More than 5,000 people die from choking each year. Aspiration remains alarmingly common, and accounts for 5-15 percent of community-acquired pneumonia cases. Airway management remains a critical and life-saving tool for EMS responders. According to one study, 1.5 percent of EMS cases in a five-month period involved intubation. Yet 25 percent of intubation attempts failed.
Whether it’s intubating a choking victim, clearing the airway in a patient suffering from pneumonia, or dealing with the aftermath of aspiration, suction catheters are a key tool in every first responder’s kit.
The stakes couldn’t be higher when it comes to airway management. Following a few simple best practices for airway management can save lives. But adept use of your airway protection equipment isn’t enough. Maintaining suction catheters in excellent working order is a critical factor in airway management. Here are five best practices.
Maintain Your Equipment
No matter the condition of your catheters, they won’t be able to effectively clear the airway if they’re connected to faulty equipment. Airway suction catheter maintenance is, first and foremost, about maintaining the equipment. Your portable suction unit should always be ready to go, since the catheter is worthless without it.
The type of unit you use will determine the precise daily maintenance routine. At minimum, you should do the following daily:
- Make turning on and testing your machine a part of your routine truck inspection. Today’s long-life batteries should mean that a portable suction unit remains charged. But if there’s a problem with the battery, unit, or power supply, you need to know that before a life hangs in the balance.
- Ensure you have a backup canister and backup battery at the ready.
- Run the unit for 15 minutes each morning to check for indicator lights. If any appear, check the manual or notify your supervisor.
Practice Good Sanitation
Management of hazardous wastes is a key part of the job, yet it’s easy to get sloppy when you’re dealing with life-or-death situations. Never reuse disposable parts, including catheters. Instead, follow your company or hospital’s protocols for hazardous waste disposal. Remember that you’re already dealing with vulnerable people, so exposing them to hazardous wastes, even inadvertently, can be life-threatening.
Have the Right Equipment Available
A suction unit and catheter alone won’t save lives. You’ll need all of the equipment necessary to operate your unit, including canisters, tubing, and other disposable devices. Err on the side of having too much equipment in a variety of sizes. Most adults need a size 7.0 or 8.0 tube, but smaller sizes are necessary for pediatric patients.
Additionally, be sure you have the following items available:
- Suction kit, including catheter, suction device, and suction tube.
- Drape
- Gloves
- Basin
- Sterile solution
- Sterile water
- Water soluble gel
- Ambu bag with mask and oxygen source
- Face shield or goggles
- Gloves, including non-latex gloves
All of this equipment should be in your first-in bag, ready to go the moment a person having an emergency needs it.
Clean and Store Reusable Devices
After you’ve tossed used catheters, tubing, canisters, and other disposables, fully sanitize the unit. In most cases, this will require using a mild detergent that’s one part bleach to 10 parts water, but follow manufacturer guidelines for your unit.
A common EMS misconception is that, as long as the device doesn’t come into contact with bodily fluids, it is safe to reuse. However, airway suction devices can provide fertile breeding ground for dangerous pathogens. Sanitize the suction unit after each use, no matter whom it has been used on or how clean it looks. Follow the manufacturer’s specifications exactly.
Have the Right Sizes Available
Though most adults need a 7.0 or 8.0 tube, not all can accept this size. Moreover, pediatric patients are at a greater risk of choking emergencies than adults, and need much smaller tubes. So it’s critical to patient safety to have several sizes available. Keep several of each on hand, as this protects against defective equipment and user error, and ensures you always have a second tube to work with.
In general, the rule is to multiply the inner diameter of the tracheal tube by two, and then use the next smallest catheter. Catheter sizes should coordinate with tracheal tube sizes.
Rather than conceiving of the catheter as a standalone device requiring its own maintenance, it’s critically important to view it as part of a larger system. If any portion of that system malfunctions, a patient’s life may be at risk. You must maintain each component of the system, and prepare with multiple layers of backup in the event that any portion of the system fails.
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¹Cheng, E. R. (2007). Aspiration pneumonia. Retrieved from https://www.sciencedirect.com/topics/medicine-and-dentistry/aspiration-pneumonia
²Choking prevention and rescue tips. (n.d.). Retrieved from https://www.nsc.org/home-safety/safety-topics/choking-suffocation
³Myers, L., Gallet, C., Kolb, L., Lohse, C., & Russi, C. (2016). Determinants of success and failure in prehospital endotracheal intubation. Western Journal of Emergency Medicine, 17(5), 640-647. doi:10.5811/westjem.2016.6.29969
