The technique of aspiration sanitation of the upper respiratory tract. Technique for sucking mucus from the respiratory tract of a newborn Suction of mucus from the upper respiratory tract algorithm

Greater attention is required to combat blockage of the respiratory tract. It is necessary to periodically wipe the patient's mouth and pharynx with a swab, prevent the tongue from falling, systematically suck the mucus from the pharynx and trachea with a catheter inserted through the mouth or nose.

To suction mucus from the upper respiratory tract, a conventional catheter is used, from the trachea - Timanovsky, both of which are connected to a vacuum electric suction. Previously, 10 minutes before the start of suction, a 1.5 - 2% solution of soda or trypsin is injected into the trachea to thin the mucus. If there are no contraindications, every 2 hours the patient is turned in bed.

Of great importance is the so-called drainage with an inclined position, which aims to promote the outflow of liquid contents from the deep respiratory tract to the beginning of the trachea, for which the head end of the bed is set 30-35 ° below the foot end. The desired position can be created by lifting the foot end of the bed onto a chair. The body of the patient is strengthened with straps to the back of the bed.

Depending on the indications, the patient is placed in a drainage position in various positions (on the stomach, on the side). The position of the drainage is set 2 times during the day for 1 - 2 hours.

Conduct active "pulmonary therapy": chest massage - during the exhalation period, light tapping of various parts of the chest with a fist in the palm of your hand or directly with your hands with relaxed wrists, measures to manually increase the cough shock in order to improve coughing, usually weakened in these patients.

To do this, when the patient tries to clear his throat, on his own or at the suggestion of a doctor (the patient can be taught to clear his throat), immediately after the end of the initial breath, one after the other, a quick and vigorous vibrating compression of the chest - its upper part, if the patient lies on his side, or lower lateral, if he lies on his back. This procedure is repeated 4-8 times a day and each time ends with the suction of mucus from the respiratory tract.

If these measures are not enough and the airway patency for air is not completely restored (and in cases of severe acute respiratory failure immediately, without wasting time on not always reliable attempts at conservative treatment), a tracheostomy should be applied.

A tracheostomy creates the possibility of free access to the airways for their drainage, which is extremely important if it is necessary to re-suction. With tracheostomy, in addition, the "dead" space of the respiratory tract is significantly reduced, due to which the conditions for gas exchange improve, the resistance in the tracheobronchial system to inhaled air decreases, the work of breathing is facilitated, and alveolar ventilation improves.

Although tracheobronchial obstruction is a direct indication for tracheostomy, it is also indicated for ventilation disorders that are not associated with airway obstruction. In the presence of a tracheostomy, artificial respiration can be connected at any time.

The inflatable cuff on the tracheostomy cannula isolates the deep airways and prevents the contents of the pharynx from entering them and aspiration of vomit, reduces the risk of gastric lavage, if necessary, and the introduction of food to the patient.

However, it must be emphasized that the tracheostomy operation requires the participation of an experienced surgeon, and in the subsequent period - appropriate conditions for caring for such a patient, which is very important. If these possibilities are not available on the spot, the patient needs to be intubated, since special conditions are not required for this. Each physician should be able to insert an endotracheal tube at the appropriate time.

In those cases of acute respiratory failure, when the need for prolonged (more than a day) use of artificial respiration is not expected, intubation can also be performed.

"Emergency conditions in the clinic of internal diseases",
S.G. Weissbane

Airway sanitation algorithm

General information: Sanitation is carried out from the nose, oropharynx, trachea and bronchi. To perform the procedure, individual aspirators, a rubber balloon with a soft tip, and aspirators are used. The most effective suction with aspirators using catheters.

Target: remove pathological contents from the upper respiratory tract.

Indications: the inability of the patient to independently remove pathological contents from the respiratory tract.

Contraindications:

1) nosebleeds;

2) convulsive syndrome.

Complications:

1. hypoxemia;
2. atelectasis;
3. tissue injury;
4. infection;
5. prolapse of the endotracheal tube from the lumen of the trachea;
6. cardiac arrhythmias.

