Trach suctioning. Bullet vs. no bullet - page 2

I know in the past NS bullets have been used to help clear thick secretions in trached/ vented pts. I know that EBP says we should NOT do this. I personally will not do it as an RN. If RT wants to do it then fine but I will not.... Read More

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    Biff just sign up it's free and you can get CEUs too as well as a nice little drug reference for your itouch.

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    I just wanted to review the reference, not sign up for car insurance!
    Sehille4774 likes this.
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    The article does discuss use in neonates though...
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    The whole purpose of the NS bullet is to clean out the suction tube when you are finished suctioning the patient. The normal saline is not to be instilled into the patient. Think about it, if you were to put 3ml of NS into the patient and then suction their secretions, how could you ever be sure that you extracted all 3ml of NS. There is no way to measure it. Lungs are not where you want to be putting in more liquid. This would greatly increase the chance of infection.
    Up2nogood RN and Simba&NalasMom like this.
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    Quote from Jasel
    I'm not familiar with "NS bullets". What are those exactly?? Anyway if the trach is almost plugged or just really thickened up I'll just take the whole thing out and clean it. We only have one trach patient at our facility who has been there for years. She also gets atropine drops SL BID to help clear up secretions which works pretty well from what I've seen.
    Yep, atropine works like a charm.
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    I haven't had a lot of trach pts, but all the ones I've seen have those mist collars and pretty much wear them at all times when they're in bed. Never seen secretions so thick I couldn't clear them with normal sterile suctioning.
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    Quote from roser13
    What is the contraindication for the bullets? When I worked a trach floor, we didn't suction without them.
    this is from that Medscape article:

    There also exists the potential to contribute to ventilator-associated pneumonia by instilling saline before insertion of a suction catheter. Saline instillation may dislodge bacteria from a colonized ET tube, sending it down into the lower airway.[17,18] The researchers found suctioning alone has the potential to dislodge up to 60,000 viable bacterial colonies and when 5 mL normal saline was instilled, up to 310,000 viable bacterial colonies were dislodged -- a 5-fold increased risk
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    We were told to use them when we suctioned my dad here at home. I know we did it a lot toward the end, his secretions were so thick and he had pseudomonas.
    Actually they think a mucus plug is probably what killed my dad, not the ALS.
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    Quote from sunnycalifRN
    this is from that Medscape article:

    There also exists the potential to contribute to ventilator-associated pneumonia by instilling saline before insertion of a suction catheter. Saline instillation may dislodge bacteria from a colonized ET tube, sending it down into the lower airway.[17,18] The researchers found suctioning alone has the potential to dislodge up to 60,000 viable bacterial colonies and when 5 mL normal saline was instilled, up to 310,000 viable bacterial colonies were dislodged -- a 5-fold increased risk
    Interesting- I would never have thought of dislodging bacteria colonies. Would this apply to nasal suctioning too? We usually use the bullets to do a drop or too in each nare with our RSV kids.
    Sehille4774 likes this.
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    I, and all our nurses per MD orders, use NS bullets to suction my son. You do NOT dump the entire bullet down the trach (I fired a nurse from his case for doing this). It is 3-5 DROPS, bag in 3 breaths, suction, put back on vent. Even with humidity and heated circuits, his secretions are thick enough that this is necessary several times a day. It works wonders without adding another drug to his day.


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