comments so far...

  4. 1
    Back in one of my other lives I observed that you could ask two farmers about the best way to cultivate tomatos, get two diametrically opposed answers, get reasonable, rational explanations for each, and damned if you could tell them apart come harvest. Try not to let it nut you up.
    floridanurse1983 likes this.
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    I've never thought of that. I learned to suction using continuous.

    I guess it depends on if the patient has a good cough. If they have an effective cough then intermittant would probably be o.k. But if not (which is usually why we suction in the first place), I would think intermittant would leave some residual sputum and cause the need to suction more, which would negate any benefit of trauma to the patient.

    What source did your instructors use when you learned to suction intermittant?
  6. 0
    I'm not sure if they have a source. I think they're teaching what they do- how they were taught. I asked one of them about the respiratory therapist's advice, and she said that respiratory was probably just more concerned about effectiveness, while the nurse worried about patient saftey.

    The textbooks I have talk about the issue as a debate, they don't give solid instructions, which is why I want more opinions!
  7. 0
    I was always taught continuous suctioning. I agree that intermittent suctioning would be cause for more work, and more damage to the patient. Insert catheter to proper depth, begin suctioning as you slowly withdraw it, twirling it as you go. Don't forget to hold your breath, since the patient can't breathe. That way you know when to stop.
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    2nd year nursing student here working as PCT. I found this thread doing research on this issue because we use continuous at work and the nurse like to set it to the high side of low. I like definitive numbers so I started researching it.

    Using a salem tube:

    If continuous is used, setting should be 30-40 mmHg. For more than that go to intermittent up to 120 mmHg.

    Low Continuous covers a lot of numbers, so I wanted to know more specific so I started looking around.
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    Well..first thing I noticed from your post is Look at the age of those two references ...1991 and 1995. Trust me, evidence based practice has changed regarding suctioning since then. Also, just because EBP now tells us that 1 way is best for doing something...doesn't mean that others, even Doctors, your institution and people you trust are doing it the most up to date way..Outdated respiratory practices in my experience seem common. People who have found one thing that works good, tend to kling to that I guess. But do yourself a favor and get in the habit of informing yourself as to what the current best practices are and stick to them. RANT OVER heh.

    I believe the American Thoracic Society is authoritative for pulmonary info..much like the American heart association is for cardiac.

    I might have access to some good sources that I'll shoot your way later today when I go home.
  10. 0
    ****. Time for bed! I didn't even see the OP was dated 2006! Lol.
  11. 0
    I was actually taught different ways in school too. When I was oriented to a private duty case about 6 months ago I was showed the way graysonret described, continuous and twirl, I also hold my breath. Like it's been said, once people are taught one way that works they tend to stick to it (and even swear by it)
  12. 0
    Quote from adnrnstudent
    2nd year nursing student here working as PCT. I found this thread doing research on this issue because we use continuous at work and the nurse like to set it to the high side of low. I like definitive numbers so I started researching it.

    Using a salem tube:

    If continuous is used, setting should be 30-40 mmHg. For more than that go to intermittent up to 120 mmHg.

    Low Continuous covers a lot of numbers, so I wanted to know more specific so I started looking around.
    I believe the OP is referencing airway suctioning. Your information pertains to ng suctioning. With ng suctioning, continuous suction should never be used without a Salem tube, which allows free air to be drawn in to prevent the formation of a vacuum should the tube lodge against the lumen of the stomach.


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