Workplace equipment:

1) electric pump and connecting tubes;

2) oxygen supply system;

3) sterile aspiration catheter;

4) sterile solution for moistening the catheter (0.9% sodium chloride solution or distilled water)

5) sterile material (gauze wipes) in a package or bix;

6) sterile tweezers;

7) tweezers for working with used tools;

8) equipment tray;

9) tray for used material;

10) gloves, mask;

11) manipulation table;

12) antiseptic for the treatment of hands;

13) containers with a disinfectant solution for disinfecting the apron, surfaces and used equipment.

Execution sequence:

Preparatory stage of the manipulation.

1. Wear appropriate clothing (hat, robe, apron).
2. Wash hands under running water, lathering twice, dry with a disposable napkin (individual towel).
3. Carry out hygienic hand antisepsis and put on gloves, after checking them for integrity.
4. Prepare the manipulation table for work.
5. Prepare medicines, put the necessary equipment on the table.
6. Put the necessary accessories on the tray. Unpack the package with the catheter, having previously checked the tightness and expiration date, remove the catheter from the package with tweezers, check its integrity.
7. Fill the jar-collector of the electric suction with a disinfectant solution, check the readiness of the electric suction for operation (pressure in the system is 0.2-0.4 atmospheres, tightness of fastening).

The main stage of the manipulation.

1. For the rehabilitation of the upper respiratory tract, attach the catheter to the suction connecting tube of the electric suction (put the inserted end of the catheter into the hand on a napkin, connect its other end to the electric suction).
2. Transfer the catheter with a gauze pad to the right hand and take it like a writing pen at a distance of 3-5 cm from the insertion end.
3. Moisten the catheter.
4. For sanitation through the mouth: insert the catheter into the oral cavity without touching the posterior pharyngeal wall.
5. For sanitation through the nose: insert the catheter, gently moving it forward and down 4-6 cm through the lower nasal passage using rotational movements in places of resistance. The suction catheter may be without a vacuum trap.
6. Connect the electric suction and produce intermittent aspiration for 5-15 seconds, depending on the age of the patient. Sanitization is repeated until the content is completely removed.
7. Quickly remove the catheter. Seriously ill patients should be given humidified oxygen.
8. Assess the nature and extent of the aspirated content. As prescribed by the doctor, send the material to the microbiological laboratory for sowing.

The final stage of the manipulation.

1. Rinse the catheter in a container and soak with a disinfectant solution, then place it in a container with waste.
2. Disinfect the collection vessel, plastic and rubber parts that have come into contact with the suction liquid. It is allowed to remove the lid from a filled collection vessel and empty the contents only in a specially designated room.
3. Remove gloves and place them in a container with disinfectant.
4. Wash and dry hands, treat with cream if necessary.
5. Note in the case history the time and frequency of sanitation, the nature of the contents, the patient's reaction.

Mucus suction is carried out from the moment the head is born by a doctor or midwife. At all stages, the rules of asepsis and antisepsis are strictly observed in order to avoid infection of the respiratory tract. The contents of the trachea are removed after intubation.

2) sterile disposable catheter or rubber balloon; 3) set for intubation.

1. 
   After the birth of the fetal head, attach the catheter to the electric suction.
2. 
   Turn on the electric pump.

1. 
   Insert the catheter alternately into the nose, mouth and pharynx of the newborn.
2. 
   During the sanitation of the mouth and pharynx, the catheter advances to a depth of 5-7 cm, with the duration of one suction manipulation up to 30 seconds, and then after giving oxygen, it can be repeated. More thorough suction is performed after the birth of the fetus.
3. 
   Do not hold the catheter in one place for a long time, so as not to injure the respiratory mucosa.

The final stage.
6. Switch off the electric pump.

Prevention of gonoblenorrhea in a newborn.
Prevention of ophthalmoblenorrhea is mandatory, since the possibility of infection of the eyes of a newborn when it passes through the birth canal is not ruled out. Eye damage by gonococci leads to serious consequences, including blindness.
Indications: 1) prevention of gonoblenorrhea in a newborn.

Workplace equipment:

3) a sterile package for the primary treatment of a newborn;

4) sulfacetamide (30% sodium sulfacyl solution).

1. 
   Take sulfacetamide (30% sodium sulfacyl solution) and carefully read the label on the vial.
2. 
   View the date and hour of opening the vial.
3. 
   Open cork.
4. 
   Put on an apron, wash your hands under running water for 1-3 minutes. with soap, then dry them with a sterile cloth. Treat hands with an antiseptic for 3-5 minutes. Put on a sterile mask, sterile gown and gloves.

