Overweight or obese patients can present suctioning difficulties. Because most American adults are overweight or obese, medical providers must train in the treatment of bariatric patients. These patients are highly susceptible to airway difficulties, particularly during surgery. The following strategies can help you effectively suction bariatric patients, even when they present with difficult airways.
Know When to Suction
Though obese patients are more likely to have airway difficulties, particularly during surgery, routine suctioning is not appropriate. Follow the same guidelines for suctioning that you would for any other patient, including:
- Audible respiratory sounds in a patient who is unable to clear their airway
- An airway obstruction
- Vomiting
- Aspiration or high aspiration risk
Additionally, some obese patients struggle to spontaneously breathe during surgical procedures, so you must be prepared to suction and intubate.
Be Prepared for a Difficult Airway
Bariatric patients are more likely to present with a difficult airway, especially if they have underlying comorbidities. One of the biggest issues is often a matter of positioning. If your patient has mobility issues, you may struggle to get them into a safe suctioning position. Having two team members work together can reduce the risk of failed intubation, as well as injury to the patient.
Use the LEMON acronym to assess the probability of a difficult airway:
- L: Look at the airway for signs of a challenging intubation, such as missing teeth, a large tongue, or a broken jaw.
- E: Evaluate using the 3-3-2 rule. The mouth should be at least three fingers wide when open. The space from the chin to the hyoid bone should also be three fingers wide. The length of the space between the thyroid notch and hyoid bone must be at least two inches wide.
- M: Mallampati score. Assign a score to predict airway difficulty.
- O: Obstruction. Assess for medical conditions that might result in a physical airway obstruction, as well as the obstructions themselves.
- N: Neck mobility. Any neck mobility limitations, including those related to obesity or poor muscle tone, can undermine suction.
Train for the Real World
Suction training sessions rarely mimic the complicated realities of treating human patients. Adjust your training sessions so that they include the wide variety of experiences you are likely to encounter in the real world, including intubating obese patients in high-stress situations, such as those that may follow a mass casualty or a car accident. The more accustomed you become to these stressful, difficult situations, the better prepared you will be when you encounter them in real life.
Prevent Suction Complications
Suctioning-related complications are more common in bariatric patients because they are more likely to present with a difficult airway and comorbidities. So although you must follow best practices with every patient, doing so is of the utmost importance with the bariatric patient. Always preoxygenate the patient. Never suction for longer than 10-15 seconds, and choose the size of the catheter based on the endotracheal tube size—not the patient’s size. A large patient might still need a typically sized catheter. Monitor the patient for signs of distress, and do not immediately attribute distress to the patient’s body size.
Be Prepared for Emergency Suction
One of the biggest challenges of treating a bariatric patient is moving them in an emergency. Wall-mounted suction won’t help in these scenarios. You must be prepared with an emergency unit, even if your agency primarily relies on wall-based suction units. With emergency suction, you can tend to the patient wherever you find them, improving outcomes and reducing the risk to first responders of attempting to quickly move them in an emergency. For help finding the ideal machine for your agency, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.
