To suction or not?

[romantic, BSN, RN]

Hello all!

I need your opinion. You have a patient after ICH with Glasgow coma 8. low grade fever 100.4, taken axillary; 96% on RA; normal BP 123/60; hr 70-80; but tachypneic- rr in 30s;

lung sounds diminished, but no wheezing. good cough reflex. normal glucose level.

Will you suction?

how do you make the decision to suction? based on what findings?

don't you think that when airways are obstructed, you should auscultate wheezing?

if it is completely obstructed, you should see drop in Sats?

[Lunah, MSN, RN]

I am stuck on the axial temp. Core temp would be better! Temp sensing Foley?

[romantic, BSN, RN]

this patient is not considered to be in a critical condition at this time. the patient has been on neuro-tele floor.

[MunoRN, RN]

I don't see a clear indication to suction the patient, or even a vague one for that matter. The patient is tachypneic, which could certainly be a reason to suction but only when combined with other findings, particularly since an ICH can often cause neuro induced tachypnea or other respiratory abnormalities. (By suctioning I'm assuming you're referring to NT or OT suctioning). There would need to be a valid reason to believe there are tracheal secretions that require invasive suctioning (an audible 'rattle', rhonchi that does not clear by other means, acute changes to sats, etc)

[romantic, BSN, RN]

Thank you. That was my assumption, too. No "rattle".

I thought, maybe I am missing something.

[MunoRN, RN]

Thank you. That was my assumption, too. No "rattle".

I thought, maybe I am missing something.

It's possible for tracheal suctioning to be indicated without a rattle, such as when the mucous is so thick and tenacious that it simply doesn't move when air is moving through the trachea, therefore not producing any audible signs, or if the airway is completely obstructed, but there would still be other findings that would indicate the need for suctioning.

[romantic, BSN, RN]

Thank you for the good point.

I know that in asthmatic patient lack of respiratory sounds is a bad sign-- complete obstruction of airways; though, I never encounter this case in my practice.

Do you think it is possible to have RR in 30s with normal sats because of partial obstruction with thick mucous (that's why no rattle sound and lung sounds diminished)?

You mentioned other findings that would indicate the need for suctioning. Please, clarify. Thank you.

[JaySanbrem]

Anytime I ask myself if I should suction or not I've always found that the answer is a strong yes. Worst case scenario is that your patient's sqeaky clean airway is now a little bit more spotless. Ideally the proper answer is to look first for something objective, but as they say, "treat the patient, not the monitor." If someone seems like they have respiratory distress from secretions then they probably have respiratory distress from secretions regardless of what their vital signs say and would probably benefit from suction ASAP.

[LovingLife123]

A GCS of an 8 is an indication they may not be protecting their airway all that well. And no, you don't necessarily ascultate wheezes when there is an obstruction. You can literally hear all kinds of sounds, it's not specific to wheezing.

We have a phrase, Under 8, intubate. So the fact your patient is riding that line is concerning. You don't want secretions collecting.

[Julius Seizure]

this patient is not considered to be in a critical condition at this time. the patient has been on neuro-tele floor.

This surprises me a little bit. But what do I know, not my specialty.

[LovingLife123]

This surprises me a little bit. But what do I know, not my specialty.

Me too. The only time I can think that's it's not critical is if this is the patient's baseline Neuro status. This is how they have been and will be and maybe they are treating this patient for a new onset Neuro issue.

And I'm in this specialty.