The main stage of the manipulation.

1. 
   Cover the disinfected tray for receiving a newborn with two sterile diapers.
2. 
   Put the born child on a tray placed at the feet of the mother on Rakhmanov's bed.
3. 
   After sucking the contents from the upper respiratory tract of the newborn, wipe his eyelids from the outer corner to the inner with a dry gauze ball (for each eye separately).
4. 
   Take a sterile pipette from the unwrapped package for the initial treatment of the newborn.
5. 
   Take two sterile gauze balls, lift the upper eyelid, slightly pulling it up, and the lower eyelid is slightly pulled down.

sodium).

3 drops of sulfacetamide (30% sodium sulfacyl solution), not

touching the eyes, and for girls to drip on the external genitalia.

The final stage.

12. Manipulation is repeated after 2 hours, using another

sterile pipette.

Work with one opened vial no more than 12 hours.

Primary processing of the umbilical cord.
During the primary treatment of a newborn, it is very important to observe measures to prevent nosocomial infections in obstetric hospitals.
Indications: 1) live newborn.

Workplace equipment: 1) a disinfected tray for receiving a newborn; 2) two sterile diapers;

3) a disposable sterile catheter for sucking mucus from a newborn; 4) a sterile package for the primary treatment of the umbilical cord: 3 Kocher clamps, 2 sticks with cotton wool, 1 medical scissors, sterile gauze balls; 5) ethyl alcohol 70°;

6) iodine (1% iodonate solution); 7) obstetric instrumental table.
Preparatory stage of the manipulation.

1. 
   Cover the decontaminated delivery tray with two sterile diapers.
2. 
   Put a disposable sterile catheter on the tray to suction the mucus from the newborn.
3. 
   Remove a sterile bag from the bix for the primary treatment of the umbilical cord (unfold it when the baby is born), put the bag on the tray.
4. 
   Put iodine (iodonate 1%), ethyl alcohol 70 º on the obstetric table - check and open the vials.
5. 
   Put on an apron, wash your hands with soap and running water for 1-3 minutes. Dry your hands with a sterile cloth, treat them with an antiseptic for 3-5 minutes. Put on a sterile mask, gown and gloves. Treat gloves with ethyl alcohol 70º.

The main stage of the manipulation:

1. 
   Put the born child on a tray covered with sterile diapers, placed at the mother's feet on Rakhmanov's bed, suck the mucus from the upper respiratory tract with a sterile catheter using an electric suction, while aspirating amniotic fluid or meconium - from the esophagus and stomach.
2. 
   Apply one Kocher clamp on the umbilical cord at a distance of 10 cm from the umbilical ring, the second - 8 cm from the umbilical ring, the third clamp - as close as possible to the external genital organs of the woman in labor.
3. 
   Treat the section of the umbilical cord between the first and second Kocher clamp with a cotton swab with ethyl alcohol 70º and cut the umbilical cord with scissors.
4. 
   Smear a section of a child's umbilical cord stump with a solution of iodine (iodonate 1%).

The final stage.

10. Show the child to the mother, pay attention to the gender of the child and

congenital malformations, if any.

11. Put the baby on the mother's stomach, cover it with sterile

diaper and blanket.

Secondary treatment of the umbilical cord

When reprocessing the umbilical cord, it is very important to follow measures to prevent nosocomial infections in obstetric hospitals.

2) a sterile package for the secondary processing of the umbilical cord: two sticks with cotton wool, scissors, cotton balls, gauze wipes, a disposable sterile bracket; 3) ethyl alcohol 70°; 4) 5% solution of potassium permanganate.

1. 
   Remove the package for the secondary processing of the umbilical cord with a sterile forceps from the bix.
2. 
   Place the umbilical cord reprocessing kit on the changing table, opening it slightly.
3. 
   Remove gloves and put them in a container with disinfectant. Wash your hands under running water with soap for 1-3 minutes, dry them with a sterile cloth, treat your hands with an antiseptic for 3-5 minutes. Put on sterile gloves, treat them with ethyl alcohol 70 °.

The main stage of the manipulation.

