Airway Clearance Techniques

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Airway Clearance Techniques

• By Jim Clarke

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Airway Clearance Techniques

• Suctioning - negative pressure applied within the
  airway
• Can be via ET or Trach tube or
• Through the nose into the trachea
• This is called NT or naso-tracheal suctioning
• Bronchoscopy
• Flexible Fiberoptic bronchoscopy
• Rigid tube bronchoscopy

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Indications for Suctioning

• Patient has an inability to clear secretions
• Ineffective or absent cough with
• Evidence of retained secretions in upper airway
• A sample of sputum is to be obtained for lab
  analysis purposes
• Use a sterile sputum trap (Lukens trap)

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Lukens Trap for Obtained Sputum Sample
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Contraindications to NT Suctioning

• Absolute contraindication evidence of croup or
  epiglottitis
• Relative contraindications
• Occluded nasal passages
• Nasal bleeding
• bleeding disorder
• Acute facial, head or neck injury

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Hazards Complications of NT Suctioning

• Hypoxia/Hypoxemia
• Trauma to nasal passages, pharynx or trachea
• Cardiac or respiratory arrest
• Cardiac dysrhythmias or bradycardia
• Atelectasis
• Bronchospasm

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When do patients need suctioning?

• Listen over anterior chest with stethoscope
• Evidence of loud rhonchi?
• Does patient have audible crackles when breathing
  with their mouth open?
• Place hand on anterior chest
• Does patient have tactile fremitus?
• Have patient cough. What is the character of the
  cough? Loose but non-productive?

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Monitoring During Suctioning

• Respiratory rate pattern
• ECG tracing (if available), Heart rate
• Skin color SpO2
• Subjective response
• Sputum character color, consistency, amount and
  any odor
• Evidence of airway bleeding?

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Equipment Used During Suctioning

• Suction Regulator attached to wall OR portable
  suction unit (see next slide)
• Suction canister to collect secretions
• Suction supply tubing
• Suction kit sterile (sheathed or unsheathed)
  catheter, sterile gloves basin for irrigation
  water sterile water Lubifax or KY Jelly (for NT
  suctioning)

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Suction Regulator
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Procedure for Suctioning

• Assess need
• Turn on set suction pressure on regulator
• Adults negative 100 - 120 mmHg
• Children negative 80 - 100 mmHg
• Infants negative 60 - 80 mmHg
• Prepare patient Communicate!!!!!!!!!!
• Make sure patient is well oxygenated

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Suctioning Procedure Continued

• Open necessary sterile saline or water
  containers open lubricating jelly containers
• Open kit and put glove(s) on
• Lubricate catheter (NT suction only)
• Insert catheter slowly
• Apply suction only while withdrawing using
  rotating motion (10-15 seconds only)

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Suctioning Procedure Continued

• Make sure patient is reoxygenated after catheter
  has been removed
• Monitor patient and assess need for additional
  suctioning
• Repeat as necessary based upon need and ability
  for patient to tolerate procedure

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Closed-System Multi-Use ET Catheter
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Closed-System Multi-Use Trach. Catheter
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Unsheathed Sterile Catheter
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Sterile Suction Kit
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Cath-n-sleeve Catheter
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Sizes of Catheters

• When suctioning though an ET tube
• Take ET tube size (I.D.) and multiply by 2
• 7.5 mm tube X 2 15
• Next closest size is 14 French
• Mostly commonly used adult size is 14 F
• Largest current adult size is 14 French
• Other smaller sizes are 12F 10F 8F 6F

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Bronchoscopy

• Therapeutic bronchoscopy
• To visualize and remove mucus from the airway
• Can be used to intubate in situations where
  standard intubation techniques have failed
• Diagnostic bronchoscopy
• To visualize tumors and obtain tissue samples for
  pathology analysis

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Parts of the Fiberoptic Bronchoscope
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Picture from Therapeutic Bronch
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Picture from Diagnostic Bronch
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THE END!