When you think of in-hospital suction, you probably picture the typical wall-mounted unit that is supplied by vacuum lines piped throughout the building. What may not come readily to mind are portable suction units, but portable suction plays a vital role in the hospital setting. Let's familiarize ourselves with in-hospital suction strategies.
Hospital Scenarios Requiring Portable Suction
Although most hospitals have suction outlets in each patient room, there are numerous scenarios that require portable suction. Here are the most common:
- Crash Carts: Crash carts provide mobile resuscitation throughout the hospital and should be outfitted with a portable suction unit for use during cardiac arrest.
- Transport: As critical patients are transported throughout the hospital, hang a portable suction unit on the stretcher to control oral secretions and maintain airway patency.
- Near Exits: Because some patients may not make it into the emergency department, hospital personnel must be able to respond to parking lots and grounds. A portable suction unit near each exit will come in handy if personnel are forced to resuscitate outside of the hospital.
- Nursing Stations: A portable suction unit may be necessary if a wall-mounted unit fails.
- Disaster Response: In the event of a disaster, hospitals may be called upon to treat large numbers of patients, overwhelming normal equipment demands.
How Many Units Will Your Facility Need?
The number of portable suction units your hospital needs will depend on several criteria. They include:
- The number of beds within your facility
- The average number of patients intubated
- The number of deliveries (births) per day
- Frequency of inter- and intra-facility transports each day
- Number of areas throughout the hospital that lack wall-mounted suction
- Number of exits according to your facility's disaster plan
Form a committee when deciding on the number of suction units, so that each area of the hospital is represented and their concerns are addressed.
Suction and Emergency Airway Crash Carts
Another key location for a portable suction unit is on an emergency airway crash cart, which may be practical for larger hospitals with greater coverage area. Aside from the portable suction unit, your airway crash cart should include:
- Fiber-optic bronchoscopes
- Retrograde wire intubation kits
- Jet ventilators
- Percutaneous cricothyrotomy kits
- Laryngeal mask airways
- Surgical airway equipment and multiple sizes of tracheostomies
- Intubation catheters or bougies
- Videolaryngoscope
Having an emergency airway crash cart allowing airway intervention throughout your facility is just as useful as having the cardiac version.
Areas to Avoid
There are certain areas in the hospital where you do not want to store your portable suction units. They include:
- Wet areas, such as near hazmat showers
- Areas exposed to extreme temperatures (outdoors)
- Areas under construction, where dust and debris are heavy
- Unsecured areas, where the unit could be damaged if dropped
Protect your units by storing them in safe, secured locations.
Suction Basics: A Quick Review
Because we're discussing in-hospital suction strategies, a key strategy is using proper technique when suctioning your patient. As a quick review, here are the guidelines:
- Preoxygenate your patient using 100 percent oxygen for at least 30 seconds prior to suctioning
- Position the patient, maintaining spinal immobilization when necessary
- Limit suctioning to 10 seconds or less to prevent hypoxia
- Monitor for dysrhythmias, signs of ischemia, or rate changes
- Use pulse oximetry to monitor O2 saturation
- Monitor blood pressure and end-tidal CO2
- Reassess continuously, including breath sounds
Don't Forget Maintenance
A critical strategy for in-hospital portable suction is maintaining the units. Sometimes we fail to maintain equipment we rarely use, which is why it is important to designate someone to check the unit at the start of each shift. The suction unit is of no use if its batteries are dead. Here are a few maintenance reminders:
- Check the batteries at the beginning of each shift and after every use
- Test your batteries periodically per manufacturer’s guidelines and replace when necessary
- Ensure all parts of the unit are attached and in good working condition
- Sanitize after each use
- Have extra catheters of various sizes on hand
- Never reuse disposable parts, including the canister, patient tubing, and catheters
- Always properly dispose of biohazardous materials
- Disinfect using a mild detergent or a mixture of bleach and water (one part bleach/10 parts water)
- Never submerge the unit
Familiarizing yourself with in-hospital suction strategies is a vital part of your patient-care responsibilities. Having portable suction at the ready ensures you can handle any respiratory emergency, anywhere in your facility. A bit of planning goes a long way.