suctioning the intubated pt...1 nurse/RT, or 2?

[kessadawn, BSN, RN]

recent topic of discussion in my picu...

when you have an intubated patient, regardless of level of sedation, ease of the intubation, vent settings, etc., what is your picu's policy on suctioning, do you do it yourself, or does one person bag while a second person stays sterile and suctions? we have travelers at our facilty frequently during busy times, and many of them have told me that in other facilities, you suction alone. not sure if it's a staffing issue, or what, but how do you stay sterile, for one thing? how is this scenario even remotely safe for the patient? okay, maybe your vent is set on minimal support settings, pt breathing on his own, the pt is calm, whatever, but what if they start to crump, or your ett plugs off? just seems like an accident waiting to happen, imo.

so, what are your thoughts and experiences?

[TexasPediRN]

Dont you have inline suction on your trachs/ett?

Its sterile suction each time, so no need for 2 people- one is perfectly fine.

I've never waited for another person to suction the pt..

-Meghan

[danissa, LPN, LVN]

I have found that it's very much a judgement call. if you know your patients tolerance to vent disconnection, even for seconds, then you can do the required suction, with one hand sterile, as a one person job. In an unstable wee one, however, I would always call for that extra pair of hands to be there to bag etc. Sometimes its an emergency call, you start your suction whilst calling for help...you will get the feel for how and what you do.....luck to ya!

[kessadawn, BSN, RN]

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dont you have inline suction on your trachs/ett?

its sterile suction each time, so no need for 2 people- one is perfectly fine.

i've never waited for another person to suction the pt..

-meghan

we do use inline suction set ups, usually on our trached kiddos, but not on everyone. i'm just talking about when you don't have inline suction as an option, and the nurses i spoke with stated that they can suction them alone as well. it just made me very uneasy.

[NotReady4PrimeTime, RN]

In the unit where I work now we use inline suction but we're expected to have the RT come to the bedside when we suction kids with ETTs. (Trachs they don't seem to care about much.) I was quite confused at first because the RT will take the kiddie off the vent and bag them, then suction with the inline. I think it defeats the purpose completely to break the system when it isn't needed. Our docs are really into recruiting of lung volume with suctioning and we did a study a few years ago about it. Of course that means that we have to include the RTs when we suction, even if they're technically not needed. What that does is creates a whole cohort of nurses who don't know how to handventilate and who are reluctant to act, even if the kid is going down the tubes.

In my previous unit, once you'd been there for awhile you were expected to get the job done on your own in most cases. We didn't use inline unless the child met certain criteria (PEEP >+8, OI >20, HFOV, HFJV). We used sterile polyurethane gloves that were attached to a sheet of paper much like the gloves that come packaged with hair colour. One got quite adept at pulling a glove out of the box, attaching the suction catheter to the tubing without taking it out of the sleeve and tucking it under one's nondominant arm, putting the bagger on the ETT, bagging, disconnecting and reconnecting with the nondominant hand, sliding one's hand into the glove and peeling it off with the non-dominant hand all the while bagging the patient, pulling the suction catheter from the sleeve and keeping it sterile, disconnecting and suctioning, then reconnecting all without touching anything with the catheter. For small people I would hold thier heads still with my nondominant elbow. If we had a bigger kid who would become really active with suctioning or if we had a neonate that would brady with even brief interruptions in bagging, then the resource nurse or the nurse at the next bedside would come to help. But for the most part, we were on our own. Believe it or not, our VAP rates were quite low.

[PICNICRN, BSN, RN]

We have all inline suction. Sometimes, if the kid is really junky we will take them off the vent and sterile suction them.

Before in lines came along, we did do 1 person suction all the time. Suction cath hand is sterile, other hand bags. Usually no problem.

If the kiddo was on a high peep or did not tolerate bagging or suctioning well, we would use 2 people. Depends on the kid.

[NicuGal, MSN, RN]

Our hospital policy states that if no inline, then you must 2 man suction, no 1 man. Does your hospital's vent/suctioning policy say anything? That would be the best route to go.

[kessadawn, BSN, RN]

our hospital policy states that if no inline, then you must 2 man suction, no 1 man. does your hospital's vent/suctioning policy say anything? that would be the best route to go.

our policies are a little vauge, but tradition is always 2man, for all intubated kiddos. i was just curious as to what the rest of the planet does, as 1 man suctioning just seems dangerous...we don't do it at all unless there's inline suction or the kid's trached and not on a vent.

[marilynmom, LPN, NP]

We always have 2 people to help when suctioning a patient. One bags and the other suctions.

I like the inline sxn caths (which most of our patients have) but sometimes they just don't seem to do the job.

[tigkaskit, BSN]

We very very very rarely use in-line suctioning. I'm not quite sure why.

Policy states 2-man suction is required if PEEP>8, difficult airway, or new trach (prior to 1st trach change).

Generally we do what we're comfortable with otherwise. I feel like most everyone suctions an ETT with 2 people, but trachs are either 1 or 2 person (Trachs are easier to connect the bag to when you're bagging 1-handed.)

[Sweden]

(Trachs are easier to connect the bag to when you're bagging 1-handed.)

Hi

I´m sorry if this is a dumb question, but why are you bagging when you are suctioning. When do you do it (before / after)?

I´m a nicu nurse here in sweden and we never use bagging in conection to suctioning, but maybe it´s different with older children?

We try to use two persons for suctioning (except in extreme emergencies) simply because it cuts down the time the baby is without his/her ventilator. It also gives an extra set of hands to calm and support the baby. We don´t use RT´s here so it´s usually two nurses doing it. We don´t use in-suctioning in my unit and we only use clean gloves (not sterile) and then keep the catheter sterile.

Anna

[rnguy25]

Hi

I´m sorry if this is a dumb question, but why are you bagging when you are suctioning. When do you do it (before / after)?

I´m a nicu nurse here in sweden and we never use bagging in connection to suctioning, but maybe it´s different with older children?

We try to use two persons for suctioning (except in extreme emergencies) simply because it cuts down the time the baby is without his/her ventilator. It also gives an extra set of hands to calm and support the baby. We don´t use RT´s here so it´s usually two nurses doing it. We don´t use in-suctioning in my unit and we only use clean gloves (not sterile) and then keep the catheter sterile.

Anna

Hi Anna,

Bagging during suctioning is needed to maintain adequate arterial oxygenation levels and to maintain adequate lung volumes, especially for those patients who require a high PEEP. All of which, if lost, can induce hypoxia. Since you don't use in-line suction catheters on your unit, bagging will help those babies maintain good lung volumes while off the vent. It'll cut down even more time away from their needed pressures and oxygen as you were already doing.

-T