Thursday, 8 December 2011

Tracheo-bronchial suction


Suction is used to 'suck up' the 'gunk' (secretions) sitting on your bronchial tree for patients that can't clear their own airway for themselves.

You can suction via...
  • Trachy (tracheostomy)
  • Endotracheal tube
  • Oral airway
  • Nasal airway (e.g. Nasopharangeal)

Indications (when to think about using it!)
  •  Reduced cough effort or inability to cough to clear airway
Contradications (when to NOT use it!)
  •  Frank haemoptysis (expectoration of blood only)
  • Severe bronchospasm
  • Undrained pneumothorax
  • Compromised CVS
  • Raised ICP
  • Fractured skull/facial bones
Hazards of Suctioning
  • Mucosal trauma
Suction is an invasive procedure and causes irritation to the delicate lining of the airways (tracheal/bronchial epithelium). This adverse effect is minimised by using an appropriate size catheter (simple calucation to figure this out: double size of trachy and minus 2 e.g. size 8 trachy = 16 - 2 = size 14 catheter). Also make sure to use correct pressures e.g. around 25.

  • Hypoxia
If ventilation is interupted (e.g. too big a tube, suctioning for too long etc) a reflex bronchospasm may occur. Pre and post Rx O2 can help reduce any hypoxia.

  • Cardiac arrthymias/bradycardia
Suctioning can cause a vasovagal reflex (a GI tract reflex that controls contraction of gastrointestinal muscles in response to stretching of the tract by food, controlled by the stretch/osmo & chemoreceptors of the dorsal vagal complex). This can lead to arrthymias so check with medics first.

  • Raised ICP
Suction raises ICP so if someone already has elevated levels (e.g. TBI, SAH etc) then be very cautious and seek medical opinion prior to attempting suction.

1 comment:

  1. Thrombocytopenia - reduced platelet (thrombocyte) count. Normal range for platelets is (150–400)×109 per litre. Check platelet count before performing suction. If it's too low, damage to tracheal/bronchial lining can bleed excessively.