At times it is astonishing how fast a 12-hour shift in the hospital can go. You find yourself in constant motion, carefully assessing each patient and making sure to complete all of your necessary duties before the next nurse comes on to relieve you.
During these busy shifts, there are some patient care tasks that you do with such frequency that they become almost habit. However, it is always good practice to review, and hopefully even improve, your nursing skills.
Today, let’s take a look at suctioning, since airway management should be a priority for every patient. The American Association for Respiratory Care’s Clinical Practice Guidelines indicates the following. (The guidelines were written specifically for endotracheal suctioning, but many of the key points apply to all types of patient suctioning.)
Monitoring your patient is key
Prior to, during, and following suctioning it is very important that you assess your patient closely. Though there are no absolute contraindications to suctioning when it is needed, there are potential complications that can occur. Therefore, careful monitoring is necessary.
Pay close attention to the following as well as other parameters called out in the American Association for Respiratory Care’s Clinical Practice Guidelines:
- Breath sounds
- Oxygen saturation
- Vital signs- pulse, respiratory rate, blood pressure
- Sputum color, volume and consistency
- Intracranial pressure, if monitoring
- Ventilator parameters- Peak Inspiratory Pressure, Tidal Volume, FiO2
Successful suctioning will result in improved breath sounds, decreased peak inspiratory pressure, increased tidal volume, decreased secretions, and improved oxygen saturation (American Association for Respiratory Care, 2010).
Suction when indicated, not routinely
Patients should be suctioned when secretions are present or when they are exhibiting signs of a compromised airway. Regularly scheduled suctioning should not be a part of routine airway management due to potential for complications, such as tissue trauma, hypoxia, and bronchospasm (AARC, 2010).
Check the negative pressure each time before suctioning
Occlude the suction tubing prior to suctioning your patient to check that your unit is set to the proper negative pressure. Follow your hospital’s policies to determine the correct amount of negative pressure to be used. The goal is to use the least amount of suction necessary to effectively clear the airway of secretions (AARC, 2010).
Do not instill normal saline prior to suctioning
Normal saline used to be instilled into artificial airways before suctioning to help liquefy and loosen secretions. However, there is not enough study evidence to validate this. At this time, it is not recommended to routinely use normal saline before a patient is suctioned (AARC, 2010).
Hyper-oxygenate before and after suctioning
It is recommended that adult and pediatric patients receive 100% oxygen and neonates receive 10% over their baseline FiO2 for 30-60 seconds prior to suctioning. Additionally, the same increase in oxygen should be delivered for one minute after suctioning to patients who exhibited signs of hypoxia prior to or during suctioning (AARC, 2010).
Do not suction for longer than 15 seconds
Suction should not be applied while inserting the suction catheter into the airway and should only be applied while the catheter is being removed. To reduce the risk of complications, it is recommended that each suction attempt not last any longer than 15 seconds (AARC, 2010).
If you have been a nurse for a long time, you have likely seen recommendations for airway management change over time. Even though many of these suction guidelines may be review, it is important to do a quick refresher of your basic nursing skills to make sure that you are incorporating the most recent, evidenced-based guidelines into your nursing practice.
These recommendations, and more are embodied in the American Association for Respiratory Care’s Clinical Practice Guidelines. Follow that hyperlink to read the entire document.
American Association for Respiratory Care. (2010). AARC Clinical Practice Guidelines Endotracheal Suctioning of Mechanically Ventilated Patients With Artificial Airways 2010. Respiratory Care, 55(6), 758-64. Retrieved from http://www.rcjournal.com/cpgs/pdf/06.10.0758.pdf