Student confused about suctioning

[JSouba]

I'm a student nurse in my second semester of school, and I'm a little stumped on continuous versus intermittent suctioning. I was taught to always use intermittent in class, and the nurses on my unit say to use intermittent, because it decreases the risk of damaging the airway. However, when I used intermittent suctioning in front of a respiratory therapist, she told me to always use continuous because it's more effective, and every other respiratory therapist I've talked to agrees.

So, now I have to change my method depending on who is watching me!

I've found two articles on the topic (references below). Glass and Grap say to use continuous, as there's no evidence that intermittent reduces trauma. Czarnik et al. found that both methods were equally damaging to the airways of dog, but they were using suction pressures of 200 mmHg...

I'm wondering what eveyone else is being taught, and if you've found one to be more effective or more damaging.

I already posted this in the pulmonary nursing section, but I'm posting here and in the general section to get more opinions. I'm going to write a paper on this for my theory class, so I'd love to get as many opinions as possible!

Thank you!

Glass, C., & Grap, M. (1995). Ten tips for safe suctioning. American Journal of Nursing, 5(5), 51-53.

Czarnik, R., Stone K., Everhart, Jr. C., and Preusser, B. (1991). Different effects of continuous versus intermittent suction on tracheal tissue. Heart and Lung, 20(2), 144-151.

[Daytonite, BSN, RN]

Well, I would say that if a question like this shows up on a test your nursing instructor gives you, give the answer the nursing instructor is looking for.

However, I worked in a stepdown unit for some years where we had a lot of respiratory patients and did a lot of suctioning. I was also taught how to suction by a respiratory therapist when I was a student nurse. I thought the case against continuous suction was because it deprived the patient of oxygen. It's high suction pressures that traumatize the mucosa and cause bleeding. I was taught to hold my breath while suctioning as a way of reminding myself that while I was suctioning the patient also wasn't breathing any oxygen. You have to continuously suction in order to get some of those big, thick hockers out of some of those respiratory tracks, believe me! Then, between suction attempts you have to give the patient time to take in a couple of breaths to recover. Seems like the sputum of patients with trachs and ET tubes gets really sticky and thick which makes it really hard to grab onto with suction and get out.

[JSouba]

Thanks!

[canoehead, BSN, RN]

If you usecontinuous suctioning you can twist the tubing in yourfingers as you draw it back to prevent constant suction to one part of the airway, and everyone will be happy.