Frequency of Suctioning (Care of the Child with a Chronic Tracheostomy)

  • 2013.09.23 Monday
  • 11:00

American Thoracic Society¤Î³Ø½Ñ»ï¤Ç¤¢¤ë¡ÖAmerican Journal of Respiratory and Critical Care Medicine¡×¤Ë2000ǯ¤Ë·ÇºÜ¤µ¤ì¤¿¤â¤Î¤Î°ìÉôÈ´¿è¤Ç¤¹

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Frequency of Suctioning
Background.

Routine suctioning is performed according to a set schedule, for example, every 2 h.

¡ÈSuctioning as needed,¡Éor p.r.n., is based on assessment of the patient.

Suctioning as needed is most frequently recommended.

The frequency of suctioning will vary on the basis of individual characteristics including age, muscular and neurological status, activity level, ability to generate an effective cough, viscosity and quantity of mucus, and maturity of the stoma.

In addition to removing secretions, suctioning allows the caregiver to assess tube patency.

This is important because tubes can become obstructed without clinical symptoms.

Consensus

a.Suctioning should be done on the basis of clinical assessment.

b.In children with no evidence of secretions, a minimum of suctioning, at morning and bedtime, to check for patency of the tube is recommended.

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Suctioning Depth(Care of the Child with a Chronic Tracheostomy)

  • 2013.09.23 Monday
  • 10:00

American Thoracic Society¤Î³Ø½Ñ»ï¤Ç¤¢¤ë¡ÖAmerican Journal of Respiratory and Critical Care Medicine¡×¤Ë2000ǯ¤Ë·ÇºÜ¤µ¤ì¤¿¤â¤Î¤Î°ìÉôÈ´¿è¤Ç¤¹

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Suctioning Depth
Background. 

¡ÈShallow suctioning¡É describes the insertion of a catheter just into the hub of the tracheostomy tube to remove secretions the child has coughed to the opening of the tracheostomy tube. 

The ¡Èpremeasured technique¡É involves the use of a catheter with side holes close to the distal end (0.5 cm or less) of the catheter tube; the catheter is inserted to a premeasured depth, with the most distal side holes just exiting the tip of the tracheostomy tube. 

¡ÈDeep suctioning¡É describes the insertion of the catheter until resistance is met, withdrawing the
catheter slightly before suction is applied.

Animal model studies clearly demonstrate denuded epithelium and inflammation where deep suctioning is routinely performed. 

Abandoning the routine use of deep suctioning has been advocated in the literature for more than a decade, yet practice patterns continue to describe the frequent or exclusive use of deep suctioning by the majority of nurses. 

Injury to the airway can be minimized by using the premeasured technique.

Exact depth of insertion in the premeasured technique is critical to avoid epithelial damage (if inserted too deeply) or inadequate suctioning of the tip of the tracheostomy tube (if not inserted deeply enough). 

A tracheostomy tube, the same size as the one in the child, may be used to measure the exact depth to which the catheter should be inserted. 

The use of premarked catheters is also helpful in assuring accurate insertion depth. 

In children with standard fenestrated tracheostomy tubes, suction catheters may accidentally go through the fenestration. 

If this happens repeatedly, granulation tissue may develop at this site.

Consensus

a.The premeasured technique is recommended for all routine suctioning.

b.The technique should also include twirling or rotating the catheter between the fingers and thumb, not stirring the catheter with the entire hand. 

Twirling the catheter reduces friction, so that the catheter is more easily inserted, and moves the side holes of the catheter in a helix, thereby suctioning secretions off all areas of the tracheostomy tube wall.

c.The use of premarked catheters is strongly recommended to ensure insertion to the proper depth.

d.Special circumstances may necessitate the occasional use of deep suctioning, but this increases the risk of epithelial damage.

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SUCTIONING(Care of the Child with a Chronic Tracheostomy)

  • 2013.09.23 Monday
  • 09:00

American Thoracic Society¤Î³Ø½Ñ»ï¤Ç¤¢¤ë¡ÖAmerican Journal of Respiratory and Critical Care Medicine¡×¤Ë2000ǯ¤Ë·ÇºÜ¤µ¤ì¤¿¤â¤Î¤Î°ìÉôÈ´¿è¤Ç¤¹¡£

¡ÖCare of the Child with a Chronic Tracheostomy¡×¤Ç¸¡º÷¤¹¤ë¤ÈÁ´Ê¸¤¬¥À¥¦¥ó¥í¡¼¥É²Äǽ¤Ç¤¹¡£

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SUCTIONING

Maintaining and ensuring a patent airway by suctioning is a vital component of management for a child with a tracheostomy.

Techniques of suctioning are designed to efficiently clear the airway of mucus while avoiding the potential hazards of suctioning.

The techniques described in nursing and respiratory care literature typically give recommendations for suctioning that assume the patient is critically ill and has an artificial airway .

