Trach suctioning. Bullet vs. no bullet

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    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. What are some other ways to effectively remove thick secretions without a bullet? I have had a few trach pts that are unable to clear secretions and will end up with a plug or just be very junky and it can be very difficult to suction the secretions because they are sooo thick. *yuck* Any tips?
  2. 31 Comments so far...

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    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.
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    RT will sometimes use nebulized acetylcysteine along with either IPV or CPT. The acetylcysteine sometimes helps to break down the thick secretions. Also, a humidified and/or warmed oxygen source is helpful as well. For CF'ers we used to use nebulized Pulmozyme but I've never used it for the non-CF patient; I believe that it's rather expensive.
    sevensonnets likes this.
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    What is the contraindication for the bullets? When I worked a trach floor, we didn't suction without them.
    netglow and sevensonnets like this.
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    Really? The little "pillows" is what you are referring to right? Bullets? Never knew they were called that. Easy to see how they help... like a little nettie pot.
    sevensonnets likes this.
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    EBP from my understanding is that instilling actually creates a higher risk for instances of pneumonia.

    Interventions that I've seen is adding a heated circuit to the ventilator line, or if the patient is on t-piece, adding in moisture helps. Some advocate for more frequent Sx, but I don't really think that helps much.

    As said above the Inh mucomyst is sometimes ordered, percussion, etc. Resp neb Tx's by themselves sometimes are effective.
    hikernurse likes this.
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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.
    I am also interested in hearing the answer to this question. They are used them where I work as well..

    EDIT: Sorry, the above post was not there when I started my post!
  9. 0
    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.
    NS bullets is a name normal saline that comes in the individual dose packets of 3ml is given. There are a few others names but on this forum they're usually referred to as NS bullets.
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    Here's a link for all those who question why bullets should not be used:

    http://www.medscape.com/viewarticle/552862
    Free registration required to access--great CEU resource site. Karen

    I know the AACN (American Association for Critical care nurses) also has that issued addressed in its procedure manual but right now I can't find my copy. Sorry
    Last edit by NRSKarenRN on Apr 30, '11 : Reason: Added registration info
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    Quote from highlandlass1592
    Here's a link for all those who question why bullets should not be used:

    http://www.medscape.com/viewarticle/552862

    I know the AACN (American Association for Critical care nurses) also has that issued addressed in its procedure manual but right now I can't find my copy. Sorry
    That link requires a login.


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