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Nebulizing & Suctioning
Laily Hidayati
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Nebulizing
Nebulization is a process of adding fine drops of
moisture or fine particles of medication to
inspired air The water or medication is usually broken up by
gas under pressure or by high-frequency
vibrations (ultrasonic nebulization).
Nebulization improves the clearance ofpulmonary secretions by altering the tracheo-
bronchial mucosa.
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Equipment
Aerosol Face Mask / Trach Mask / mouth
piece
Connective tubing
Nebulizer manifold
Normal saline
Medication as per doctor order
stethoscope
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Implementation
1) Gather all required equipment.
Check to ensure that all medications are available and
expiration dates are current.
2) Provide privacy and wash hands.
3) Place person in a comfortable sitting position in a
wheelchair or semi-fowler's position.
Diaphragmatic expansion and lung compliance are greater in this
position. This ensures maximal effectiveness of medication(aerosolized
particles) to the basilar areas of the lungs.
4) Wash hands.
5) Take person's heart rate before and after the treatment.
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Implementation
6) Add the prescribed amount of medication and saline to
the nebulizer.
7) Connect the tubing to the Nebulizer machine
8) Place the face mask on person and verbally encourage
him to breath deeply.
9) Observe for person's chest expansion.
10) Turn Nebulizer machine on.A fine mist from the device should be visible. Nebulization will
normally take 15-20 minutes.
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Implementation
11) On completion of the treatment, there may be
increased secretions and coughing. Encourage several
deep breaths.
The medication may dilate airways, facilitating expectoration of
secretions.
12)Assess for need to suction.
13)Record medication used, description of secretionsand amount suctioned.
Note tolerance of the treatment.
14)Change nebulizer filters every 6 months.
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SUCTIONING
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Suctioning
Used to clear the airway of excessive
secretions when the patient is unable to
clear the respiratory tract with coughing.
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Signs and symptoms
of excess secretions
1) Assess oral cavity:
gurgling noise on inspiration or expiration,
obvious oral secretions,
gastric secretions or vomitus in mouth, and
productive cough without expectorating
secretions from the mouth.
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Signs and symptoms
of excess secretions
2) Assess for lower airway obstruction:
coughing, secretions in the airway,
labored breathing,
restlessness or irritability,
unilateral breath sounds,
cyanosis,
decreased oxygen saturations or level of consciousness,
increased fatigue, dizziness,
increased pulse rate,
increased respiratory rate and/or elevated blood pressure.
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Three primary
suctioning techniques
1) Oropharyngeal suctioning-used when the patient
is able to cough effectively but is unable to clear
secretions by expectorating or swallowing.2) Nasotracheal suctioning-necessary when the
patient with pulmonary secretions is unable to
cough and does not have an artificial airway.
3) Tracheal suctioning-accomplished through anartificial airway. The artificial airway may be an
endotracheal or nasotracheal tube or it may be a
tracheostomy tube.
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Preparation
1) Assess lung sounds
Auscultating all lung fields for adventitious
sounds such as rhonchi, rales and orwheezing.
2) Assess the patients understanding of the
procedure
Remove excess secretions by one of the
primary suctioning techniques.
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Procedures
1. Verify MD/PA order as required for procedure. Some hospitals
require a physicians order to suction the trachea
2. Explain the procedure to the patient and the reason that it is tobe done. Explain how the procedure with help clear the airway
and relieve breathing problems and that temporary coughing,
sneezing, gagging, or shortness of breath is normal.
3. Gather equipment necessary to correctly perform the
procedure. Some facilities have commercially preparedsuctioning kits. Check what is available in your facility or check
procedural manuals for equipment lists.
4. Don gloves (nonsterile) and use mask or face shield as per
local policy.
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Procedures
5. Fill basin or cup with approximately 100 cc of water
6. Connect one end of connecting tubing to suction
machine. Check that equipment is functioning properly bysuctioning a small amount of water from basin
7. Turn on suction device. Set regulator to appropriate
negative pressure: wall suction, 80-120 mm Hg; portable
suction, 7-15 mm Hg for adults
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Oropharyngeal
suctioning
1. Attach suction catheter to connecting tubing. Remove oxygen
mask from patient if present. Nasal cannula or prongs may be
left in place while performing this type of suctioning.
2. Assist the patient to assume comfortable position for theprocedure. Usually this will be a semi-Fowlers position or
sitting upright. Proper positioning reduces stimulation of the
gag reflex, promotes patient comfort and aids in secretion
drainage.
3. Insert catheter into patients mouth. With suction applied, movethe catheter around the mouth, including the pharynx and the
gum line until secretions are cleared. If the catheter does not
have a suction control to apply intermittent suction, take care
not to traumatize oral mucosal surfaces with continuous
suctioning.
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Oropharyngeal
suctioning
Encourage the patient to cough. Coughing moves secretions from
the lower and upper airway into the mouth where they can be
easily suctioned.
Repeat suctioning as needed until the mouth is clear of excess
secretions.
Replace the oxygen mask if removed earlier.
Suction water from the basin through the catheter until the catheter
is cleared of secretions. Clearing secretions from the catheter andthe tubing before they dry reduces the possibility of transmission
of microorganisms and insures delivery of accurate suction
pressures.
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Oropharyngeal
suctioning
Place the catheter in a clean, dry area for reuse with the suction
turned off. If the patient has been taught to use the suction
catheter, leave the suction on and the catheter within reach of
the patient.
Dispose of water and clean the basin as per policy. Remove
your gloves and dispose of per local policy.
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Oropharyngeal
suctioning
NOTE: Oropharyngeal suctioning is usually
performed using a rigid plastic catheter with one large
and several small eyelets that mucous enters when
suction is applied. This type of catheter is called aYankauer or tonsil suctioning device. Alert patients
can be taught to use this device to control excess
secretions in the mouth.
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HAND SUCTION
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