Clinical Techniques in Respiratory Care

Proficiency in Clinical Settings

  • Importance of proficiency in clinical practices to ensure effective responses to emergencies.

  • Students should be prepared but are not expected to be fully equipped when starting clinicals.

  • Opportunity to observe codes (medical emergencies) before participating.

Maintaining Airway

  • Definition of a "patent airway": An airway that is unobstructed, allowing the patient to breathe easily.

  • Method for determining airway safety: Assessing whether the patient can breathe through it.

Suctioning Techniques

  • Suctioning Implications: Suctioning removes not only secretions but also lung volume and oxygen.

  • Importance of hyperoxygenating the patient before suctioning to counteract loss of oxygen (i.e., oxygen before suctioning).

  • Different suction methods:

    • Upper airway suctioning through nose/mouth.

    • Lower airway suctioning into the trachea.

Monitoring During Suctioning

  • Key parameters to monitor:

    • Heart rate.

    • SpO2 (oxygen saturation).

    • Signs of gagging.

  • Gagging during suctioning does not indicate poor technique; it can occur naturally.

Types of Suction Devices

  • Yankauer suction:

    • Rounded tip designed for oral suctioning to minimize trauma.

    • Used in patients with Artificial Airway (e.g., ET tube) for mouth care.

    • Required due to increased salivation in sedated patients.

Types of Techniques

  • Sterile Technique: Disconnecting the ventilator to suction through the ET tube, often deemed outdated.

  • Closed Technique: Inline suctioning through a protective covering attached to an ET tube.

    • Calculation of Catheter Size: Size of suction catheter is determined using the formula:
      \text{Size}_{\text{catheter}} = \text{Size of ET tube} \times 2 - 2

    • Example: For a size 8 ET tube, use a size 14 suction catheter.

  • Standard practice differs among institutions: Clean technique may be acceptable in some hospitals.

Timing and Frequency of Suctioning

  • Suctioning must never be scheduled; it is only performed as needed (PRN).

  • Signs indicating suctioning is necessary:

    • Coarse crackles or bronchi sounds on auscultation.

    • Patient distress or ineffective cough.f

    • Low oxygen saturation (SpO2).

Visual and Practical Techniques

  • Understanding the fit and feel of different-sized suction catheters through tactile demonstration.

  • Importance of hyperoxygenation: At least 30 to 60 seconds before suctioning due to oxygen depletion.

  • Special consideration for neonates: Increase their oxygen concentration by 10% from baseline rather than supplying a full % of oxygen.

Monitoring Patient Response

  • Noting the vagus nerve implications during suctioning:

    • Vagus nerve: Stimulation can lead to decreased heart rate and potentially fainting.

  • Technique considerations:

    • Intermittent suctioning versus continuous suctioning depending on secretion thickness.

    • Coughing indicates effective placement of the catheter.

Types of Airway Devices

  • Nasal Airway (Nasal Trumpet): Minimizes trauma for patients requiring frequent suctioning.

  • Oral Airway: Prevents tongue occlusion and is reserved for unconscious patients to avoid gag reflex.

Types of Tracheostomy Tubes

  • Various types include:

    • Metal Trach: For chronic patients; requires cleaning.

    • Cuffed Trach: Holds pressure and prevents aspiration.

    • Fenestrated Trach: Assists with weaning by allowing airflow through the holes.

Techniques for Insertion

  • Endotracheal Tubes (ET Tubes):

    • Suited for both oral and nasal intubation.

  • Stylet: Helps mold the ET tube for ease of insertion.

  • LMA (Laryngeal Mask Airway): Used in surgeries requiring short ventilation times without the need for direct intubation.

Troubleshooting Airway Issues

  • Monitoring cuff pressures to avoid tissue damage: Ideal ranges are 20-30 mmHg.

  • Cuff inflation management to prevent leaks and maintain ventilation.

Extubation and Decannulation

  • Extubation: Removal of ET tube.

  • Decannulation: Removal of tracheostomy.

Final Notes on Practical Application

  • Awareness of securing airways and managing patient comfort is crucial in respiratory therapy.

  • Continuing education and practice will lead to increased proficiency with airway management.