Basics of Suctioning: Cardiopulmonary Physiotherapy (Lec.7) DR - Mustafa Abdulrahman

Basics of Suctioning
When patients are unable to mobilize their secretions, you may need to suction any
secretions from the oropharynx and/or trachea to maintain a patent
airway. Patients may be unable to clear their own airway due to a number of
different problems, including neuromuscular disease, sedation or neurological
deficits, such as a CVA. In addition, patients with an artificial airway, such as
those who have been intubated, usually require suctioning while they are on a
ventilator.
Suctioning may be done through an endotracheal tube, tracheostomy tube or
through the nose or mouth into the trachea. Although each procedure is slightly
different, indications, supplies, procedures and risks are similar.
1|Cardiopulmonary physiotherapy (Lec.7) Dr.Mustafa Abdulrahman

INDICATIONS FOR SUCTIONING
Clinical indications for suctioning include respiratory distress due to increased

retained secretions. Signs of respiratory distress may include increased respiratory
rate, tachycardia, gasping and difficulty talking.
In the intubated patient decreased SPO2 is an indication that suctioning may be
required.
Patients with artificial airways may routinely require suctioning.
Patients who are not intubated and have coarse breath sounds should be
encouraged to cough before suctioning is performed.
In some instances, mucus plugs or increased sputum production may cause a
decrease in oxygen levels. If this occurs, suctioning will be required.
In addition, there may be times when we need a sputum sample and the patient is
unable to cough effectively enough to provide a sample.
SUPPLIES
There are closed suction catheters and open suction catheter systems. If you are
suctioning an endotracheal tube or a patient with a tracheostomy, you can use
either a closed suctioning system or a regular suction catheter. During open
endotracheal suctioning, the patient is temporarily removed from the ventilator to
breathe freely, or manually ventilated, while endotracheal suctioning is performed.
Conversely, with closed system suctioning, the patient remains attached to the
ventilator, or their supplemental breathing device.
Be sure to choose the correct size catheter. For performing nasal-tracheal
suctioning, a 12 or 14 catheter size is appropriate for most adults (lubricant).
Also saline, gloves, an ambu bag, a suction canister and connective tubing should
be available.
For adults, the suction vacuum should be set at 80 to 120 mmHG. For pediatric
patients, suction vacuums should be between 60 and 80mmHG. Setting levels too
high should be avoided and can lead to tissue damage.
It is important that the lowest effective suction pressure is used, especially when
secretions are loose. If secretions are not clearing with the above pressures, higher
pressures can be used with caution up to a maximum of 150mmHg.

PROCEDURE
✓ Explain the procedure to the patient and collect supplies.

✓ Use personal protective equipment including an eye shield.
✓ Be sure to use sterile technique in order to reduce the risk of infection.
✓ For suctioning an endotracheal tube, hyperoxygenate your patient by giving him a
few breaths with 100 percent oxygen.
✓ For suctioning through the nose, apply lubricate to the end of the catheter for easier
insertion.
✓ Once the catheter has been inserted to the appropriate depth, apply intermittent
suction and slowly withdraw the catheter, using a twirling motion as you withdraw.
If you will be suctioning more than once, allow the patient time to recover between
suctioning attempts.
✓ Suctioning attempts should be limited to 10 seconds. Applying the suction longer
can cause injury, hypoxia and bradycardia.
✓ During suction, monitor oxygen levels and heart rate to make sure the patient is
tolerating the procedure well.
✓ Don’t apply suction while inserting the catheter. This can increase the chances of
injuring the mucus membranes.
✓ During suctioning through the nose, do not force the catheter. Don’t be aggressive
when inserting the tube through the nose. In some instances, due to a person’s
anatomy, it may be difficult to move the catheter through their nose into the
trachea. Try different angles and reposition the patient’s head. In some instances,
attempting to insert a catheter through the other nostril may work. Research has
shown that the right nostril is the larger in the majority of adults.

Nebulization Therapy
In medicine, a nebuliser or nebulizer is a drug delivery device used to
administer medication in the form of a mist inhaled into the lungs.
Nebulizer therapy is an effective and efficient way to deliver medications directly
into the lungs by inhalation.
Function:
A nebulizer is a device that uses a small compressor to convert liquid medication
into tiny droplets of mist that can be inhaled directly into the lungs.
Since the medication goes straight to the lungs, onset of the medication’s action
often takes place rapidly. This promotes quick symptom relief in the case of
illnesses such as Asthma. Also, it minimizes the risk of side effects of the
medication.
Using a Nebulizer
A nebulizer comes with a small compressor that sits on a table or desk and plugs
into a wall socket.
It typically comes with a tubing kit, which contains a mouthpiece or mask, a cup
that screws on to the mouthpiece or mask, and a long piece of tubing that connects
to the compressor.
Using a nebulizer generally requires placing the medication into the nebulizer's
cup, connecting the tubing, turning the compressor on, and breathing the medicated
mist.
PURPOSE
A. To add moisture to oxygen delivery system.
B. To hydrate thick sputum and prevent mucus plugging.
C. To administer various drugs to the airways.

