Open tip suction catheter Assessing the need for suctioning

➔ Oropharyngeal and nasopharyngeal

suctioning removes secretions from the
upper respiratory tract.
➔ Endotracheal suctioning is used to
Suctioning remove secretions from the trachea and
➔ Aspiration of secretions catheter connected bronchi
to a suction machine suction outlet. ➔ The nurse should auscultate the lung fields
and note any adventitious sounds
Rationale for suctioning include: Whistle tip suction catheter (crackles, rhonchi, rales, wheezing), NOT
➔ To remove secretions that obstruct the “coarse” breath sounds.
airway ➔ Also, the upper airway needs to be
➔ To facilitate ventilation (either via adequately assessed for any
nasopharynx, oropharynx, obstruction by secretions.
tracheostomy or endotracheal tube)
➔ To obtain secretions for diagnostic purposes
➔ To prevent infection that may result
Other clinical signs indicating the need for suctioning
from accumulated secretions.
may include:
● Although the upper airways (oropharynx ★ Restlessness
➔ Measure the depth for insertion (tip of nose
and nasopharynx) are not sterile, sterile ★ Gurgling sounds, during respiration
to earlobe) which usually measures ★ Skin color (pallor, cyanosis)
technique is recommended for all approximately 5’ or 13 cm. ★ Rate and pattern of respirations (retraction,
suctioning to avoid introducing pathogens ➔ Rotate the catheter when suctioning use of accessory muscles, flaring,
into the airways. (not when inserting the catheter) grunting, etc)
● Suction catheters may be either open ➔ Encourage deep breathing and coughing ★ Pulse rate and rhythm
tipped or whistle tipped. The ➔ Always use the least amount of pressure ★ Decreased SaO2 levels (O2 saturation)
whistle-tipped catheter may be more necessary when suctioning (use ★ Change in mental status
effective for removing thick mucous plugs. appropriate suction settings)
Most suction catheters have a thumb port ➔ Too frequent suctioning may cause irritation
on the side to control the suction. of mucous membranes and increase
secretions.
➔ A suction attempt should last =<10
seconds.
➔ There should be 20-30 second
intervals between each suction
(non-respiratory or O2 dependent)
 ➔ Limit suctioning to 5 minutes in total Oropharyngeal/ Nasopharyngeal suctioning ➔ Unless contraindicated, hyperventilate the
➔ Applying suction for too long may cause ➔ Perform vital signs pre-suctioning lungs prior to suctioning
increased secretions &/or decrease the (baseline) and post-suctioning ➔ Oxygen should be set to 12-15 L/min (FiO2
client's oxygen demand. 100%)
➔ Suctioning should last no longer than
Positioning:
Complication of suctioning 10 seconds in order to minimize
➢ Conscious client (+gag reflex)
★ Hypoxemia oxygen loss
★ Trauma to the airway ● Oropharyngeal suctioning: in
➔ Hyperventilate between suctioning attempts
★ Nosocomial infection semi-fowler's position with head turned to
and allow 2-3 minutes between
★ Cardiac dysrhythmia (related to one side
suctioning.
the hypoxemia ● Nasopharyngeal suctioning: with the
➔ Monitor O2 saturations of pt which should
neck hyper-extended (nasopharyngeal
be maintained between 95-100%
suctioning). This will facilitate insertion of
Preventing complication with ➔ Clients with ET or trach tubes should
the catheter and help prevent aspiration.
receive mouth care Q3-4 hours.
oral/nasopharyngeal suctioning ➢ Unconscious client should be placed in a
lateral positioning, facing you (risk for
Pressure on the suction gauge (used in LaGCC Sources of oxygenation
vomiting)
lab): ➢ Ambu (bag-valve-mask): 100%
➢ Respirator (different FiO2 settings)
**Note: different institutions may use different
Suctioning Endotracheal or Tracheostomy tubes ➢ CPAP/BiPAP
settings ➢ Face masks:
● Simple face mask (varies in % of O2
Positioning:
Wall unit: delivery)
● Semi-Fowler’s position to promote deep
★ ADULT 100-120 mmHg ● Partial face-tent (varies in % of O2
★ CHILD 95-110 mmHg breathing, maximum lung expansion, and
delivery
★ INFANT 50-95 mmHg productive coughing.
● Non-rebreather (close to 100% oxygen
(*same for ET/Tracheostomy ● Deep breathing oxygenates the lungs,
delivery)
suctioning) counteracts the hypoxic effects of
➢ Oxyhood
suctioning and may induce coughing which
➢ Oxygen tent
Portable Unit: helps to loosen and move secretions ➢ Nasal Cannula (delivery of O2 in liters)
★ ADULT 10-15 inchesHg ➔ Assess for need of analgesia
★ CHILD 5-10 inchesHg ➔ Oxygen flow via bag-valve-mask
★ INFANT 2-5 inchesHg (Ambu) should be set at 100%
➔ Sterile technique
➔ “Lubricate” with sterile NS (to be used
for suctioning)
 ● Persons with increased pulses
● Unconscious patients (inhalation may be Side effects
done via mask but the therapeutic effect ➔ Dry or irritated throat, temporary or
➔ Process of medication administration via may be significantly low) occasional cough
inhalation. It utilizes a nebulizer that ➔ Sneezing, stuffy or itchy nose, watery eyes
transports mediation to the lungs by Equipment ➔ Burning or bleeding of your nose
means of mist inhalation. ➢ Nebulizer and nebulizer connecting tube ➔ Nausea, heartburn, stomach pain
➔ Process of dispersing a liquid medication ➢ Mouthpiece/mask ➔ Urinating more or less than usual
➢ Respiratory medication to be administered ➔ Dizziness, drowsiness, headache
into microscopic particles and delivering ➔ Unusual or unpleasant taste in your mouth
➢ Normal saline solution
into the lungs as the patient inhales
➢ Sterile water
through the nebulizer ➢ Cotton balls
➢ Face mask
Indication ➢ Sputum mug with disinfectant
Indicate for various respiratory problems and ➢ Disposable tissues
➢ Kidney tray
diseases such as:
➢ Medication card
● To relieve respiratory insufficiency to
bronchospasm
Complications
● Chest tightness
Possible effects and reactions after
● Excessive and thick mucus secretions
nebulization therapy are as follows:
● Respiratory congestion
● Palpitations
● Pneumonia- Infection of the lungs
● Tremors
● Atelectasis- A complete or partial
● Tachycardia
collapse
● Headache
● When a person has an acute asthmatic
● Nausea
attack
● Bronchospasms (too much ventilation may
● A person is unable to use an inhaler.