Those recommendations are not specific to a child with a chronic tracheostomy.

Therefore, issues related to the suctioning procedure were reviewed and considered for appropriateness specific to a child with a tracheostomy.

These recommendations would include care for a child at home, school, and in other community settings as well as hospitalbased care.

The consensus recommendations that follow are made to provide the most effective and least traumatic suctioning to a child with a tracheostomy. 

They are distinctly different in some areas from traditional suctioning methods and should be considered in their entirety, since the recommendations are interrelated. 

These recommendations are not to be applied when suctioning a child with an orotracheal or nasotracheal tube.

Clean versus Sterile Technique

Background. 

¡ÈSterile technique¡É is defined as the use of a sterile catheter and sterile gloves for each suctioning procedure. 

¡ÈClean technique¡É is defined as the use of a clean catheter and nonsterile, disposable gloves or freshly washed, clean hands for the procedure. 

Care is taken not to allow the portion of the catheter that will be inserted in the tracheostomy tube to contact any unclean surface. 

Sterile technique has been the typical method of suctioning in the hospital setting, although this practice is changing toward a ¡Èmodified clean technique¡É (nonsterile gloves and sterile catheters). 

Clean technique is the usual method for suctioning in the home setting.

A typical cleaning procedure for suction catheters might include four steps: 

(1) washing and flushing the used catheters with hot, soapy water, 

(2) disinfecting the catheters by soaking them in a vinegar-and-water solution or a commercial disinfectant, 

(3) rinsing the catheters inside and out with clean water, and 

(4) air drying. 

Minimal research is available in this area. 

Secretions go through the interior of the catheter in one direction only; therefore, the cleanliness of the outside of the catheter is more important than the cleanliness of the internal surface of the catheter. 

However, dried secretions on the internal surface of the catheter will interfere with the ability ofthe catheter to suction optimally.

One study describing a home cleaning technique similar to the above demonstrated that 98% of the catheters had sterile exteriors and 91% had sterile interiors after cleaning.

These catheters were then stored for 20 d and recultured and showed no new bacterial growth. 

The catheters tolerated repeated cleaning cycles without any change in integrity or appearance, except for a mild cloudiness of the plastic.

 Consensus

a.Clean technique is recommended for home care. 

All caregivers should thoroughly wash their hands before and after each suctioning procedure. 

Alcohol or disinfectant foam is an acceptable substitute when soap and water are unavailable for handwashing. 

Nonsterile, disposable gloves should be worn for the protection of any caregiver that is not a family member or by anyone who is concerned about infection.

b.After suctioning is complete, the catheter is flushed with tap water until secretions are cleared from the lumen; the outside of the catheter is then wiped with alcohol and allowed to air dry. 

A hydrogen peroxide flush is useful when particularly adherent secretions are present.

The catheter is then stored in a clean, dry area.

c.Individual catheters can be used as long as the catheter remains intact and allows inspection of removed secretions.

d.There are a number of methods available for more thorough cleaning including commercial products (Control III; Maril Products, Tustin, CA), alcohol, and a vinegarand-water soak. 

There are no data to suggest the frequency of ¡Èmore thorough¡É cleaning or that one method is better than another. 

Methods that do not unnecessarily burden an already busy family should be considered.

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Suctioning(Care of the Chronic Tracheostomy)

  • 2013.09.23 Monday
  • 08:00

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Suctioning

Patients with a chronic tracheostomy generally have increased secretions and require frequent suctioning. 

Removal of secretions is important for maintaining tube patency; however, suctioning can be uncomfortable for the patient. 

For home care, use of a clean catheter and nonsterile disposable gloves, or freshly washed, clean hands is recommended.

Suctioning should be performed as needed, and a fixed schedule is not necessary.

The catheter tip should be inserted just beyond the tip of the tracheostomy tube, suction is applied, and the catheter is rotated as it is pulled back. 

Deep suctioning should not be performed routinely, because it has the potential to cause airway injury.

The patient should receive some highvolume breaths with the ventilator and be well oxygenated before suctioning is performed. 

Closed suction systems are not only as effective as conventional suction catheters, they have the advantages of maintaining oxygenation during suctioning and a lesser chance of becoming contaminated from the environment.

Saline is instilled into the airway during suctioning to loosen secretions, stimulate cough, and to lubricate the catheter. 

However, the routine use of saline for suctioning is not recommended. 

Instillation of saline could lead to a decrease in oxygen saturation and has the potential to dislodge microorganisms from the tube into the lower respiratory tract.

Saline instillation should therefore be used selectively to remove thick and tenacious secretions that are not removed by routine suctioning.

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  • 2013.05.02 Thursday
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  • 2013.04.26 Friday
  • 08:00
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  • 2013.04.25 Thursday
  • 08:00
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