IntroductionEndotracheal intubation prevents the cough reflex and interferes with normal muco-ciliary function, therefore increasing airway secretion production and decreasing the ability to clear secretions. Show
Endotracheal tube (ETT) suction is necessary to clear secretions and to maintain airway patency, and to therefore optimise oxygenation and ventilation in a ventilated patient. ETT suction is a common procedure carried out
on intubated infants. The goal of ETT suction should be to maximise the amount of secretions removed with minimal adverse effects associated with the procedure. AimThe aim of the guideline is to outline the principles of management for infants requiring ETT suction for clinicians on Butterfly Ward at the Royal Children’s Hospital. Definition of Terms
AssessmentETT suction should be based on a clinical assessment of the infant. The inspired gas is warmed and humidified (therefore decreasing the amount of secretions drying and occluding the airway). Auscultate with stethoscope before and after ETT suction to evaluate necessity and effectiveness of the procedure. Monitor the infant closely before, during and after the procedure to assess
baseline, acute physiological changes and recovery. Parameters to observe:
Clinical Indications for ETT suction
Effectiveness of ETT suction should be assessed after the procedure by observing:
Measurement of Length to SuctionSuction should only be to the tip of the ETT, and should never exceed more than 0.5cm beyond the tip of the ETT, to prevent mucosal irritation and injury. Measurement of length to suction is to be predetermined at shift commencement. Length is determined by using the centimetre markings on the ETT; and by adding the length of additional space of the ETT adapter (usually 1-1.5 cm). If patient on HFOV or HFJV, allow for different lengths of suction adaptors. Equipment
ManagementProcedure for open suction technique on Butterfly
Procedure for closed suction technique on Butterfly
Please note, that if you are going to trim an ETT do this prior to attaching closed suction system. If you need to trim ETT once closed suction system in place, please remove from ETT, replace original adaptor and attach neopuff, trim ETT and then insert closed suction system Open vs Closed suctionThere is some evidence that utilizing a closed suction method during mechanical ventilation in neonates will help to reduce the de-recruitment phase of ventilation. Closed suctioning reduces the risk for contamination with environmental pathogens, reduces viral and bacterial colonisation within the ventilation circuit and it also safely protects nursing and medical staff from exposure to patient bodily fluids. It therefore appropriate to use this technique when caring for patients with infectious respiratory conditions.
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