During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing

Option 2 : Stop the procedure and reoxygenate the patient

Free

200 Questions 200 Marks 180 Mins

Concept:

• Endotracheal suctioning -> It is a process done to remove pulmonary secretions from the patient and improve ventilation.
• Heart rate -> Heart beats per minute.
• Priority Action Approach -> The technique used to combat an emergency situation while dealing with a patient.

Explanation:

• Normal heart rate of an individual is 60-100 times per minute.
• The steps of the Priority Action Approach are:-

1. Primary assessment
2. Critical interventions
3. Secondary assessment
4. Treatment

• In case of a decreasing heart rate in a patient undergoing endotracheal suction, the first priority action should be to stop the procedure and reoxygenate the patient.
• This would help to improve the patient outcome in this emergency situation.

• Continue to suction -> Continuing suction without reoxygenation the patient might lead to further deterioration of his condition.
• Ensure that suction is limited to 15 seconds -> This step would not be much useful in the case of a dropping heart rate.
• Notify the physician immediately -> The nurse should take immediate action and reoxygenate the patient rather than informing the physician first and then taking any action.

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Sooner or later, every nurse must suction a patient. For nurses who work in intensive care units or emergency care or who support patients with spinal cord injuries, suctioning may be a daily part of the job. When suctioning becomes routine, it’s easy to lose sight of the risks. Some simple precautionary measures can both reduce risk and improve patient outcomes.

Conduct a Risk Assessment

Some patients face a higher risk of suctioning-related morbidity. They include: 

• Patients with a recent head or neck injury 
• Geriatric and pediatric patients, who have fragile airways 
• Those with cognitive or mental health conditions that make it more difficult for them to understand the procedure and cooperate 
• Patients with loose dental hardware 
• Those with a difficult airway or a history of suctioning complications 
• Patients with bradycardia 
• Patients with hypoxia

While there’s no single condition that is an absolute contraindication for suctioning, it’s important that nurses avoid routinely suctioning without first assessing risk.

Prepare the Patient 

Suctioning can be scary and uncomfortable. Prepare the patient ahead of time by telling them what you need to do and why—even if they seem uncooperative. When working with a child or a person with cognitive disabilities, explain things in terms they can understand, and be warm and reassuring. Ask their caregiver to remain present and avoid using force or restraints unless absolutely necessary.

During the procedure, reassure the patient that they are safe. If there are unusual sounds that could be frightening or complications that require additional treatment, continue to reassure the patient and talk them through what you are doing. Even if the patient is very young, very old, or very confused, talking to them can be reassuring and is a sign of respect. Do not talk about the patient as if they are not there or cannot hear you.

Do Not Suction Too Long 

Prolonged suctioning increases the risk of hypoxia and other complications. Never suction a patient for longer than 15 seconds. Rather than prolonged suctioning, withdraw the catheter, re-oxygenate the patient, and suction again.

Avoid Forcing the Catheter 

A difficult airway can be stressful and upsetting, particularly if the patient requires emergency suctioning. Yet forcing the catheter can cause serious airway trauma. Never force the catheter, and do not attempt to insert it into an airway you cannot see. 

Monitor for Complications 

During and after suctioning, monitor the patient for common complications such as bradycardia and hypoxia. Take their vital signs before and after the procedure and be mindful of any complaints the patient reports. Light-headedness, difficulty breathing, a racing heart, raspy breathing sounds, and similar symptoms may signal suction-related complications. 

Choose the Right Equipment 

Without the right equipment, even a flawless suctioning technique may prove inadequate. The right catheter size is key. In most cases, the suction catheter should have an external diameter that is less than half the internal diameter of the endotracheal tube. Geriatric and pediatric populations often require smaller suction catheters. Children have smaller airways, and elders may have more difficult airways due to loss of muscle tone. 

You must also choose the right catheter for the job. For patients who are continuously vomiting or bleeding during resuscitation, the DuCanto catheter enables rapid airway decontamination via the SALAD technique.

A portable emergency suction machine offers more than just emergency care. It enables nurses to care for patients wherever and whenever they need treatment, including while being transported to surgical wings. A portable machine also ensures you can meet your obligations under the Emergency Medical Treatment and Labor Act (EMTALA) to provide treatment to patients within a 250-yard radius of the hospital. For help choosing the right suction machine for your patients, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.

Editor's Note: This blog was originally published in April 2021. It has been re-published with additional up to date content.