ET Tube suction.

[Sun*shine]

Hello. I'm really new to neonates and I'm loving it so far. My main concern is I'm underconfident when it comes to suctioning a Et tube.

I know how to do it, but I struggle with when to do it, if I should use saline, how many times I should do go down etc. I ask for help every time I need to suction a baby but our unit is really busy and at times no one is available. I'm also aware that the more I ask for help, the more I'm finding myself never wanting to do it on my own.

Does anyone know of any resources online that are helpful in this topic?

[Bortaz, MSN, RN]

As long as we're discussing sx and rt staff...I swear, I'm going to body slam the next rt that comes into my micropremies room, cranks open the bed, and tries to suction my baby while I'm steady telling them "THIS BABY DOESN'T NEED TO BE SX! Quit before I break your arm! No, I will never again let you sx my preemie just because you're a worker bee and have no critical thinking skills. No, I won't let you sx just because 'its time' to sx. Quit being so task directed. AND UNLESS YOU CAN ASSURE ME YOU GET OUT THE SAME AMOUNT OF NS THAT YOU FLUSH IN, I will not let you use that bullet."

yes, I feel strongly about this...and someone's about get get a knot yanked in their tail. Carry on!

[NicuGal, MSN, RN]

Wow! We have a whole protocol just for suctioning. We only suction as needed, use inline (and even if we use the adapter with a regular suction Cath we don't disconnect, you do lose volume, no matter what anyone says, and bagging changes ICP pressures which can lead to bleeds. We don't use saline, that was a hard habit to break. Our RT's are great, they actually helped write the protocols and implement them.

[Bortaz, MSN, RN]

No protocol will stop some of these wankers...

[NicuGal, MSN, RN]

We had a few, we wrote them up lol I feel bad for you!

[Bortaz, MSN, RN]

I hope to eventually move back to civilization at some point soon. :)

[Sun*shine]

Thank you all for making me feel better about asking for help with suctioning. I felt like by now I should be able to do such a basic thing as this on my own. Reading your comments has helped me realise that suction is neither basic nor straightforward.

I couldn't fathom why we didn't have in-line suction but when I asked around the nurses said that in-line suction doesn't work as well as disconnecting the vent. I've never used inline so I wouldn't know.

Nicugal I'd love to read through a protocol like that.

I don't have that clinical judgement yet as to when not to suction if I'm asked to. Generally every time a baby has a bad gas the first intervention the doctors would like is suction. I've known them to want it doing even if it was only done recently "just to see what's there". So I can see where you're coming from Bortaz.

When I ask people if I should be suctioning or not they often tell me 'have a listen to their chest.' Fair enough if anything clinically has changed or if they sounds particularly bad then I'd suction them. But if their ventilation and Fi02 hasn't changed and Sp02 is steady away...then do you suction just because you can hear secretions? I think that in some babies you can always hear them, especially when they've got bad RDS. Do you wait until the secretions become a problem?

[Bortaz, MSN, RN]

Especially for our microrottens, my rule of thumb is that we don't suction them unless we see stuff in the ett, or if the baby obviously needs it aeb desatting and other clinical presentations (including sounding crunchy). I watched a nurse deep suction a 23.6 weeker one night ("on schedule")...not five minutes later, blood gushed up into the ETT, and 10 minutes later, I was shrouding the baby for the morgue. This nurse is a 30 year vetern of the NICU, but sometimes they are the last to accept new standards.

[Sun*shine]

Yikes

Ah, so would 'sounding crunchy' (love that term btw) alone give cause for suction, or would you not go there until you've got other clinical features alongside it?

[Bortaz, MSN, RN]

No,often lung sounds would not be enough, alone, for me to suction. There are times when you can hear that it's needed, but it's not always the case.

[champagnesupeRNova]

Especially for our microrottens, my rule of thumb is that we don't suction them unless we see stuff in the ett, or if the baby obviously needs it aeb desatting and other clinical presentations (including sounding crunchy). I watched a nurse deep suction a 23.6 weeker one night ("on schedule")...not five minutes later, blood gushed up into the ETT, and 10 minutes later, I was shrouding the baby for the morgue. This nurse is a 30 year vetern of the NICU, but sometimes they are the last to accept new standards.

Bortaz, this story freaks me out!! On our unit, we suction routinely every 2-4 hours. It has always either helped the patient by getting rid of all the gunk in there and improving O2 sats or maintained status quo. I've never seen suctioning actually hurt a patient. I've only been in NICU for 7 months though and have only had a handful of micro-preemies.

[NicuGal, MSN, RN]

We stopped routine suctioning years ago. It isn't that good for the kids. RDS is not a secretion producing problem and micronates should only be suctioned when needed as it can cause trauma and increase pressures and cause bleeds, especially in the first 72 hours. We usually only do hands on care with our intubated kids every 6 hours, including suctioning unless they show signs of needing it, desats, increased working, really junky breath sounds.

[lytning]

we don't use inline suction either. We do suctioning 2-3 hours but i prefer doing it 3-4 hours interval unless the baby has desat and i can hear secretions. When I started my orientation at the NICU, the common practice was to use saline flush to loosen secretions. I had to go online for any EB lit on the use of saline to assure myself that I'm not shoving a foreign body to my baby's lungs. Most research i found though does not recommend the use of saline because it increases the risk for infection and a worsening oxygenation esp if the patient doesn't have a cough reflex.

Over the years, I noticed that most of the saline I instill in the ET I don't get back when i suction. (). Naturally, that makes me nervous. I don't routinely use saline nowadays, but when I do, I use 0.5-1ml. Oh, and btw it is routine in our unit to do CPT with all back tapping, vibration and stuff. I was shocked at first especially since most of the RTs working in our hosp are males and they're quite rough so yeah, even if it's annoying to be doing somebody's job, I'd rather not let those RTs touch my baby.