Suction

[JPINFV]

You have to be able to do magic. (alternatively User CP->edit your details->custom user title)

 

[VentMedic]

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.

Whoa!! Do not go near a child with 200 mmHg!

Please review your text books and P&Ps for the proper way to do this very basic but vital skill.

 

[traumateam1]

My Mistake!

Sorry Vent! I worded that wrong.. I would never ever ever go near a ped with 200 mmHg.. I was referring to the time limit only when I made that comment!
I apologize to everyone for the confusion!!!

 

[Ridryder911]

Personally never seen an on-board suction unit ( and I have seen many EMS units) without a method of controlling the amount of suction, met some medics that did not know the parts or how to use their suction unit device


Even each one of these suction devices has an ability to adjust the amount of suction

There is usually a knob that those that are familiar with their equipment, located at the top of the canister and should have a gauge either on the suction or in the wall. This is to ensure patient safety. The switch is alike all other suction units just to turn it off and on.

Not knowing is not excusable, this is general basic information that should had been discussed in the Basic EMT as it is part of the EMT curriculum.

R/r 911

 

[GregEMT19]

Sweet, thanks all who helped answer my question. Thanks for the welcoming Trama. Seems like there are some pretty knowledgable people on here. I'll contribute when I can.

 

[mikie]

I know our ambulance mounted suction has a control knob but I'm fairly sure that our portable is just a switch (at least visible to the eye). It hasn't been used too frequently lately, but I'm going to check it out and see if there is indeed a knob.

[lol-knobologist]

 

[KEVD18]

you need 500 posts for a custom forum title.

 

[marineman]

So when suctioning turn it to 200 mmHg (or less) and suction for a maximum of 15 seconds (peds are 5 of course)

Maybe it's a Canadian thing but here adult is 15 max, peds are 10, and infants are 5 (use a bulb syringe anyway so what's the point?)

 

[imurphy]

As to why the Suction unit (LSU on my bus) goes up to 520+, I've found it's GREAT for a Vac-Mattress!

 

[Foxbat]

After reading many posts I do wonder what school or texts they used (or if ever read).

The only thing my EMT-B textbook (Mosby's, revised 2d edition) says about pressure on suction unit is "if the unit has a pressure gauge, check the pump to be sure that it can generate a 300 mm Hg vacuum".
What is even more surprising is that even some hospital staff has issues with proper suctioning (judging from this article).

 

[wxduff]

For the benefit of discussion, I just checked my EMT-Basic book.

The book doesn't say much about suctioning, at all, which surprised me.

The book did say the following...

"To be effective, suction devices must furnish an air intake of at least 30 liters per minute at the open end of a collection tube. This will occur if the system can generate a vacuum of no less than 300mmHg when the collecting tube is clamped..."

That seems high, and I believe the medic who's teaching our class said 200 in lab...

 

[Jon]

...That seems high, and I believe the medic who's teaching our class said 200 in lab...

Go with the book. Medics can be wrong, especially when they are speaking in a lab classroom.

 

[wxduff]

The only problem I have with going with the book is part of this discussion has been about how 200 should be the most suction used ever, yet the book says go with 300, my instructor says 200, etc...

It's like there isn't a straight answer...:wacko:

 

[marineman]

Ok you guys made me go and check my text again. Mosby's paramedic textbook revised third edition. Here is a direct quote from the book so I don't miss anything (begining of page 467 for anyone that wants to follow along)

Before any suctioning is begun, all equipment should be checked. Also, the suction should be set between 80 and 120 mmHg (Higher suction is needed for tracheo-bronchial suctioning.)

Also it goes on to say that suction should be applied for no longer than 10-15 seconds in an adult and no longer than 5 seconds in a ped. For that I owe trauma team an apology. I am 100% sure the 5, 10, 15 rule is what we were taught is that a variation set by the state, local protocols or is the book a touch off base?

 

[mycrofft]

My speedometer says 120 at the top...of my first car, a Rambler Ambassador.

