Fundamentals of Nursing Q 411
Nurse Aldrin is preparing to perform endotracheal suctioning for a client. Which of the following are appropriate guidelines for the nurse to follow? Select all that apply.
A. Apply suction while withdrawing the catheter.
B. Perform suctioning on a routine basis, every 2 to 3 hours.
C. Maintain medical asepsis during suctioning.
D. Use a new catheter for each suctioning attempt.
E. Limit suctioning to 2 to 3 attempts.
Correct Answer: A, D, & E
Within intensive care units (ICUs), one such common procedure is the suctioning of respiratory secretions in patients who have been intubated or who have undergone tracheostomy. The traditional goal of suctioning is to aid in maintaining airway patency and prevent complications related to the retention of secretions
Option A: The nurse should apply suction pressure only while withdrawing the catheter, not while inserting it. One interesting thing to note about ETS is that negative pressure is created inside of the lungs only while air flows out of the suction catheter. As soon as secretions are aspirated into the catheter, the intrapulmonary pressure returns to that of the atmospheric level, and lung volume loss stops.
Option B: The nurse should not suction routinely because suctioning is not without risk. It can cause mucosal damage, bleeding, and bronchospasm. Although there has been a very limited number of studies regarding a scheduled frequency of performing ETS every 1, 3, 4, 6, 8, or even 12 hours, the overall recommendation is to suction only as indicated (as needed).
Option C: Endotracheal suctioning requires surgical asepsis. The second method of suctioning is the shallow (premeasured) technique, which is also considered minimally invasive.1-3 With shallow ETS, the catheter is inserted only to the tip of the ETT, thereby avoiding injury to the airway.
Option D: The nurse should not reuse the suction catheter unless an in-line suctioning system is in place. If a suction catheter is too large for the ETT, and/or there is too much vacuum pressure, massive atelectasis may occur. Therefore, the general recommendation is to use a suction catheter that has an external diameter less than 50% of the size of the ETT inner diameter.
Option E: To prevent hypoxemia, the nurse should limit each section in session to 2 to 3 attempts and allow at least one minute between passes for ventilation and oxygenation. The reason for this is because there is considerable risk with using “routine” suctioning. It has been suggested by Pedersen et al3 that ETS should be performed at least every 8 hours to slow the formation of the secretion biofilm within the lumen of the endotracheal tube (ETT). Clifton-Koeppel1 made a good general recommendation that ETS should be performed as infrequently as possible—yet as much as needed.