Airway Clearance Technique

Airway Suctioning
Mohamed Kassim bin Abdul Wahab

Objective
To educate on procedures & safety involved in Suctioning Hands on practice in assisting Physiotherapist during suctioning To educate on application of Oral Airway

What is Suctioning?
It is methods of clearing secretions by the application of negative pressure via an appropriately sized tracheal suction catheter inserted through the mouth or nostril. This procedure may be required in an emergency situation or as part of a patients planned care.

Common Indications
Raised respiratory rate Inability to clear secretions effectively Reduced air entry on auscultation Audible secretions Spontaneous but ineffective cough Reduced oxygen saturation levels

Contraindications
Nasopharyngeal Suctioning
Skull fractures Craniofacial surgery/Injury

Endotracheal/Orophryngeal
No contraindications

Precautions
Low SpO2 Unstable Cardiovascular System Patient on Anticoagulant Therapy Clotting Disorders Low platelet count Severe bronchospasm Immediately after lung surgery

Types of Suction Catheter

Open Tip

Whistle Tip
-more effective for removing thick mucous plugs

Nasopharyngeal

Oropharyngeal

Sites for Suctioning

Endotracheal Tube

Tracheostomy

Oral Airway
Is a medical device called an airway adjunct used to maintain a patent (open) airway

Use of Oral Airway?

Preventing the tongue from covering the epiglottis, which could prevent the person from breathing. When a person becomes unconscious, the muscles in their jaw relax and allow the tongue to obstruct the airway
Tongue

Epiglottis

Oral Airway Size

It is chosen by measuring from the middle of the persons mouth to the angle of the jaw.

Oral Airway Insertion

The airway is then inserted into the persons mouth upside down. Once contact is made with the back of the throat, the airway is rotated 180 degrees, allowing for easy insertion, and assuring that the tongue is secured.

Oral Airway Insertion

Risks of Oral Airway

If the person has a gag-reflex they may vomit When it is too large, it can close the glottis and thus close the airway Improper sizing can cause bleeding in the airway

Procedure for Suctioning

Preparation of PT/PTA Prepare the patient Prepare suction apparatus and related equipment's Application of suction Tidying Up

Preparation of PT/PTA
Steps Rationale

Wash your hands

To reduce the risk of crossinfection.

Put on disposable apron ,mask & disposable gloves

To reduce risk of cross-infection and to protect yourself from droplets/sputum contamination.

Prepare the patient

Steps Introduce yourself, confirm the patients identity, explain the procedure, and obtain consent (conscious patient). Give instructions to patient (conscious):Not to move while suctioning Raise the hand if intolerable Rationale To identify the patient correctly and gain informed consent (when applicable).

To minimize risk of mucosal trauma

Prepare suction apparatus and related equipment's

Prepare Suction Kit

Suction machine (if portable)

Suction Tube

Prepare suction apparatus and related equipment's

Suction Catheter
Size Mode

Size 6 or 8
Size 10 Size 12 Size 14

Neonates & Paediatric

Endotracheal Tube <7mm diameter Endotracheal Tube medium size Endotracheal Tube >9mm diameter

Prepare suction apparatus and related equipment's

Sputum Trap

Normal Saline & sterile water as per requirement Oral Airway (If needed)

Prepare suction apparatus and related equipment's

Tear the upper part of the pack and connect the suction catheter to the suction tubing Turn the machine on to the desired level:
Patients Neonates Suction Pressure 60-80 mmHg

Infants
Children Adults

80- 100 mmHg

100- 120 mmHg 100-150 mmHg

Close the suction port to check for if there is suction produced

Application Sterile Technique

Step Rationale

Pre Oxygenate for 2 minute if necessary

To prevent hypoxemia (deficiency of oxygen in blood)

Wear a sterile glove over your disposable To reduce risk of cross-infection to the glove on the suctioning hand patient Withdraw suction catheter from sleeve with clean gloved hand and grasp catheter with sterile gloved hand away from catheter tip. Open the airway connecter from the endotracheal or Tracheostomy tube Advance catheter gently until a cough is stimulated or resistance is felt. Do not apply suction during catheter insertion. To minimize risk of mucosal trauma To reduce risk of cross-infection

Application Sterile Technique

Step
When a cough is initiated or resistance is felt, withdraw the catheter approximately 1 cm and apply suction by occluding suction control port on catheter with thumb.

Rationale
To reduce potential complications from suctioning.

Withdraw gently. Procedure should last no more than 15 seconds.

To minimize risk of mucosal trauma

Close the Airway connector after catheter is withdrawn

Application Sterile Technique

Step Check on patients monitor to make sure Vital signs are stable Clean the suction catheter with sterile water if necessary To ensure sputum does not block further suctioning Rationale

Repeat procedure if required, having checked the patients vital signs.

Application Non Sterile Technique

Step
PreOxygenate for 2 minute if necessary

Rationale
To prevent hypoxemia (deficiency of oxygen in blood)

Insert airway (Oral or Nasopharyngeal) if If airway obstructed, to be able access necessary smoothly

Withdraw suction catheter from sleeve

Advance catheter gently (Orally or nasal) To minimize risk of mucosal trauma until a cough is stimulated or resistance is felt. Do not apply suction during catheter insertion. In case of nasopharyngeal suction use KY jelly over the tip of the catheter before suctioning To facilitate smooth passage of suction catheter

Step

Rationale

When a cough is initiated or resistance is felt, withdraw the catheter approximately 1 cm and apply suction by occluding suction control port on catheter with thumb. Withdraw gently. Procedure should last no more than 15 seconds Check on patients monitor to make sure Vital signs are stable

To reduce potential complications from suctioning.

To minimize risk of mucosal trauma

Clean the suction catheter with sterile water if necessary

Repeat procedure if required, having checked the patients vital signs

To ensure sputum does not block further suctioning

Tidying Up
Dispose of the suction catheter Clean the Suction Tube with sterile water before reducing the suction pressure Clean up the area and dispose of accordingly

Thank you for your listening

PRACTICAL SESSION