1. 
   Put the newborn in a sterile diaper on the changing table.
2. 
   Using a sterile gauze wipe, squeeze the cord residue from the base to the periphery and wipe it with a gauze ball moistened with 70 ° ethyl alcohol.
3. 
   Apply a disposable sterile bracket at a distance of 0.5 cm from the umbilical ring.
4. 
   With sterile scissors, the umbilical cord is cut off 5 mm above the superimposed bracket.
5. 
   The cut surface, the base of the umbilical cord and the skin around the umbilical residue are treated with a cotton swab moistened with 5% potassium permanganate solution.
6. 
   In case of Rh-negative blood in the mother, isosensitization of the mother according to the ABO system, voluminous umbilical cord, as well as premature and underweight children, newborns in serious condition, when the vessels of the umbilical cord may be needed for repeated infusion therapy, a disposable bracket should be applied to the umbilical cord at a distance of 4 cm from umbilical ring and cut off 5 mm above the bracket. After treating the umbilical residue with a 5% solution of potassium permanganate, a sterile triangular gauze bandage is applied to it.

Anthropometry of the newborn.
Anthropometry of a newborn is important for establishing the degree of term of a newborn.

Indications: 1) childbirth.
Workplace equipment: 1) changing table; 2) tray or electronic scales; 3) a sterile package for the secondary treatment of the newborn, where the centimeter tape is located.
Preparatory stage of the manipulation.

1. 
   Check the correct operation of the tray scales.
2. 
   Wash hands under running water with soap for 1-3 minutes, dry them with a sterile cloth, treat with an antiseptic for 3-5 minutes.
3. 
   Put on sterile gloves, treat them with ethyl alcohol 70 °.
4. 
   With sterile cotton swabs moistened with sterile vaseline oil from an individual bottle, gently remove the original lubricant, mucus, blood, meconium from the head and body of the child.

The main stage of the manipulation.

1. 
   The head circumference is measured with a sterile tape - along the line passing through the frontal tubercles and the back of the head in the region of the small fontanel.
2. 
   The circumference of the chest is measured with a centimeter tape along the line of the nipples and armpits.
3. 
   The height of the child is measured with a tape from the occiput to the calcaneus.
4. 
   A newborn, wrapped in a sterile diaper, is weighed in a tray or electronic scales.

The final stage.

1. 
   After weighing the child on a tray scale in a sterile diaper, subtract the weight of the diaper.
2. 
   The obtained data of anthropometry are recorded in the history of the development of the newborn.

Filling "bracelets" and "medallion" for the newborn.
Indications: 1) the availability of information about the newborn.
Workplace equipment: 1) bracelets and medallions;

2) antiseptic.

1. 
   Remove a sterile bag with bracelets and a medallion from the bix with a forceps.
2. 
   Treat gloved hands with an antiseptic.

The main stage of the manipulation.

1. 
   Write on the bracelets (2 pcs) and medallion: number of the mother's birth history, last name, first name, mother's patronymic, date, time of birth, child's sex, weight and height, clearly write the midwife's last name, first name, patronymic.
2. 
   Let the mother's bracelets and medallion be read.
3. 
   Treat your hands with an antiseptic for 3-5 minutes.
4. 
   Tie bracelets to the child's hands.
5. 
   After swaddling the newborn, tie a medallion over the blanket.

The final stage.
8. Place the child in an individual bed.
Swaddling a newborn in the delivery room.
Swaddling a newborn in the delivery room is carried out in warm sterile diapers and a blanket.

Indications: 1) swaddling a newborn.

Workplace equipment: 1) a sterile bag for swaddling a newborn (3 diapers and a blanket); 2) changing table;

3) antiseptic, ethyl alcohol 70°; 4) apron; 5) sterile gloves; 6) baby bed; 7) sterile gown.

1. 
   Using a sterile forceps, take out the baby changing bag and place it on the changing table.
2. 
   Put on a disinfected apron.
3. 
   Wash your hands under running water with soap for 1-3 minutes, dry your hands with a sterile cloth, treat them with an antiseptic for 3-5 minutes, put on a sterile gown, sterile gloves and treat them with 70 ° ethyl alcohol.

The main stage of the manipulation.

