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Trach suctioning. Bullet vs. no bullet

Pulmonary   (34,350 Views 32 Comments)
by divaRN* divaRN* (New Member) New Member

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I know in the past NS bullets have been used to help clear thick secretions in trached/ vented pts. I know that EBP says we should NOT do this. I personally will not do it as an RN. If RT wants to do it then fine but I will not. What are some other ways to effectively remove thick secretions without a bullet? I have had a few trach pts that are unable to clear secretions and will end up with a plug or just be very junky and it can be very difficult to suction the secretions because they are sooo thick. *yuck* Any tips?

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Jasel works as a Registered Nurse.

6,183 Visitors; 197 Posts

I'm not familiar with "NS bullets". What are those exactly?? Anyway if the trach is almost plugged or just really thickened up I'll just take the whole thing out and clean it. We only have one trach patient at our facility who has been there for years. She also gets atropine drops SL BID to help clear up secretions which works pretty well from what I've seen.

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sunnycalifRN has 6 years experience and works as a ICU RN.

8,394 Visitors; 902 Posts

RT will sometimes use nebulized acetylcysteine along with either IPV or CPT. The acetylcysteine sometimes helps to break down the thick secretions. Also, a humidified and/or warmed oxygen source is helpful as well. For CF'ers we used to use nebulized Pulmozyme but I've never used it for the non-CF patient; I believe that it's rather expensive.:twocents:

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roser13 has 17 years experience and works as a RN.

2 Likes; 50,454 Visitors; 6,504 Posts

What is the contraindication for the bullets? When I worked a trach floor, we didn't suction without them.

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netglow works as a RN.

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Really? The little "pillows" is what you are referring to right? Bullets? Never knew they were called that. Easy to see how they help... like a little nettie pot.

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5,383 Visitors; 379 Posts

EBP from my understanding is that instilling actually creates a higher risk for instances of pneumonia.

Interventions that I've seen is adding a heated circuit to the ventilator line, or if the patient is on t-piece, adding in moisture helps. Some advocate for more frequent Sx, but I don't really think that helps much.

As said above the Inh mucomyst is sometimes ordered, percussion, etc. Resp neb Tx's by themselves sometimes are effective.

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PediLove2147 has 7 years experience.

13,318 Visitors; 648 Posts

What is the contraindication for the bullets? When I worked a trach floor, we didn't suction without them.

I am also interested in hearing the answer to this question. They are used them where I work as well..

EDIT: Sorry, the above post was not there when I started my post!

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tyvin works as a RN Hospice Consierge Services.

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I'm not familiar with "NS bullets". What are those exactly?? Anyway if the trach is almost plugged or just really thickened up I'll just take the whole thing out and clean it. We only have one trach patient at our facility who has been there for years. She also gets atropine drops SL BID to help clear up secretions which works pretty well from what I've seen.

NS bullets is a name normal saline that comes in the individual dose packets of 3ml is given. There are a few others names but on this forum they're usually referred to as NS bullets.

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highlandlass1592 has 13 years experience.

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Here's a link for all those who question why bullets should not be used:

http://www.medscape.com/viewarticle/552862

Free registration required to access--great CEU resource site. Karen

I know the AACN (American Association for Critical care nurses) also has that issued addressed in its procedure manual but right now I can't find my copy. Sorry

Edited by NRSKarenRN
Added registration info

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2 Likes; 9,962 Visitors; 1,097 Posts

Here's a link for all those who question why bullets should not be used:

http://www.medscape.com/viewarticle/552862

I know the AACN (American Association for Critical care nurses) also has that issued addressed in its procedure manual but right now I can't find my copy. Sorry

That link requires a login.

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netglow works as a RN.

3 Likes; 33,421 Visitors; 4,412 Posts

Biff just sign up it's free and you can get CEUs too as well as a nice little drug reference for your itouch.:up:

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2 Likes; 9,962 Visitors; 1,097 Posts

I just wanted to review the reference, not sign up for car insurance! :D

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