The extrication has been ongoing for over half an hour, but the crews are still struggling to free the trapped driver. As the medic in charge, you are wedged into the passenger seat, trying to control the blood streaming from the patient’s nose and mouth. The victim is conscious, but his blood pressure is dropping, his pulse is weak and thready, and he’s fighting agonizing pain from his crushed legs. All you can do is continue suctioning his airway, when suddenly your catheter becomes clogged. What do you do?
Suctioning a patient is usually a messy job, especially when dealing with profuse bleeding or vomitus. Sometimes it’s all you can do to keep up with the deluge. But the average suction catheter can only do so much. Eventually, it may become clogged. So, what are your choices? You either clear it or replace it. Let’s examine both options.
Clearing the Catheter
If your suction catheter becomes clogged, there are techniques you can use to clear the debris. You can try flushing it with saline, which can be effective for breaking up blood clots, but it may not work against gastric contents. You can insert a stylet and simply ram the object from the catheter, but if you don’t have a stylet on hand, you’ll be digging through the airway bag at the most inopportune moment.
Airway maintenance is all about time. How long can your patient go without a patent airway? How long can you watch a patient struggle? The answer: not very long. We’re talking seconds. So, taking the time to dislodge a clog from your catheter may not be a viable option.
Replacing the Catheter
Your best and most expedient option is to simply replace the suction catheter. It’s imperative that you keep backups on hand, so make sure your portable suction unit is fully stocked at the start of each shift. Also, be sure you have an array of catheters on hand, so that you can choose the size that best fits the task. Smaller tips are fine for sputum, but when dealing with traumatic injury or a vomiting patient, the smaller tips are bound to clog.
Now there are larger, more efficient suction catheters that allow you to clear tissue, teeth, clots, and food particles from the airway, so be sure to include these rugged tips in your inventory. Today’s suction catheters are also better designed for the curvature of the airway, allowing you greater access and depth. There’s no more effective means of visualizing the cords than by utilizing a well-designed suction catheter to clear your field of vision.
Clogged suction catheters are just one of the obstacles you must overcome when securing an airway. But by choosing the right equipment from the start, you can minimize the risk and save yourself the headache. Keep plenty of backups on hand, keep a range of sizes at the ready, and select the right size for the job, and you can avoid facing the decision of clearing versus replacing.