set-up : clock, coke bottle, ETT, ballard suction device, suction source.
BEFORE : coke bottle (=2L of volume) – approximate the size of your lung.
AFTER : how long to suction 2L of air out of a closed system (totally FLATTENED)? 15 seconds.
In a nutshell :
Benefit : rids the lung of secretions.
Risk : may cause atelectasis to varied extents depending on the patient’s pulmonary status.
The risk : benefit ratio approaches unacceptable level of risk when the lung has a propensity to want to collapse.
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The long winded version :
A long time ago, I read that when suction is initially applied on a closed system that has been connected since the last time the patient was suctioned, the initial insult of the “built-up suction back-pressure” (BUSBP) might be excessively high.
If the pressure had been set at -100cmH2O, the “built-up suction back-pressure” may be in the range of -250-300cmH2O.
Therefore, it was important to break the suction circuit before apply suction to the patient.
That article suggested / demonstrated that excessively negative pressures might collapse a lung.
In this case, the demo shows that a 2L coke bottle can be flattened in approximately 15seconds of normal continuous suctioning.
Most people I see suctioning are quick to suction the trachea but leave continuous suctioning on (~15 seconds) while they clear the line with NSS (normal saline solution).
THE SCENARIO :
Situation : Patient sounds junky.
Background : Patient has been in the hospital for 2days post-op. HD=2 POD=2
Assessment : Patient suctioned but “did not get anything.”
Recommendation : Start mucomyst.
THE LESSON :
Be wary of frivolous suctioning.