I've seen "switch on/switch off" units before. I've seen suction units with unreliable vacuum gauges, too. Now before I break into a James Taylor medley, let's consider the suction handpiece.

(Before I go on, let me say our cohorts are right despite their sarcasm. The sarcasm should make it stick. It just makes me look for a stick. At any rate, make sure your vacuum gauge works, and remember that the mmHg climbs rapidly if the handpiece is occluded, and over a certain point you're going to stop doing good and start doing harm).

Handpieces..yes. Don't use a one cm shotgun barrel when a Yankauer will do, and a Yankauer has lots of little holes to allow liquid pickup from four directions, but also helps keep your OP suctioning from becoming a "China Syndrome" event. And that little hole on the end by your thumb or finger or thumb-finger is designed to allow you to CONTROL the suction, mostly off/on, but if you're slick and at lower suctions it can even moderate it a little.

At my work, our erstwhile equipment manager wants us to "ramp up" to stronger suction, but we're just fine now that all our VVAC's finally ate it (all the one-way valves rotted out after six years, make it like a lousy fireplace bellows).

 

[VentMedic]

Ok you guys made me go and check my text again. Mosby's paramedic textbook revised third edition. Here is a direct quote from the book so I don't miss anything (begining of page 467 for anyone that wants to follow along)

Before any suctioning is begun, all equipment should be checked. Also, the suction should be set between 80 and 120 mmHg (Higher suction is needed for tracheo-bronchial suctioning.)

Also it goes on to say that suction should be applied for no longer than 10-15 seconds in an adult and no longer than 5 seconds in a ped. For that I owe trauma team an apology. I am 100% sure the 5, 10, 15 rule is what we were taught is that a variation set by the state, local protocols or is the book a touch off base?

No you are not necessarily wrong. Different text books have slight variations. Also, there is a difference between total time of the procedure and the actual suction application.

Tracheo-bronchial does not require higher suction and the recommended should be used. Lung tissue is very delicate as are the alveoli and changing pressures. Oral suction may exceed slightly but only with caution. Elderly people may need the pedi settings.

NT, Trach and ETTs as well as oral recommendations for kids and the elderly:

Neonatal:
40 - 80 mmHg with 60 being the most common
The procedure should take no more than 10 seconds which is about 5 seconds for suctioning.

Pedi:
80 - 100 mmHg
Depends on the age with 10 - 15 seconds for the duration of the procedure and no more than 10 seconds for suctioning being applied.

Adult:
120 mmHg
15 seconds

For the oral cavity, you can go slightly higher. I will rarely exceed 150 mmHg with a yankauer except if I can visually see what I am suctioning and have a good aim at it so not to damage the soft tissue.

 

[traumateam1]

Oh don't worry about it marinema. I know everyone has different protocols.

 

[marineman]

Vent fantastic post, good information that's not in my textbook but I wrote it in the margin on that page. For the neonate I'm assuming there's something more high tech than the bulb syringe that we've always been taught with but I've never seen anything. What type of cath would you use just a standard flexible or is there actually a neonatal sized rigid cath?

 

[VentMedic]

What type of cath would you use just a standard flexible or is there actually a neonatal sized rigid cath?

Both. There are size 5, 6 and 8 Fr suction catheters for ETT suctioning and for suctioning the stomach contents after birth (usually an 8 fr). Note French is the measurement and not the name of the catheter.

There are also various rigid devices for clearing the nares and oral cavity with extreme caution of course.

http://neotechproducts.com/suction-c-4.html

http://www.smiths-medical.com/catal...hmark/cathmark-neonatal-suction-catheter.html

Child trach suctioning (adult is similar) Good site for other info about trachs.

http://www.tracheostomy.com/care/suction.htm


Good article on neonatal RN techniques as observed:

http://www.marshall.edu/etd/masters/craig-register-2002-msn.pdf.pdf

 

[2boss4]

why is there a 15 second rule? if there's no airway, one would think youd want to get one est. asap