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1. RC 275 Manual Ventilation
Secretion removal
3. Manual Ventilation Devices:Bag-Valve-Mask Devices Are usually self inflating for adults
Neonatal bags are usually flow inflated
May be reusable or disposable
4. High FIO2 Achieved By: Use an O2 flow of at least 15 LPM
Use a reservoir device with the BVM
Allow Adequate bag re-filling time
5. AHA Recommendations for Adult BVMs (Resuscitator Bags) Self-inflating
Non-jam inspiratory valve at 15 LPM
Suitable for manikin practice
No pop-off valve (or ability to override if present
15/22 mm fittings for connectors High FIO2 capability
True non-rebreathing valve
Satisfactory performance in all environments
Adult and pediatric models
6. Puritan-Bennett PMR BVM
7. Laerdal BVMs (reusable)
8. Technique Use an oropharyngeal or nasopahryngeal airway
Best if done with two people
One secures the airway by positioning and sealing the mask
The other squeezes the bag with both hands
9. The mask can be removed from a BVM allowing a direct connection to an ET tube
10. Demand Valve Powered by 50 psi O2
FIO2 100%
Patient can trigger flow or operator can
Usually easier to ventilate with if only one person
May cause gastric insufflation
Should be used with oral or nasal airway
May be attached to ET tube
12. Airway Suctioning Indicated when normal clearance mechanisms are impaired and/or overwhelmed
13. Yankauer (“tonsil sucker) – for oropharyngeal suctioning Is inserted into mouth “upside down” and then rotated once past tongue
May also stimulate a spontaneous cough
14. Tracheal Suction Catheters A, B, and D are whistle tips
C is Argyle aero-flow
Should minimize mucosal invagination
E is Coude’ for getting into left main stem bronchus
Note side holes on all
15. Inline Tracheal Suction Catheter A closed system used on ventilator patients
Attaches between ventilator circuit and ET tube
16. Suctioning: Equipment Needed Suction catheter
Outside diameter of catheter should be no more than ˝ the internal diameter of the airway
Catheter size (French) = ID (in mm) X 3
2
17. Suctioning: Equipment Needed (cont.) Vacuum source– for adults set at 80-120 mmhg (some say up to 150 mmhg)
Sterile gloves (may use one or two)
If using two, only the one handling the distal end of the catheter is sterile!
Sterile water
Pour some in tray and check vacuum and catheter patency
18. Suctioning: Technique Use sterile technique
Always wash hands first!
Hyperoxygenate and/or hyperinflate patient
Insert catheter until resistance is felt Apply suction while withdrawing catheter
Apply suction for no longer than 15 seconds each attempt
Flush catheter with sterile water in between attempts
Hyperinflate/hyper-
oxygenate after each pass
19. Maintain asepsis throughoutMonitor patient throughout Note quality and quantity of secretions for charting
20. Nasotracheal suctioning Same preparation and similar procedure to endotracheal tube suctioning
Use lubrication on distal six inches of catheter
Insert tip into nostril in a posterior and medially direction
Do not aim catheter up!
May use catheter as a stethoscope while advancing towards trachea
21. Suctioning: Complications Hypoxemia
Atelectasis
Mucosal trauma
Arrhythmias Increased ICP
Laryngospasm and/or bronchospasm
Hypotension
Contamination and/or infection
22. By using good, aseptic technique, you will minimize the occurrence and severity of any complications