Suction

[GregEMT19]

Hey guys, I'm now in my second month of EMT-B cert and have been reading this forum. Very helpful, and I figured I would throw a question out there for anyone that knows the answer. We just got done covering suctioning in my class and I came across something that was bothering me. We were taught to never suction higher than 200(mmHg??) But if thats the case, how come the suction devices go well above and beyond 200?

 

[Hastings]

Hey guys, I'm now in my second month of EMT-B cert and have been reading this forum. Very helpful, and I figured I would throw a question out there for anyone that knows the answer. We just got done covering suctioning in my class and I came across something that was bothering me. We were taught to never suction higher than 200(mmHg??) But if thats the case, how come the suction devices go well above and beyond 200?

Never heard any such limits. We just crank our's all the way up. The only limit I'm concerned with is time. No longer than 15 seconds. No deeper than what you can visualize. Those are my suctioning rules. Other than that, never heard anything about the uh...power.

 

[JPINFV]

Because suction is used in cases other than patient's that need their upper airway suctioned and there's no real benifit for the companies to make special ambulance models where the only difference is the highest level the suction goes.

 

[GregEMT19]

I suppose a higher suction strength could be used to clear the catheter in the event it was clogged. Is there any benefit to suctioning at a higher rate? Or is there any danger to the pt by going higher?

 

[VentMedic]

I suppose a higher suction strength could be used to clear the catheter in the event it was clogged. Is there any benefit to suctioning at a higher rate? Or is there any danger to the pt by going higher?

The suction units go to 200 mmHg and beyond because they have can have other purposes by being attached to other equipment.

ABSOLUTELY you can do serious damage to a patient with high suction!!!

Never heard any such limits. We just crank our's all the way up. The only limit I'm concerned with is time. No longer than 15 seconds. No deeper than what you can visualize. Those are my suctioning rules. Other than that, never heard anything about the uh...power.

Hastings! After reading some of your posts, where did you get your Paramedic cert?

Hopefully you aren't "cranking all the way up" especially when you do ETI suction. I really hope your machine is not capable of 200 mm Hg of suction if that is the way you and your co-workers think.

 

[VentMedic]

If you use 200 mm Hg to clear a line or grap a large piece of something WITH THE FULL knowledge of the potential for damage, that is one thing.

If you are operating a piece of equipment inside a patient's mouth or lungs with little or no knowledge about the damage you can do or even how the equipment works, that is something else all together.

 

[VentMedic]

Now, before anybody, including Hastings, thinks what I said in reference to his post is inappropriate, I want to explain why some information on the open forums can be just misleading or in some cases can not be in the best interest of the patient.

Many things, like the suction, can be easily referenced in the EMT or Paramedic texts. Too many come off with "its the new wording or way", "I've never heard of any other way" or "I'll do it my way anyway" when spouting off about some procedure or med without any evidence that their method is better or even correct.

There are some procedures that should not be that big of a mystery and should not be done without some knowledge and training. Many of the very fundamental or basic procedures fall into that category and should be well understood since they may be the first steps in saving a life or preventing further harm to the patient.

I don't criticize anyone for asking questions on this forum. However, if you offer advice, be able to back it up with some reference. If you are of higher level of training, you should remember some of the basics of medicine and procedures.

The EMT and Paramedic textbooks are not that large but they do have a lot of information that should be referenced even after you have completed school. You P&P manual should also be readily available. There should be no doubt about any piece of equipment or procedure that is part of your job description.

If you can not find information, there are many on this forum that can point you to a source with the information.

Unfortunately, some who themselves have not found these sources or do not utilize the sources available to them are those that think they have the all the correct advice and opinions.

To the OP, check your EMT book or P&P for the specific info. If you can not find it, I'll post the links later if someone else doesn't.

 

[Ridryder911]

After reading many posts I do wonder what school or texts they used (or if ever read). I guess many never heard of intermittent suction as well or low volume suctioning. Yet, so many proclaim to be emergency medical experts, yet fail to understand something as simple as suctioning.

I guess as well many has never transported patients with chest tubes using pluer-evac or drainage systems, or attach suction to Naso Gastric tubes? Again, routine transports and as well I do wonder about the education if one does NOT know about evacuating gastric contents through a NG tube? .. One would NEVER use higher than 20mm/Hg as such causing a potential tear of the gastric lining.

As well I guess none of these so called ALS personal ever tracheal suction patients? One should never use high pressure also causing damage...

Again, it amazes the education level or should I say lack of education that is taught within programs...

R/r 911

 

[Sasha]

How did we get from suction questions to bashing other peoples education and certification?

 

[VentMedic]

How did we get from suction questions to bashing other peoples education and certification?

There should be some very basic knowledge that should be required to get one's certification as either an EMT or Paramedic.

The question posed is "Are schools not teaching fundamental principles or are students not reading and retaining the material"?

Are the educators not educated enough to teach foundation material?

Are preceptors and FTO failing to train and be available?

Too many memorize vital information instead of learning it and then it is quickly forgotten once the test is taken. This is unfortunately what happens in programs that have no prerequisites and the instructors also do not need much more than a cert in the class they are teaching.

Yet, some in this profession still manage to present themselves with cockiness and arrogance to make up for what they do not know.

 

[mikie]

so have we come to the conclusion that 200mmHg is the max for basic oral suctioning?

