Critical Care Techniques Day 2

Front 1

Assignment 2

Back 1

White, clinical lab competencies page 456 to 460

Egan, chap 36 page 744 to 750

Workbook page 247 to 250

Front 2

Leukins invented the sputum trap

Back 2

Sputum specimen trap

no suction until you occlude the thumb port, never suction on insertion.

Front 3

Suctioning

Back 3

Selecting suction catheter size

:External diameter(ED) of suction catheter should be no more than 1/2 internal diameter(ID) of artificial airway

have to convert french to millimeters to ensure the the suction catheter

:There are formula to estimate proper catheter to use when you suction

When you have an ETT that is 8, that means the internal diameter

::ID of the ETT x 3/2 (then use the next larger Fr size

::ID x 2 (then use the next smallest Fr size

Fr only comes in even numbers. or if you prefer use the ID x2. much easier

so if the ID of the ETT is 8, then 8 x 2 = 16, next smallest size even is 14

Front 4

Suctioning

Back 4

Vacuum Pressure

:Adults should be -120 to -150 mmHg

:children should be -100 to -120 mmHg

:Infants -80 to -100 mmHg

Front 5

Adult trachea

Back 5

Adult trachea

:20 to 24 cm

:7.75 to 9.5 inches

Front 6

Endotracheal suctioning

Back 6

Two techniques for endotracheal suctioning

:Open, sterile technique requires disconnecting patient from ventilator

:Closed technique uses sterile, closed in line suction catheter which is attached to ventilator circuit

::suction catheter can be advanced into patients endotracheal airways without patient ventilator disconnection

Front 7

Endotracheal suctioning

Back 7

Step 1: assess patient for indications

:Patient should never be suctioned according to preset schedule, they should be suctioned PRN

:Abnormal breath sounds (e.g. coarse crackles or rhonchi) suggest that suctioning is needed

Front 8

Endotracheal suctioning

Back 8

Step 2: assemble and check equipment

Step 3: hyperoxygenate patient (give high FiO2 for a few breaths before suction procedure)

:Use 100% oxygen

Step 4: insert catheter

Step 5: Apply suction/Clear catheter

:Total suction time should be less than 15 seconds

Step 6: reoxygenate patient

Front 9

Endotracheal suctioning

Back 9

Step 7: monitor patient and assess outcomes(breath sounds, Pulse via the pulse ox, SpO2, respiratory rate and tidal volumes, skin color, and consistency of sputum)

Minimizing complications and adverse responses

:Pre oxygenation helps minimize incidence of hypoxemia

:Avoid atelectasis by limiting amount of negative pressure used and the time suctioning

Front 10

Endotracheal suctioning

Back 10

Minimizing complications and adverse responses

:Keeping duration of suctioning as short as possible

:Using appropriate size suction catheter, and avoiding disconnection from ventilator

:Use sterile technique during suctioning and manually ventilating patient to minimize bacterial colonization

:Do not routinely instill sterile normal saline into artificial airway prior to suctioning unless necessary to help mobilize thick secretions

Front 11

Nasotracheal suctioning

Back 11

Indicated for patients who retain secretions but do not have artificial airway in place

Placing catheter in larynx and trachea is facilitated by having patient assume "sniffing position"

Procedure may cause patient to gag or regurgitate

:Avoid suctioning immediately after meals (wait at least 30 minutes)

:Prepare to reposition patient and suction oropharynx if this occurs(use yankaur suction)

Front 12

procedures thath minimize complications of suctioning, include all of the following, except:

Back 12

Preoxygenation

Limiting negative pressure

Using septic technique

Limiting suction time

Front 13

Sputum sampling

Back 13

Purpose: collect to identify organisms from the airway that affect the patient

Patients with strong enough cough can provide ample sample sputum specimen by expectorating into a sterile cup

Sterile technique must be maintained when touching connection points on sterile/Lukens trap

Front 14

Pharyngeal airways

Back 14

We have two pharyngies, nasopharynx and the oropharynx. the soft rubberized plastic goes in the nasal pharynx, the hard plastic goes into the orophraynx

Front 15

Establishing an artificial airway

Back 15

Routes

:Pharyngeal airways extends only into pharynx

:Artificial airways placed through mouth and nose into trachea are called endotracheal tubes

Routes

:Intubation: process of placing artificial airway into trachea

::orotracheal intubation is when tube is passed through mouth on its way into trachea

::nasotracheal intubation is when endotracheal tube is passed through nose first

Front 16

Pharyngeal airways

Back 16

Nasopharyngeal airway is most often placed to facilitate frequent nasotracheal suctioning

Nasopharyngeal airways is the nasal trumpet

:Minimize trauma to nasal mucosa caused by suction catheter

:Used for repeated suction attempts

Front 17

Pharyngeal airways

Back 17

Oropharyngeal airways should be restricted to unconscious patient to avoid gagging and regurgitation

Maintaining Patent airways is number 1 goal

:Maintains patent airways by preventing tongue from obstructing oropharynx

:can be used as a bite block for patients with oral tubes

Front 18

Pharyngeal airways

Back 18

:Nasopharyngeal airway

::also called nasal trumpet

:Provides airway

::Also route for N/T suctioning

Front 19

Pharyngeal airways

Back 19

Oropharyngeal airways

(very uncomfortable, so unconscious or semi conscious)

:insert in mouth with tip pointing up

:then rotate so tip rests against back of tongue

:NOT tolerated in the conscious patient