Ultrasonic nebulizer
An ultrasonic nebulizer is a small, portable device that uses ultrasonic sound waves
to break liquid particles down into a fog so that they can be inhaled easily.
An ultrasonic nebulizer does not use compressed air like a traditional nebulizer
machine. Instead, an ultrasonic nebulizer uses high frequency vibrations (waves) to
aerosolize the medication into a very fine mist. Since ultrasonic nebulizers don’t
compress air, they operate very quietly. A limitation of ultrasonic nebulizers is that
they do not nebulize suspensions efficiently.
What's an Inhaler?
Inhalers are little devices that can fit in hand and are small enough to carry in a
backpack, purse, or pocket. There are two types of inhalers:
Metered dose inhalers (MDI); are the most commonly used. Like little aerosol
cans, these inhalers push out a spray of medicine.
Dry powder inhalers; deliver medicine in powder form, but it does not spray out.
The person must do more of the work by inhaling the powdered medicine quickly
and deeply.

Oxygen Therapy
People with chronic lung disease may need oxygen therapy. Oxygen therapy is used to normalize
the oxygen level in blood during sleep, rest and activity and during acute illnesses in the hospital.
Oxygen is a colorless, odorless, tasteless gas that is essential for the body to function properly
and to survive. Oxygen therapy is the administration of oxygen at a concentration of pressure
greater than that found in the environmental atmosphere. The air that we breathe contains
approximately 21% oxygen. Oxygen therapy is a key treatment in respiratory care.
What are the benefits of oxygen therapy?

There are many benefits of oxygen therapy. In many adults with chronic lung disease, studies
have shown that long-term oxygen therapy has improved quality and length of life. Oxygen can
decrease shortness of breath when you are active and allow you to do more.
Indications:
• Acute respiratory failure. • Acute myocardial infarction.
• Cardiac failure. • Shock.
• During CPR. • During anaesthesia for surgery.
Oxygen – a prescribed drug:

• Must be written by the doctor.
• Prescription should be dated.
• Doctor must indicate duration of O2 therapy.
• The O2 % concentration must be prescribed.
• The flow rate must be prescribed.
There are also some side effects of oxygen therapy:
➢ The skin around the facemask or nasal cannula can get irritated.
➢ The inside of nose might become dry or nosebleeds.
➢ In the morning, the patient may wake up tired or with a headache.
➢ Oxygen has vasoconstrictive effects on the circulatory system.
➢ High levels of oxygen given to infants causes blindness by promoting overgrowth of new blood
vessels in the eye.
➢ Excessively high concentrations can cause oxygen toxicity such as lung damage or result in
respiratory failure in those who are predisposed.

Sources and regulators of oxygen;
1. Compressed gas storage – The oxygen gas is compressed in a gas cylinder.
2. Liquid storage – Liquid oxygen is stored in tanks until required, and then
allowed to release oxygen as a gas.
3. Oxygen concentrator;
There are both stationary and portable devices that can convert regular air into concentrated
oxygen. Oxygen concentrators are machines that draw in oxygen with the use of a battery or
electricity. Portable are smaller and lighter than stationary concentrators.

Oxygen Delivery Systems:
1. Nasal Cannula.
2. Simple Mask
3. Partial Re-Breather Mask
4. Non-Re Breather Mask (NRBM).
10 | C a r d i o p u l m o n a r y p h y s i o t h e r a p y (Lec.7) Dr.Mustafa Abdulrahman

5. Venturi Mask.
6. Oxygen Hood.
7. Oxygen Tent
8. Tracheostomy Collar / mask.
9. T-piece
11 | C a r d i o p u l m o n a r y p h y s i o t h e r a p y (Lec.7) Dr.Mustafa Abdulrahman

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Basics of Suctioning

1|Cardiopulmonary physiotherapy (Lec.7) Dr.Mustafa Abdulrahman

Clinical indications for suctioning include respiratory distress due to increased

4|Cardiopulmonary physiotherapy (Lec.7) Dr.Mustafa Abdulrahman

✓ Explain the procedure to the patient and collect supplies.

5|Cardiopulmonary physiotherapy (Lec.7) Dr.Mustafa Abdulrahman

6|Cardiopulmonary physiotherapy (Lec.7) Dr.Mustafa Abdulrahman

7|Cardiopulmonary physiotherapy (Lec.7) Dr.Mustafa Abdulrahman

What are the benefits of oxygen therapy?

Oxygen – a prescribed drug:

There are also some side effects of oxygen therapy:

8|Cardiopulmonary physiotherapy (Lec.7) Dr.Mustafa Abdulrahman

9|Cardiopulmonary physiotherapy (Lec.7) Dr.Mustafa Abdulrahman

3. Partial Re-Breather Mask

4. Non-Re Breather Mask (NRBM).

10 | C a r d i o p u l m o n a r y p h y s i o t h e r a p y (Lec.7) Dr.Mustafa Abdulrahman

8. Tracheostomy Collar / mask.

11 | C a r d i o p u l m o n a r y p h y s i o t h e r a p y (Lec.7) Dr.Mustafa Abdulrahman

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