This is my first question (rather than response) to the AllNurses community despite five years--pre-nursing and now final semester of nursing school--of membership!
I am reviewing my program's check-off sheets in anticipation of the skills mastery check-off we complete in the first week of the semester this August. Despite research on AllNurses and elsewhere, I can't find a specific reason why we take an apical pulse as part of the respiratory assessment prior to performing tracheostomy suctioning.
My working theory: Trach suctioning can potentially cause a vasovagal response, which may result in bradycardia. If the patient's apical pulse is already low (below 60?) then suctioning may not be appropriate.
I was actually checked off on trach suctioning and care as my mastery skill prior to beginning last semester, but wasn't asked about rationales. I just want to know for my own edification...and because knowing WHY helps me remember all of the steps for a procedure.
I appreciate all comments/insight/feedback!
P.S. Just to be clear--this is NOT a homework question. My Summer class ended yesterday (and I earned an A, woo hoo). ! I really do want to know the information.
Not everyone requires hyperoxygenation prior to endo tracheal suctioning. Most COPD patients do not. Neither do many pediatric patients. Not all patients with a tracheostomy are at risk for cardiac arrhythmia or dysrhythmia either.
Apical pulse can be helpful if you are in a LTC or home care environment where you only have pulse oximetry and no telemetry. Not just rural or third world areas.
You reduce the risk of vasovagal dysrhythmia by only going to the predetermined depth and not to the carina
In pediatrics hyperoxygenation prior to suctioning requires a specific order and is not standard protocol. Even with my kiddo that requires continuous FiO2 of 30%, we are not to hyperoxygenate pre or post suctioning even in this case
Exactly, esp Peds, even the vent dependent kiddos. For some of the cardiac peds pts oxygen could even be a detriment, especially if they are a mixer. (mixed arterial/venous)
Yes, SOME pts do need oxygenation prior/post suctioning. You can even provide that through the vent (on some vents)
Many peds pt, I pop them off the vent, suction 1-2 passes, put them back on. If they are on higher settings, I will do it post suctioning.
I would be interested in seeing some links to these EBP articles.
This is indeed an interesting discussion! I haven't covered peds yet, so this information is definitely good to know for future reference when I do start learning about pediatric nursing care. I'l make sure to circle back to this thread when/if I learn something different to what was posted. I think the key aspect of everything is that not all patients are the same, and as nurses, we have to integrate our critical thinking skills, patient's specific needs, and the evidence-based research to provide optimal care individualized for the patient. That said, when it comes to the adult patient population, here are a couple of EB research articles supporting hyperoxygenation during suctioning:
And these next two studies were interesting (albeit done in 2002 and 2004, respectively), because they found that many of their subject nurses did not know best practices for suctioning, or were using dangerous techniques.. and also disturbing was that it found no significant relationships between knowledge and practice (e.g. nurses were not doing what they knew they should have been doing)
Oh, forgot to include the link for this little nugget:
http://www.rcjournal.com/cpgs/pdf/06.10.0758.pdf --> these are guidelines published by the American Association of Respiratory Care, and it advocates hyperoxygenating patients pior-during-post suctioning. This applies especially to patients that may be hypoxemic / hypercapnic going into suctioning, which are basically your COPD patients.
RNNPICU, BSN, RN
1,310 Posts
Exactly, esp Peds, even the vent dependent kiddos. For some of the cardiac peds pts oxygen could even be a detriment, especially if they are a mixer. (mixed arterial/venous)
Yes, SOME pts do need oxygenation prior/post suctioning. You can even provide that through the vent (on some vents)
Many peds pt, I pop them off the vent, suction 1-2 passes, put them back on. If they are on higher settings, I will do it post suctioning.
I would be interested in seeing some links to these EBP articles.
great discussion!