EMS professionals have an array of tools that enable them to save lives. Cardiac monitors not only allow the identification of arrhythmias but also permit pacing, cardioversion, and defibrillation. An assortment of medications can treat everything from diabetic emergencies to allergic reactions. And intubation provides secure airways for those at risk.
But one of the most effective tools for protecting, and potentially saving, your patient is one of the most basic: your portable suction unit.
Effective pharyngeal suctioning is one of the surest ways of protecting your patient against respiratory complications. When a patient is unconscious, is semiconscious, or is disabled and unable to protect his or her airway, pharyngeal suctioning can aid in maintaining patency, can clear the chords during the placement of an advanced airway, and can remove bodily fluids that can create obstructions.
Two of the most critical complications that can be avoided through effective pharyngeal suctioning are hypoxia and aspiration. We'll examine these challenges, but first let's discuss the decision-making process of suction.
Does Your Patient Need Suctioning?
Determining when to administer pharyngeal suction begins with recognizing the signs and symptoms. First, determine to what degree your patient is compromised. Here are the general designations:
Respiratory insufficiency: The patient’s respiratory system is unable to keep up with the normal metabolic demands of the body. It may arise from a head, thoracic, or spinal cord injury or from central nervous system depression, common in drug overdoses.
Respiratory depression: When the patient’s respiratory rate falls below 12 breaths per minute for a prolonged period.
Respiratory failure: When the respiratory system is unable to meet the body’s metabolic demands. The patient may appear confused, anxious, or obtunded. If not corrected, respiratory arrest may follow.
Recognizing the Signs of Hypoxia
Early recognition is the key to effective treatment, and avoiding hypoxia in your patient is fundamental to proper airway management. The signs of hypoxia can include:
- Increased work of breathing, requiring the use of accessory muscles, belly breathing (in pediatrics), nasal flaring, or retractions
- Restlessness/agitation – the patient is unable to sit still
- Confusion and decreased level of consciousness
- Bradycardia (especially in children)
- Inadequate or abnormal breath sounds (gurgling, wheezing, stridor)
Types of Hypoxia
There are different forms of hypoxia, caused by a variety of physiological factors. The four general categories are:
- Hypoxic hypoxia: Insufficient oxygen in the blood, which affects the tissues of the body. Causes can include hypovolemia, obstruction, decreased cardiac output, and coronary artery disease.
- Anemic hypoxia: Caused by a reduction or dysfunction in hemoglobin, which reduces the oxygen-carrying capacity of the blood. Can be secondary to anemia, hemorrhage, hemoglobin abnormalities, carbon monoxide, and certain medications, such as sulfa drugs.
- Stagnant hypoxia: Tissue hypoxia due to lack of circulation, common secondary to reduced cardiac output. Can be caused by heart failure, shock, continuous positive-pressure breathing, and pulmonary embolism.
- Histotoxic hypoxia: The inability of cells to utilize oxygen due to inactivation or destruction of key enzymes. Can be caused by certain poisonings, such as cyanide and strychnine, or late-stage carbon monoxide poisoning.
Anyone can be at risk for aspiration. Although it can occur at any age, there are certain risk factors, which include:
- Decreased LOC
- Chronic GI disorders, such as gastroesophageal reflux
- Nasogastric or tracheal tube placement
- Dental procedures
- Patients with impaired swallowing abilities
Avoiding Aspiration Through Pharyngeal Suctioning
The most effective means of preventing aspiration is to maintain a clear airway. If your patient is at risk, either from excessive bleeding, saliva, or active vomiting, you should be readying the portable suction unit.
Select the appropriate size of suction catheter, depending on the type of bodily fluids encountered. Saliva is easily removed with a normal, straight-tipped catheter. But for larger jobs, where blood and vomit are involved, select a larger evacuation tool, to avoid clogs and ineffective suction.
Once you have your suction unit set up, it’s time to prepare your patient. This includes:
- Positioning the unconscious patient – maintaining C-spine immobilization when trauma is suspected
- Opening the airway using the appropriate method – using a jaw thrust for traumatic injuries
- Preoxygenating the patient for one to two minutes, either through bagging or via a non-rebreathing mask (for spontaneously breathing patients)
- Using the appropriate size of catheter
- Reassessing your patient regularly – using a cardiac monitor and pulse oximetry
- Watching for loose dental hardware, especially in the elderly
- Using care when suctioning pediatric and geriatric patients, to prevent trauma to fragile mucosal tissues
Pharyngeal suction provides an effective means of maintaining airway patency and, in some cases, may just save your patient.
2011, Pollak, A., Ed.
Critical Care Transport, American College of Emergency Physicians, Jones and Bartlett.