Airway Clearance Techniques

Airway Clearance Techniques

• Suctioning - negative pressure applied within the airway– Can be via ET or Trach tube or– Through the nose into the trachea

• This is called NT or naso-tracheal suctioning

• Bronchoscopy– Flexible Fiberoptic bronchoscopy – Rigid tube bronchoscopy

Indications for Suctioning

• Patient has an inability to clear secretions– Ineffective or absent cough with– Evidence of retained secretions in upper airway

• A sample of sputum is to be obtained for lab analysis purposes– Use a sterile “sputum trap” (Lukens trap)

Lukens Trap for Obtained Sputum Sample

Contraindications to NT Suctioning

• Absolute contraindication: evidence of croup or epiglottitis

• Relative contraindications;– Occluded nasal passages– Nasal bleeding– bleeding disorder– Acute facial, head or neck injury

Hazards & Complications of NT Suctioning

• Hypoxia/Hypoxemia

• Trauma to nasal passages, pharynx or trachea

• Cardiac or respiratory arrest

• Cardiac dysrhythmias or bradycardia

• Atelectasis

• Bronchospasm

When do patients need suctioning?

• Listen over anterior chest with stethoscope– Evidence of loud rhonchi?

• Does patient have audible crackles when breathing with their mouth open?

• Place hand on anterior chest– Does patient have tactile fremitus?

• Have patient cough. What is the character of the cough? Loose but non-productive?

Monitoring During Suctioning

• Respiratory rate & pattern

• ECG tracing (if available), Heart rate

• Skin color; SpO2

• Subjective response

• Sputum character; color, consistency, amount and any odor

• Evidence of airway bleeding?

Equipment Used During Suctioning

• Suction Regulator attached to wall OR portable suction unit (see next slide)

• Suction canister to collect secretions

• Suction supply tubing

• Suction kit; sterile (sheathed or unsheathed) catheter, sterile gloves; basin for irrigation water; sterile water; Lubifax or KY Jelly (for NT suctioning)

Suction Regulator

Procedure for Suctioning

• Assess need

• Turn on & set suction pressure on regulator– Adults: negative 100 - 120 mmHg– Children: negative 80 - 100 mmHg– Infants: negative 60 - 80 mmHg

• Prepare patient: Communicate!!!!!!!!!!

• Make sure patient is well oxygenated

Suctioning Procedure Continued

• Open necessary sterile saline or water containers; open lubricating jelly containers

• Open kit and put glove(s) on

• Lubricate catheter (NT suction only)

• Insert catheter slowly

• Apply suction only while withdrawing using rotating motion (10-15 seconds only)

Suctioning Procedure Continued

• Make sure patient is reoxygenated after catheter has been removed

• Monitor patient and assess need for additional suctioning

• Repeat as necessary based upon need and ability for patient to tolerate procedure

Closed-System Multi-Use ET Catheter

Closed-System Multi-Use Trach. Catheter

Unsheathed Sterile Catheter

Sterile Suction Kit

Cath-n-sleeve Catheter

Sizes of Catheters

• When suctioning though an ET tube;– Take ET tube size (I.D.) and multiply by 2– 7.5 mm tube X 2 = 15– Next closest size is 14 French

• Mostly commonly used adult size is 14 F

• Largest current adult size is 14 French

• Other smaller sizes are 12F; 10F; 8F; 6F

Bronchoscopy

• Therapeutic bronchoscopy– To visualize and remove mucus from the

airway– Can be used to intubate in situations where

standard intubation techniques have failed

• Diagnostic bronchoscopy– To visualize tumors and obtain tissue samples

for pathology analysis

Parts of the Fiberoptic Bronchoscope

Picture from Therapeutic Bronch

Picture from Diagnostic Bronch

THE END!