 

[Hastings]

Hopefully you aren't "cranking all the way up" especially when you do ETI suction. I really hope your machine is not capable of 200 mm Hg of suction if that is the way you and your co-workers think.

I don't know what our machine is capable of. It's either on, or it's off. There is no choice of power. So we just flip the switch and go with it, leaving the only concerns - like I said - to be time and length of insertion.

While that's the machine of choice for oral suctioning, we do have another machine for other purposes. Have yet to use it though.

 

[VentMedic]

so have we come to the conclusion that 200mmHg is the max for basic oral suctioning?

200 mmHg is more than enough to rip the soft tissue in the oral caviity. Any bleeding may lead to blood aspiration. That can lead to extended ventilator time and ARDS. That can lead to death.

If you have someone on blood thinners or who have been taking steroids for a long time, you put them at big risk.

If you are going to need 200 mmHg to clear and airway, you will have to know the damage it can do if you are not careful. If you leave your machine on 200 mmHg, the next person that uses it may not be so careful. It doesn't take much to cause real damage to a patient that can lead to further complications. Become familiar with your machine and airway clearance techniques.

Hastings, do you not have access to the manual or equipment rep? If you don't, your training officer should. There is little excuse to operate suction equipment or any equipment without having some idea of how it functions. You many also need to use this equipment for a child or infant. Don't wait until it is an EMERGENCY before you find out what you equpment is capable of.

 

[Hastings]

200 mmHg is more than enough to rip the soft tissue in the oral caviity. Any bleeding may lead to blood aspiration. That can lead to extended ventilator time and ARDS. That can lead to death.

If you have someone on blood thinners or who have been taking steroids for a long time, you put them at big risk.

If you are going to need 200 mmHg to clear and airway, you will have to know the damage it can do if you are not careful. If you leave your machine on 200 mmHg, the next person that uses it may not be so careful. It doesn't take much to cause real damage to a patient that can lead to further complications. Become familiar with your machine and airway clearance techniques.

Hastings, do you not have access to the manual or equipment rep? If you don't, your training officer should. There is little excuse to operate suction equipment or any equipment without having some idea of how it functions. You many also need to use this equipment for a child or infant. Don't wait until it is an EMERGENCY before you find out what you equpment is capable of.

I know how the equipment works. You turn it on and suction.

As stated, there's another device for suctioning in other cases. Such as pediatrics. And under those circumstances, we have specific guidelines as to what to set the machine at, which if we forget, are listed in the big book of everything.

I guess you could consider the first machine to be the quick suction. The one you can use for the common purpose of suctioning the adult patient orally, without having to worry about setting anything. It's convenient.

 

[VentMedic]

I guess you could consider the first machine to be the quick suction. The one you can use for the common purpose of suctioning the adult patient orally, without having to worry about setting anything. It's convenient.

And hopefully you will never have to use it for any other purpose or prevent member of an ICU team from using some of your equipment if you can not tell them the amount of suction.

Just "turning on a switch" is just the makings of a knobologist which is way too common for some who then want other equipment like ETCO2 monitors, pulse oximeters and ventilators.

 

[Hastings]

And hopefully you will never have to use it for any other purpose or prevent member of an ICU team from using some of your equipment if you can not tell them the amount of suction.

Just "turning on a switch" is just the makings of a knobologist which is way to common in some who then want other equipment like ETCO2 monitors, pulse oximeters and ventilators.

Actually, it's a switch. Like a light switch. Click on, click off. No turning.

So actually, it'd be a switchologist.



Never had an ICU member. Have the CC flight medics/nurses, sometimes. They choose to just flip the switch and suction too. I guess we're all just switchologists. Shame on us. Shame on us all.



Oh, also, no we don't have to use it for another purpose. We have that other machine that can be manually set for other purposes, and then a backup machine/batteries in case that one fails.

 

[VentMedic]

Actually, it's a switch. Like a light switch. Click on, click off. No turning.

So actually, it'd be a switchologist.



Never had an ICU member. Have the CC flight medics/nurses, sometimes. They choose to just flip the switch and suction too. I guess we're all just switchologists. Shame on us. Shame on us all.

A "switchologist" is someone who doesn't know the power or capability of their machine.
Fortunately the people you have transported in your ambulance probably have worked with enough equipment to know approximately how many mmHg the equipment is applying. If you read Rid's post you would know why it is of great importance for them to know these things. They may also need to know this because they often can not expect to get that information from those whose trucks they are in.

 

[traumateam1]

Like many people have said, and I'll just reiterate it again. Suctioning more than 200 mmHg can cause serious damage to the mouth, cause bleeding and some other problems, which will lead to more suctioning
So when suctioning turn it to 200 mmHg (or less) and suction for a maximum of 15 seconds (peds are 5 of course), followed by high flow O2 or BVM. After the 15 seconds of O2 suction again if needed.
If there is active vomiting or bleeding than (if possible) turn the patient onto their side to allow for drainage so you aren't tied up with suctioning every 15 seconds.

Cheers!
Oh and welcome to the tribe GregEMT19 :beerchug:

 

[traumateam1]

Woohoo!!

YAY!!! My 250th post.. Forum Captain now!!

 

[Sasha]

Im jealous. How high do you have to be to be keeper of the nrb? I wanna steal it from JP