# Suctioning



## MidTech (Sep 28, 2012)

This probably sounds very elementary.
During my EMT class we were taught how to suction, using the hard catheter, for patients aspirating their emesis.  However, I recently began working as an EMT for a transport company and had a pt with a trach kit.  His ventilations sounded as if he was aspirating mucous/saliva and I wanted to do something for him, such as suctioning using the soft french catheters, but I was completely unsure how to do so.  Could anyone explain?


----------



## DesertMedic66 (Sep 28, 2012)

It all depends on your areas protocols on suctioning. As for my protocols i can only suction at the very opening of the trach. Deep suctioning is a medic skill here.


----------



## Akulahawk (Sep 28, 2012)

Doing tracheal suctioning may or may not be in your authorized scope of practice. It could be simply suctioning no deeper than the tip of the trach, or it could be deep tracheal suctioning. Or as stated above, could be simply at the opening and no deeper.

If you want to know _how_ to do it, google is your friend. Just remember that it's a sterile technique as you don't want to cause pneumonia.


----------



## BLS Systems Limited (Sep 28, 2012)

As mentioned above, stick with your protocols and education.  If you do feel its necessary, maintain sterility as much as possible, never force the catheter beyond where it naturally stops and never ever whip it around thinking that you are spinning the tip 360 degrees (I had to mention this as I have seen it far too many times).  The lining of the airways are extremely sensitive and are prone to bleed.  Its a classic area where "helping" can cause more damage.


----------



## mycrofft (Sep 28, 2012)

One difference between oropharyngeal and tracheostomy-tracheal suctioning is the former is likely to yield food, nasopharyngeal secretions/blood, vomitus and saliva, the latter is more likely to produce mucus and "trachea snot".

Another is that it is easier to rob the breath out of someone tracheally (whether that is pro-tracheal or stomal-tracheal) versus oropharyngeally.


I think I just broke my spellchecker.


----------



## NYMedic828 (Sep 28, 2012)

Most patients with a tracheotomy frequently clear their stoma similar to how you blow your nose. (it is absolutely gross)

Its a normal finding as long as they are breathing ok and the mucus is not in the lower airways.


----------



## Cindigo (Oct 5, 2012)

This is slightly off topic, but I'll continue on, since the title of the thread is suctioning. A paramedic told me that when she starts to suction a pt, she holds her breath. When it starts to become uncomfortable for her, she withdraws.

End off topic.


----------



## DesertMedic66 (Oct 5, 2012)

Cindigo said:


> This is slightly off topic, but I'll continue on, since the title of the thread is suctioning. A paramedic told me that when she starts to suction a pt, she holds her breath. When it starts to become uncomfortable for her, she withdraws.
> 
> End off topic.



That's often used in the field. The thinking behind it is that when it become uncomfortable for the Medic/EMT then it's uncomfortable for the patient and you should let the patient get some air.


----------



## Cindigo (Oct 5, 2012)

firefite said:


> That's often used in the field. The thinking behind it is that when it become uncomfortable for the Medic/EMT then it's uncomfortable for the patient and you should let the patient get some air.



I like learning these things as a baby EMT. I also like that it seems like the people in this field that like to teach, really like to teach. One more off topic.....this forum rocks. So glad to have it as a resource even if I do just lurk around most of the time.


----------



## VFlutter (Oct 5, 2012)

Cindigo said:


> This is slightly off topic, but I'll continue on, since the title of the thread is suctioning. A paramedic told me that when she starts to suction a pt, she holds her breath. When it starts to become uncomfortable for her, she withdraws.
> 
> End off topic.



I would keep suctioning under 10-15 seconds. A healthy person can hold their breath longer and tolerate it much better than a patient in acute distress. 

What if the paramedic was a swimmer and held her breath for a minute before she got uncomfortable? :rofl:


----------



## Medic Tim (Oct 5, 2012)

ChaseZ33 said:


> I would keep suctioning under 10-15 seconds. A healthy person can hold their breath longer and tolerate it much better than a patient in acute distress.
> 
> What if the paramedic was a swimmer and held her breath for a minute before she got uncomfortable? :rofl:



agreed

Chances are if the pt needs suctioning they are not going to be able to hold their breath as long as you comfortably.


----------



## 7887firemedic (Oct 6, 2012)

In MI&OH tracheal suctioning is an ALS procedure. Maintain a sterile enviroment, gently slide the soft cath down the site until resistance, begin suction as you withdrawl the cath, should be no longer than 15 seconds


----------



## Veneficus (Oct 6, 2012)

7887firemedic said:


> In MI&OH tracheal suctioning is an ALS procedure. Maintain a sterile enviroment, gently slide the soft cath down the site until resistance, begin suction as you withdrawl the cath, should be no longer than 15 seconds



Could I just point out we teach parents how to deep suction kids who are sent home with trachs?


