Sputum Suction Device

Introduction

Sputum suction device is one of the commonly used emergency equipment in clinical practice. Therefore, sputum suction is used as an emergency treatment technology before and in hospital. It is a method to suck out respiratory secretions through the mouth, nose and artificial airway to keep the respiratory tract unobstructed and prevent complications such as aspiration pneumonia, atelectasis, and suffocation.

Indications for sputum suction

Sputum suction is suitable for critically ill, elderly, comatose and post-anesthetized patients who cannot clear respiratory secretions or aspirate vomitus due to weak cough, slow cough reflex or epiglottal insufficiency. When breathing difficulties occur, in emergency situations of suffocation, such as drowning, inhalation of amniotic fluid, etc., sputum suction should be used immediately.

Complications of sputum suction

Intratracheal suction can cause many complications, such as tracheal mucosal damage, pain, patient discomfort, infection, severe fluctuations in hemodynamics, atelectasis, increased intracranial pressure, and changes in intracranial blood perfusion, especially for critically ill patients, which may cause greater harm.

Steps and methods of using the suction device

1. Turn on the power, connect the portable suction device, and then turn on the suction device switch to check whether the suction device is in good performance and whether the suction tube is unobstructed.

2. Let the patient face the operator, with his head slightly tilted back. The comatose patient can use an opener to help open his mouth, and then insert the suction tube into the cheek and pharynx of the mouth.

3. If oral suction is difficult, you can insert the nasal cannula into the pharynx. When it is inserted into the appropriate position, turn on the power, rotate the suction tube left and right, slowly move it up, and raise it upward to suck out the pharyngeal and oral and nasal secretions section by section.

4. During the suction process, water should be sucked and flushed at any time to prevent sputum blockage. If the sputum is too deep and difficult to be sucked out, the mechanical stimulation of the suction tube can be used to make the patient cough effectively, and then suck after the cough stops. After suctioning, rinse the sputum tube, and finally insert the off-duty connector into the bottle of disinfectant on the bed rail.

5. When suctioning sputum in patients with endotracheal intubation and tracheotomy, nurses should wash their hands and preferably wear sterile gloves. When delivering the tube, negative pressure should be interrupted. When it reaches a certain depth, negative pressure suction should be performed again, and the suction tube should be rotated left and right, sucking and lifting at the same time.

6. After hearing the sound of sputum, stop for a few seconds to suck out the sputum in that place. Before and after suctioning sputum, the oxygen flow rate or the oxygen concentration of the ventilator should be increased for 1-2 minutes to increase the patient's blood oxygen concentration and prevent hypoxia.

7. When the sputum is viscous, 29% sodium bicarbonate or saline with 5ml of chymotrypsin can be repeatedly used, and injected into the airway for airway flushing when the patient inhales to stimulate the patient to cough and dilute the sputum. After the drug is injected for 1-2 minutes, suction is performed again.

8. The suction tube should stay in the airway for no more than 10-15 seconds, and the oxygen supply should be stopped for no more than 20 seconds.

9. For patients with spontaneous breathing, the second suction should be performed after 5 deep breaths and when vital signs return to the original level.

Precautions for using the suction device

1. Suction only when necessary

Suction only when the patient coughs, has difficulty breathing, hears wet hiccups on auscultation, the ventilator reports an increase in pressure, and Pa02 and Sp02 suddenly decrease. Routine suction without considering the condition of the patient not only easily damages the respiratory mucosa, but also increases secretions due to respiratory tract irritation.

2. High concentrations of oxygen must be given before and after suction

It is recommended to routinely use 100% oxygen inhalation 30s before and after endotracheal suction. If the oxygen concentration is not increased before and after suction, the patient may develop hypoxemia.

3. Correctly judge whether pressurized oxygen is needed

Before and after suction, in addition to high concentrations of oxygen, most patients need pressurized oxygen. It is particularly important to evaluate the patient's response to high-concentration oxygen. If the patient's heart rate and Sp02 are stable, high-concentration oxygen can be given. Otherwise, pressurized oxygen is required.

4. It is not advisable to inject 0.9% sodium chloride injection during suction

Many people believe that dripping 0.9% sodium chloride injection into the trachea during suction can dilute the secretions and facilitate suction. However, studies have found that 0.9% sodium chloride injection and respiratory secretions cannot be fully mixed. On the contrary, this operation will affect oxygenation and increase the risk of respiratory infection.

5. Choose a suction tube with appropriate thickness

Usually, a suction tube with an outer diameter less than 1/2 of the inner diameter of the endotracheal tube can be selected to facilitate air entry into the lungs and prevent atelectasis caused by excessive negative pressure.

6. Pay attention to the size of negative pressure during suction

Put the suction tube in sterile saline before each suction to test whether the suction tube is unobstructed and whether the suction force is appropriate. The suction negative pressure should not be too large. Generally, it is 100mmHg (13.3kPa) for children and 150mmHg (20kPa) for adults. The action should be gentle, and it is not advisable to suction at the same site for too long. The suction should be done while the tube is withdrawn to avoid damaging the tracheal mucosa. Each suction time should not exceed 15 seconds to avoid causing tracheal spasm and aggravating hypoxia. Intratracheal suction can be performed when necessary, but the longest should not exceed 8 hours.

7. Strictly implement aseptic operation

Wash hands before and after the operation, wear masks, hats, and gloves. Before and after the operation, use ethanol to disinfect the tracheal tube port and the outer end of the tube 1~ 2cm; after the operation, use ethanol to disinfect the tube joint and the joint between the ventilator tube and the tube.

8. Closely observe changes in the condition

When suctioning sputum, closely observe changes in the patient's heart rate, heart rhythm, Pao2 and Spo2. If the patient is found to have arrhythmia such as tachycardia or premature contraction, low blood pressure, or confusion, suction should be stopped immediately and 100% oxygen should be given.

9. Suction depth

The depth of suction catheter entry is the depth of endotracheal intubation. When it reaches the bottom of the endotracheal tube, withdraw 1-2cm before suction.

10. Correct suction order

First oral cavity, then nasal cavity.