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suctioning the intubated patient...1 nurse/RT or 2?

Specializes in pediatric critical care. Has 7 years experience.

i am a picu rn, and i know that things are hugely different in the icu world of adults (no pun intended;)), but i'd like your input please.

recently i have been told by some of our traveling rns that in some facilities, you suction etts by yourself. not trachs, not with inline suction set-ups, good old fashioned, pop em off and bag suctioning. first of all, how in the world do you remain sterile? what if the patient is on very high levels of vent support? i just cannot fathom how this is even a remotely safe thing to do. what if your patient crumps, or plugs the ett?

so, what are your opinions/experiences? the whole idea just freaks me out, personally. what do you think?

tryingtohaveitall

Specializes in PICU. Has 23 years experience.

I also work in a PICU, it would be an extremely rare event to suction alone and even then, only if the kid was going to arrest without being suctioned immediately. If need be, I'd pop the kid off and bag him til someone could get there to help me suction.

sicushells, RN

Specializes in SICU, Peds CVICU. Has 3 years experience.

In the Huge adult world it's no big deal (at least, not at my job)

Usually I loosed the ett/vent connection so the patient is still connected, but I know it'll be easy to pop off. I put the vent on 100% FiO2 (pre oxygenate), set up the bag and suction tubing nearby. I put my sterile gloves on, wrap the suction cath around my right hand, disconnect the patient from the vent with my left hand (my left hand is now "clean" not sterile).I hold the end of the ett with my left, advance suction cath with my right, close the little hole with my left hand as I pull the suction cath out. attach and bag with my left hand, repeat once more and then reattach to the vent. They're completely off vent support for maybe 10-20 seconds, so even with very unstable pt's it's not long enough for them to decompensate. I suppose if they were prone to that, we'd probably throw an inline on though...

If they're going to plug the ett, the only way to get it out is to suction anyway so i don't think it's a reason not to suction. Holy cow that was a long post... I hope I answered all your questions.

ghillbert, MSN, NP

Specializes in CTICU. Has 20 years experience.

In my adult ICU experience in Australia, we suctioned alone (not even sure what you mean, why would you need someone else there?).

We had adaptors between the ETT and vent tubing with a one-way valve so you don't have to disconnect the vent. Suctioning is a clean and not sterile procedure.

- wipe one-way valve with alcohol swab and let dry

- put on clean gloves

- put vent on 100% O2 "suction" setting

- open suction cath, insert via one-way valve and suction

Having said that, this was becoming rarer as most places were using or going towards in-line suction.

wanderlust99

Specializes in ICU/PACU. Has 10 years experience.

Why would you unhook the inline suctioning set up? I've seen some nurses pop them off the vent & bag them, but doesn't really appear to help anything.

kessadawn, BSN, RN

Specializes in pediatric critical care. Has 7 years experience.

our picu very rarely uses inline suction set-ups, meaning they aren't even there as an option. only if the pt is requiring very high support from the vent, or on a kiddo who needs suctioned a ton. not really sure why we don't use them more. if your pt needs suctioned, you have to pop them off the vent.

Reno1978, BSN, RN

Specializes in SRNA. Has 6 years experience.

Where I work, we only use in-line suction catheters for our adult patients on a vent and we suction alone.

If the pt. has a plug that just won't come up, we will disconnect the inline suctioning and bag them and suction between bags. It helps. I have always done this with two people simply because you need more than one hand, not because it's risky, just easier.

PiPhi2004

Specializes in Trauma ICU, Surgical ICU, Medical ICU.

In the Huge adult world it's no big deal (at least, not at my job)

Usually I loosed the ett/vent connection so the patient is still connected, but I know it'll be easy to pop off. I put the vent on 100% FiO2 (pre oxygenate), set up the bag and suction tubing nearby. I put my sterile gloves on, wrap the suction cath around my right hand, disconnect the patient from the vent with my left hand (my left hand is now "clean" not sterile).I hold the end of the ett with my left, advance suction cath with my right, close the little hole with my left hand as I pull the suction cath out. attach and bag with my left hand, repeat once more and then reattach to the vent. They're completely off vent support for maybe 10-20 seconds, so even with very unstable pt's it's not long enough for them to decompensate. I suppose if they were prone to that, we'd probably throw an inline on though...

If they're going to plug the ett, the only way to get it out is to suction anyway so i don't think it's a reason not to suction. Holy cow that was a long post... I hope I answered all your questions.

Thats exactly how I do it. I also agree with the plugs, the best way to get it out is to manually bag em and get it out through a good rigorous suctioning, esp with a nice new catheter that has no gunk already in it and you can use a larger one to suction and get out those big goobers. A pt is never off the vent for long, espeically not long enough to decompensate. In my experience, this is has been the best way to do it.

nrsang97, BSN, RN

Specializes in Neuro ICU and Med Surg. Has 19 years experience.

We only have in line suction.

stressgal, RN

Specializes in CCRN.

We too only use in line suctioning. I never need to call or wait for the RT to suction. It is within my scope of practice.

ErraticThinker

Specializes in thoracic, cardiology, ICU. Has 2 years experience.

Every vented patient has an inline suctioning setup on their tubing at my hospital, and I wouldn't have it any other way :) It may seem like a waste of money, but I can suction them quickly, not have to take them off the vent, and keep things relatively sterile.

Suctioning not a sterile procedure? Really? That's definitely not how I learned it and not how I practice either.

I just posted a thread asking if it is current practice not to suction. I have been lectured extensively by the RT's at my current hospital that current practice is not to suction, much less break the circuit.

I suction, when needed all the time. I'll use the closed system if it's appropriate, I can also suction by myself, breaking the circuit and keeping sterile. I cannot imagine not suctioning when needed. I do not do this act "routinely" and feel at this point I don't need too much from them (the RT's) in the way of caring for my ventilator patients.

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