----------



## VFlutter (Oct 6, 2012)

Veneficus said:


> Could I just point out we teach parents how to deep suction kids who are sent home with trachs?



And they get more experience doing it than the average paramedic will in their entire career


----------



## JPINFV (Oct 6, 2012)

7887firemedic said:


> Maintain a sterile enviroment,



So you can scrub and gown in the ambulance?


----------



## SDog (Oct 6, 2012)

Since I was in highschool my sister has been on a vent. You will find that it is a skill that nesissary for a family member to know how to do well. You will also find most pt's with a trach have there own ways they would like it to be done so always respect there techniques it's not comfortable  to have a French catheter stuck into your trachea and the only people who know them well enough know how to suction them the way they like I.e. Family members at home nurses Ect Ect. Make sure to follow your scope of practice because it is not usually a emt skill. People on vents are really suceptable to pneumonias and Is one of the main causes of deaths for vent pts. so thats why it is important to be properly trained at it. Google will not suffice.


----------



## SDog (Oct 6, 2012)

JPINFV said:


> So you can scrub and gown in the ambulance?



No the idea is to keep the suction cathater sterile. Because your  stickin it down there trachea and the infections most people can fight off they have a hard time and severly effect the quality of life they do have.


----------



## VFlutter (Oct 6, 2012)

SDog said:


> No the idea is to keep the suction cathater sterile. Because your  stickin it down there trachea and the infections most people can fight off they have a hard time and severly effect the quality of life they do have.



I may be wrong but I think JPINVF may have learned that in Med school and it was a bit of sarcasm.

Technically you are supposed to change catheters after each insertion but I have never seen anyone do that in actual practice.


----------



## SDog (Oct 6, 2012)

ChaseZ33 said:


> I may be wrong but I think JPINVF may have learned that in Med school and it was a bit of sarcasm.
> 
> Technically you are supposed to change catheters after each insertion but I have never seen anyone do that in actual practice.



I was taught years ago when I was 16 or so and have much exp with it I was taught only change the cath if you contaminated it or it becomes too clogged. I could of been taught the practical family way due to cost of medical supplies and it being hard to afford that stuff as a family but idk I wouldn't be surprised if that is the preferred method. We used to have to save our yaunkers ( always disposed of the French catheters) and put them in the dishwasher or sterlize them with vinegar to save money but like I said I bet we were taught these things in order to be able to manage the cost of supplies efficiently.


----------



## JPINFV (Oct 6, 2012)

SDog said:


> No the idea is to keep the suction cathater sterile. Because your  stickin it down there trachea and the infections most people can fight off they have a hard time and severly effect the quality of life they do have.




Disclaimer... I'm currently on my surgery rotation. 

The issue is that if you want it to be truely sterile, you're going to need a mask, hair cover, and sterile gloves, at a minimum. Otherwise it isn't sterile in the strictest sense, and definitely anything touched with exam gloves is no longer sterile. Sterile and clean are two completely different things. There's a reason why the suction catheters in care facilities are encased in plastic for easy and repeated use. 

/Yes, sometimes I get too pedantic


----------



## SDog (Oct 7, 2012)

JPINFV said:


> Disclaimer... I'm currently on my surgery rotation.
> 
> The issue is that if you want it to be truely sterile, you're going to need a mask, hair cover, and sterile gloves, at a minimum. Otherwise it isn't sterile in the strictest sense, and definitely anything touched with exam gloves is no longer sterile. Sterile and clean are two completely different things. There's a reason why the suction catheters in care facilities are encased in plastic for easy and repeated use.
> 
> /Yes, sometimes I get too pedantic



Clean hand and dirty hand


----------



## 7887firemedic (Oct 7, 2012)

Veneficus said:


> Could I just point out we teach parents how to deep suction kids who are sent home with trachs?



Yep, not that difficult, and obviously better for everyone than calling ems or a ed visit everytime the pt needs suctioned







ChaseZ33 said:


> And they get more experience doing it than the average paramedic will in their entire career



Probably, although its quite frequent with services that cover nursing homes and take pts on wait and return dr appts. I have dealt with some horrible trach conditions








JPINFV said:


> So you can scrub and gown in the ambulance?



Haha, i realize how silly a sterile enviroment concept is for the box, that is a quote from protocols-laugh. Although im sure it refers to dont pull out the cath with your bare hands, drop it on the floor, maybe pick your nose, pick it up and procede to perform tracheal suctioning


----------



## 7887firemedic (Oct 7, 2012)

JPINFV said:


> Disclaimer... I'm currently on my surgery rotation.


Good for you,that is so awesome!! I look up to the Drs on here and always try to read thier posts. No sarcasm meant.


----------