result or exacerbate bronchospasm)
Contraindications
In some cases, nebulization is restricted or
avoided due to possible outward results or
rather decreased effectiveness such as:
● Patients with unstable and increased
blood pressure
● Individuals with cardiac irritability (may
result in dysrhythmias)
 ➔ In the postprandial phase, insulin Gestational diabetes
facilitates the transportation of glucose from
the bloodstream into cells. ➔ Is high blood sugar that develops during
➔ The human body attempts to maintain pregnancy and usually disappears after
➔ CBG monitoring, previously referred to as homeostasis in BGL (4-6 mmol or about giving birth.
SELF MONITORING OF BLOOD 72-108 mg/dL) This is influenced by the ➔ It can happen at any stage of pregnancy
GLUCOSE or SMBG functional capacity of the beta-cells of the but it is more common in the 2nd or 3rd
➔ One way for people living with diabetes to pancreas, cellular (skeletal muscles, liver, trimester
measure and assess their glucose levels and adipose tissue) sensitivity to insulin
➔ Observes patterns in the fluctuation of
blood glucose levels that occur in response WHAT IS A NORMAL CBG?
to diet, exercise, medications and or Diagnostic tests ➔ Between 70 and 99 mg/dL or 3.9 - 5.5
pathological processes associated with Capillary Blood Glucose Test mmol/L
blood glucose fluctuations such as ➔ When fasting, blood glucose is b/w 100 -
diabetes. ➔ a blood drop sample is usually collected 125 mg/dL (5.6 to 6.9 mmol/L) changes in
➔ Unusually high or low blood glucose levels from a fingertip lifestyle and monitoring glycemia are
can potentially lead to acute and or chronic, Venuos (plasma) Blood Sample recommended
life threatening conditions ➔ venous blood is collected via venipuncture, ➔ BG is measured in mmol/L (millimoles per
➔ BGL monitoring undertaken in the home or and the sample processed in a liter) or mg/dL (milligrams per deciliter)
community are often referred to as capillary commercial-grade laboratory with
blood glucose tests, while blood glucose appropriate sophisticated quality control
tests carried out at clinical facilities may checks
include CBG and plasma glucose venous
blood tests Continuous Glucose Monitoring (CGM)
➔ flash flood glucose monitoring (continuous
interstitial fluid glucose monitoring) This test
Pathophysiology involves applying a water-resistant
➔ Most food products contain complex carbs disposable sensor on the back of the upper
which are broken down to supply energy to arm or abdomen
cells in our body. Food containing carbs
once ingested is broken down in the GI
system into simpler sugars such as
glucose. In the small intestine, glucose
molecules are absorbed into the
bloodstream and transported to cells across
the body and to the liver
➔ Insulin is produced by beta cells in the
pancreas in response to elevated blood
glucose levels.
Testing procedures ➔ Implementation of a systematic process
aimed at managing altered BGL (as in
➔ Recommended site: side of distal ends of diabetes) requires input and active
fingertips to minimize injury to the bone collaboration with the client as a consumer,
➔ Avoid little finger as the tissue may not be endocrinologist, diabetes nurse educator,
deep enough to prevent injury to the bone pharmacists, clinical nurse specialists,
➔ Avoid index finger and thumb as these dieticians, and data analysts.
are highly sensitive areas compared to
other fingers
➔ Avoid the arm if an IV infusion is
underway or is the side of the body where
a recent mastectomy (removal of all breast
tissue), was performed.
➔ Heel stick stab, if done can be more painful
and may require resampling.
➔ Consider pain mgt in the neonate.
★ Preferred site: on the heel is the
lateral or medial plantar surface for
babies up to 1 year of age Enhancing Healthcare Team Outcomes
➔ Managing diabetes to improve pt outcomes
Clinical significance requires a complex multidisciplinary
approach. BGM is a critical measurement of
➔ This is an essential part of case mgt in ongoing diabetes mgt
clients with diabetes. ➔ However, these blood test results should be
➔ Having very high or very low levels of BG viewed considering the complex
could impair cellular function and may be socioeconomic disease process impact
lethal if not managed appropriately. diabetes has, including on the various body
➔ Stress-related hyperglycemia may also be systems but not limited to metabolic
seen in clients who have experienced an syndrome, micro and microangiopathies (a
acute medical and surgical event disease of the capillaries, in wc the capillary
walls become so thick and weak that they
bleed, leak protein and slow the flow of
blood), adverse effects of hypoglycemia
and hyperglycemia