Here is my concern...I recently encountered a CRNA who placed the suction tube directly to the ET tube on extubation of the patient. I do not feel comfortable with this method and expressed concern with it. The patient began gasping for air, but recovered ok with hyperoxygenation and O2 on transport. This gentleman was in his mid-70's with a history of smoking and COPD, and there were visible secretions in the ET tube. Two other OR nurses in the room said nothing, however when I voiced concern, it was made clear to me that there is no reason for concern.
Most of my experience is with critically ill patient's in the Main OR, and I have NEVER seen an anesthesiologist extubate a patient this way. This occurred in the ambulatory setting.
I would love to hear opinions from my more experienced RN's.
He didn't use a suction catheter at all, he directly connected the suction tubing from the wall suction to the ETT. That sounds dangerous to me, depending on how high he had the suction turned up. You've got extreme negative pressure to the lungs, very likely causing some degree of injury and discomfort for the patient. I imagine that much suction would be terrifying, especially when you are trying to breathe for yourself for the first time.
I routinely use suction tubing to clear the airway immediately before extubation, but no, I don't think sucking the lungs right out someones throat could possibly be ok. Talk to your local RT and your manager.
I did speak with the attending anesthesiologist and he agreed that was not best practice. Unfortunately he wanted to me to name names... I didn’t like it but I did.
I want my patients to be safe.
Thanks so much for your input, it made me feel validated as to my concerns. I spent a lot of time taking care of intubated pediatric patients with TBI’s who had secretion issues and I NEVER saw anyone do that. I was horrified for my sweet little COPD guy.
canoehead, BSN, RN
6,909 Posts
I get it, OP.
He didn't use a suction catheter at all, he directly connected the suction tubing from the wall suction to the ETT. That sounds dangerous to me, depending on how high he had the suction turned up. You've got extreme negative pressure to the lungs, very likely causing some degree of injury and discomfort for the patient. I imagine that much suction would be terrifying, especially when you are trying to breathe for yourself for the first time.
I routinely use suction tubing to clear the airway immediately before extubation, but no, I don't think sucking the lungs right out someones throat could possibly be ok. Talk to your local RT and your manager.