I am increasingly irritated in my current position regarding the management of ventilator patients. I am working in a small rual hospital, 6 bed ICU and have been told repeatedly by the respiratory personnel here it is no longer accepted practice to suction the ETT, much less to break the circuit to do so. The nursing staff here do not suction, they call respiratory for any respiratory issues.
I have kept current since leaving the city and the large ICU's. I worked over 20 years trauma and burn ICU, and feel I have adequate assessment skills to make the judgement if my patient needs suctioning or not. This I do not simply do on a wim! I know the indications and the risks of ETT suctioning, but I do not think it is appropriate to simply leave all those wonderful secretions, mucous plugs, pulmonary edema, ect in there.
I am big on turning, repostioning, mouth care, HOB elevation ect. Once in a blue moon we have a patient deteriorate into full blown ARDS. (Don't want to go into what that becomes here). I have done an extensive literary search, see nothing that states ETT suctioning is not done--I have concluded if there are secretions, they get suctioned being carefull to assess patient, ect. Also stated if needed it is "okay" to break the circuit. What is your experience lately?
I think that's the stupidest thing I've read. All of our vented patients have the closed suction system Ballard thingie. We suction the ET tube. I think the risks of not suctioning are more serious than the risks of suctioning. Patients with ET tubes need to be suctioned depending on the amount of secretions they produce. Some need it more than others. I don't know if you all have ventilator bundles with your patients where you do oral care, HOB 30 degrees, turning the patient but the whole point is to prevent VAP which is not covered by medicare anymore.
The first thing we learn in assessment is airway. Infection control is way down on the list when your patient cannot breathe. If it is not necessary, I don't see why anyone would do it. The same applies in reverse. If it is necessary, I don't see how anyone wouldn't.
with respect I do think I may have been misunderstood. I never said don't suction, I said suction when it is needed.
If you are referring to the need to ensure the ETT is patent by passing the suction catheter down it then I absolutely do this as part of my assessment. AND if the patient requries frequent suction then they get frequent suction. However if they have that much sputum then perhaps a bronchoscopy is required.
And suction IS NOT PART of the ventilator bundle and I simply do not recall the RCT which demonstrated its efficacy in preventing VAP.
=CactusFlower;3270356........PIP were in the 50's...........
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I would suspect the excessive dried secretions narrowing the radius of the artificial AW caused the increased Pinsp. Just out of curiousity, do you guys check the Plateau pressure? This whole scenario sounds like someone got thier wires crossed somewhere. (bad info)
Thanks guys for all the input. This whole situation boiled down to the RT not suctioning, the nurse (me) suctioning. When the patient was suctioned for lots of secretions, it was an appropratiate intervention. To justify not suctioning (ever) by claiming that current research and evidence says to unequivally not to suction-- was a dumb move by that person.
Again, I work in a small, rual ICU with a nursing population that does not suction, they call respiratory. Not critizing here, but I am teaching a new grad nurse to function in this ICU--how to assess, how to do certain things. Throwing out bold statements as "fact" and standard of "practice" is wrong. I do not want to offend anyone here, but I think nursing can assess their patients and take the appropriate action when necessary. It may just boil down to the fact that we must all play nice in the sandbox! But, again, I am alarmed by the fact that both nursing and respiratory (here) believe that it is detremental to the patient to suction under most, if not all circumtances.
I heard the anti-suctioning argument years ago, with a different variant. It seems that many health care professionals do not like to suction. It is worse with more RT's because everyone thinks everyone else is responsible.
Just to be one more who advocates for ET suctioning when indicated - Suctioning is necessary because a trached patient cannot mobilize secretions. (Vent or not.)
One of my co-workers said that when first introduced to trach care they were required to eat peanut butter crackers then attempt to breath through a straw.
The only patients I have refrained from suctioning are the patients that are requiring high PEEP levels to maintain minimal PaO2s. In those patients when you break the circuit (the suction is going to break the PEEP) it is going to take 30 mins or so to build up the PEEP again. Of course, if they are plugging off and the peak pressures are >50, then they need it.
Seems silly to me to say that all vent patients should not be suctioned.
Specializes in SICU, EMS, Home Health, School Nursing.
All of our vented patients have in-line suctioning, so it remains a closed circuit. Our vent protocol states that the patients HOB is to be at 30 degrees or higher if at all possible, oral care every 2 hours and ETT suctioning every 2 hours.
RN1982
3,362 Posts
I think that's the stupidest thing I've read. All of our vented patients have the closed suction system Ballard thingie. We suction the ET tube. I think the risks of not suctioning are more serious than the risks of suctioning. Patients with ET tubes need to be suctioned depending on the amount of secretions they produce. Some need it more than others. I don't know if you all have ventilator bundles with your patients where you do oral care, HOB 30 degrees, turning the patient but the whole point is to prevent VAP which is not covered by medicare anymore.