NORMAL SALINE IRRIGATION OF ARTIFICIAL AIRWAYS PRIOR TO SUCTIONING

Normal Saline Irrigation Of Artificial Airways Prior To Suctioning

Abstract

Intubated patients may be unable to adequately cough up secretions. Based on the work, endotracheal suctioning (ET suctioning) is an important activity in reducing the risk of consolidation and atelectasis that may lead to inadequate ventilation. ET suctioning is defined as: “A component of bronchial hygiene therapy and mechanical ventilation and involves the mechanical aspiration of pulmonary secretions from a patient with an artificial airway in place”. The procedure is associated with complications and risks including bleeding, infection, atelectasis, hypoxemia, cardiovascular instability, elevated intracranial pressure, and may also cause lesions in the tracheal mucosa. Suctioning is described as the mechanical aspiration of pulmonary secretions from a patient with an artificial airway in position. In a healthy patient, the action of ciliated cells in the airways, the local immune system, and the cough reflex are essential for the destruction and removal of micro-organisms as well as clearing debris from the lungs. However, in the critically or acutely ill patient, these functions may be severely compromised, resulting in an excessive production of secretions, which may prove difficult to expectorate. Endotracheal and tracheostomy tubes form artificial airways, which bypass the normal physiological processes and inhibit the cough reflex.

Table of Content

ABSTRACTII

INTRODUCTION1

LITERATURE REVIEW3

Haemodynamic parameters3

Intracranial parameters3

Oxygenation3

SpO23

PaO24

SvO25

Ventilation and respiratory mechanics5

Dyspnoea and discomfort5

Tube blockage and VAP6

Gas exchange6

Sputum yield7

Tube occlusion and incidence of VAP8

Prior to suctioning11

Assessment11

Patient preparation11

Hyperoxygenation12

Hyperinflation14

Instillation of normal saline16

Maintenance of asepsis19

METHODOLOGY21

Design21

Data analysis21

RESULTS23

Suctioning performed routinely or when necessary23

What is the recommendation on routine versus “prn suctioning”?24

Appropriate catheter size24

What is the recommendation on suction catheter size?26

Level of suction pressure26

What is the recommendation on suction pressure?27

Depth of catheter insertion27

What is the recommendation on catheter insertion depth?28

Duration of suctioning procedure28

What is the recommendation on the duration of the suction procedure?28

Intermittent suctioning technique29

What is the recommendation on intermittent versus continuous suctioning?29

Saline lavage prior to endotracheal suctioning29

What is the recommendation on saline lavage?30

Hyperoxygenation prior to endotracheal suctioning31

What is the recommendation on hyperoxygenation prior to suctioning?31

Hyperinflation (manual/mechanical) prior to endotracheal suctioning31

What is the recommendation on hyperinflation prior to suctioning?33

Hygiene guidelines for open endotracheal suctioning system33

What is the recommendation on infection control in relation to suctioning?34

Closed versus open suction systems34

What is the recommendation on closed versus open suction systems?37

DISCUSSION38

CONCLUSION41

ANNOTATED BIBLIOGRAPHY42

INTRODUCTION

This leaves the respiratory tract vulnerable to opportunistic infections, with an increased production of mucus and reduced secretion of pneumocytes and surfactant. An inability to expectorate this mucus, which is often thick and tenacious, is a common problem for the patient with a tracheostomy or endotracheal tube. Periodic suctioning is required in order to clear these secretions and prevent atelectasis or alveolar collapse. This paper reviews the literature relating to suctioning to identify current research recommendations for safer suctioning practice. Although there have been a number of publications relating to suctioning in recent years, few authors have examined what happens in actual practice. This paper identifies the potential pitfalls in practice and makes recommendations for future research into nurses' suctioning practices.

Endotracheal suctioning is described by patients as painful and uncomfortable, and may ...