Tracheal Suction Technique

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Hi Everyone.

I work with a client who is ventilated, and requires tracheal suction, the specialist who liases with us recommends that we insert the suction catheter until resistance is met i.e. carina, i have come across articles which do not recommend this, i have taken on researching the practice and would like as much info as possible before addressing this issue with the specialist, any info for and against, you could give me would be of great assistance. Thanks diane1970

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He who asks is a fool for five minutes, but he who does not ask remains a fool forever

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Why not insert the catheter until you meet resistance at the carina? This is how I was taught to do it as well.

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This is my total pet peeve. You are not supposed to hit the carina! It's traumatic, and why do you need to do it? ETTs and suction catheters have measurements on them for a reason. You should pass the suction catheter no more than 1cm past the end of the ETT to avoid hitting the carina (You can pass the catheter until the 10cm mark on the catheter hits the 9cm mark on the ETT for instance). There is absolutely no reason to hit the carina when suctioning. NONE.

http://64.233.167.104/search?q=cache:8JQEbrBlUzUJ:www.aacn.org/AACN/practice.nsf/Files/ATEA02/%24file/AskExpertsAp_02r.pdf+%22ETT%22+%22suction%22+%22carina%22&hl=en&ie=UTF-8

The effect of deep suctioning istracheal mucosal damage, includ-ing epithelial denudement, hyper-emia, loss of cilia, edema, fibrosis,and granuloma formation. Thisdamage occurs when tissue ispulled into the catheter tip holes,and increases the risk of infectionand bleeding for the patient

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So true....we used to do deep suctioning...this theory has changed back and forth several times...while you did get alot more gunk out...I do believe it caused more gunk in the long run due to irritation and insult.

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I took care of a couple of trach Pt's in home health and my own personal tehnique was to apply suction frequently during insertion in an attempt to find the "culprit" so to speak I alsoo feel hitting the carina is traumatic and should be avoided if Possible, although with some you must actually induce the cough which comes with this trauma to get the nasty bugger

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Here is an excerpt from the The Journal of Clinical Nursing which throws some light on this discussion. Hope you find it useful.:coollook::p>:p>

:p>:p>

Volume 10(5) September 2001 pp 682-696:p>:p>

An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units:p>:p>

[Articles: Issues in Research Utilisation]:p>:p>

:p> :p>

SUCTIONING

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Well this is my response, as a mother of a child who has a trach.

My daughter needed granualtion tissue removed several times from below her trach due to people ramming the catheter in, far below the end and hitting her carina. Oto docs told us that you should not ever suction below the end of the trach tube or et tube. This is especially true in peds, where they are more susceptible to trauma.

This is what I know as a mother of a trached child, i carry this over into my practice as a nurse.

Allevi

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Specializes in ICU.

The JBI which is our nursing Evidence Based Pracitice Unit which performs systematic reviews has an Evidence Based Practice information sheet covering tracheal suction

http://www.joannabriggs.edu.au/pubs/best_practice.php?pageNum_rsBestPractice=3&totalRows_rsBestPractice=55

Unfortunately this does not cover how far the suction catheter should be inserted but I concur with what has been said above - ONLY insert to 1 cm past the end of the tube or until a cough is elicited - whichever is shorter.

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Diddoms, none of my patients can cough and we still do not need to hit the carina to suction effectively. Many studies showing the dangers of deep suctionning were done on premies like mine who can't cough. Sorry about the emphatic response though, I should know better than to say NEVER:), but everything I've read says there is no reason for it to be the routine. When I work with children, I've found a little saline is enough to stimulate the carina and get a cough, even when they are sedated.

Even supporters of occasional deep suctionning seem to believe it should not be routine because of the known negative affects when little or no known benefits have been shown.

http://ccn.aacnjournals.org/cgi/content/full/24/3/13-a

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Interesting thread.

I too was taught that I needed to elicit a cough(I've reached the corina).

So, is the jury still out on this?.

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Thanks everyone for your replies, I personally have never gone to the carina, why should we be inflicting more trauma on these patients than what they have already gone through. I am doing what we are taught within the code of conduct to challenge and change practice based on the best available evidence, and i am so glad there are others out there who share my belief in giving patients the best possible care we can give, not just carrying out practice the way we were shown. I would be extremely grateful if any of you have any articles they could e mail. And for my next query THE USE OF SALINE is this necessary? evidence shows NO benefit of introducing saline to break up secretions.

Regards Diane

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Diane, we don't do it routinely because it can paralyze the cilia. However, every so often we have a kid with the goopiest of secretions and a little saline will clear it out like nothing else.

https://allnurses.com/forums/showthread.php?s=&threadid=24795&highlight=saline+suction

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