1. 
   Lay out the diapers on the changing table in the following sequence: a blanket, on top of it one diaper is like a duvet cover, the second is like a diaper, the third is like a scarf.
2. 
   Put the newborn on warm diapers and swaddle - first at the beginning with a diaper diaper, then with a diaper-scarf, with the ends on the sides of the chest, the third - swaddle the torso - like a duvet cover, and in the hot season, like a blanket.
3. 
   Tie a medallion over the blanket, first give it to his mother to read.

The final stage.

1. 
   Place the child in an individual bed.
2. 
   Remove gloves, robe, apron.
3. 
   Place the bathrobe in an oilcloth bag for used linen
4. 
   Place gloves and apron in a container with a disinfectant.

Carrying out resuscitation measures depending on the condition of the newborn.

Strategically important in the course of primary resuscitation should be the desire of personnel to achieve the highest possible assessment of the state of the newborn child on the Apgar scale by the 5th minute of life. This is due to the fact that, among numerous factors, the value of the Apgar score at the 5th minute has a significant impact on the severity of the child's condition in the postresuscitation period and the likelihood of developing neurological consequences of hypoxia.

Indications: 1) asphyxia of the newborn.
Workplace equipment: 1) resuscitation table with obligatory heating; 2) warm diapers; 3) equipment that regulates the concentration and flow of oxygen; 4) heater and humidifier of the air-oxygen mixture; 5) electric pump;

6) mucus suction catheters; 7) laryngoscope (with blades No. 1, No. 2); 8) endotracheal tubes (No. 2.0; 2.5; 3.0; 3.5); 9) face masks in two sizes; 10) air ducts; 11) equipment for artificial lung ventilation; 12) a set for catheterization of the umbilical vein (umbilical catheters, scissors, tweezers, silk ligatures);

13) pulse oximeter; 14) electric thermometer; 15) gloves;

16) syringes; 17) stopwatch; 18) medicines:

epinephrine (0.1% adrenaline solution), 0.1% atropine solution, 4% sodium bicarbonate solution, 0.9% sodium chloride solution, 5%-10% albumin solution, dextrose (5%, 7.5%, 10 % glucose solution),

10% calcium gluconate solution, glucocorticoid drugs (prednisolone, hydrocartisone).

Preparatory stage of the manipulation.

1. 
   The air temperature in the ward for resuscitation should be at least 25 ° C all the time. In case of preterm birth, a temperature of 28°C is desirable.
2. 
   The presence of warm diapers for the reception of the child.
3. 
   The place of reception of the child and the surface of the table for primary resuscitation must be pre-warmed.
4. 
   The flask must have a temperature of at least 36°C.
5. 
   The air-oxygen mixture must be humidified and have a temperature not lower than 32-34°C.
6. 
   Prepare for artificial lung ventilation, laryngoscope, electric pump, pulse oximeter and sphingomanometer for work.
7. 
   The umbilical vein catheterization kit and the drug kit should be in drug packs that allow their immediate use.

Lay the child on a hard surface. To restore airway patency, tilt your head back as much as possible (if there is no injury to the spine or head). Push the lower jaw forward and open the child's mouth. Clear the oral cavity and pharynx from mucus, vomit and foreign bodies using a napkin, a rubber bulb or an electric suction for this.

STATE EDUCATIONAL INSTITUTION

SECONDARY VOCATIONAL EDUCATION

MEDICAL COLLEGE №4

OF THE DEPARTMENT OF HEALTH OF THE CITY OF MOSCOW

Intermediate certification

by academic discipline:

"Nursing in Pediatrics"

Specialty 060501 "Nursing" -51

(secondary vocational education of basic training)

Course 5 semester

1 .Spasmophilia (tetany) is a disease characterized by a tendency of a child of the first 6-18 months to convulsions and spastic conditions and is pathogenetically associated with rickets.

Etiopathogenesis. The disease develops as a result of taking large doses of vitamin D or in early spring, when hyperproduction of vitamin D in the skin occurs with increased insolation.

Large doses of active vitamin D suppress the function of the parathyroid glands, stimulate the absorption of calcium and phosphorus salts in the intestines and their reabsorption in the renal tubules, resulting in an increase in the alkaline reserve of the blood, and alkalosis develops. Calcium begins to be intensively deposited in the bones, which leads to hypocalcemia and increased neuromuscular excitability, convulsions occur.

Clinic. There are latent (latent) and explicit forms of spasmophilia.

With a latent form, children are outwardly practically healthy, psychomotor development is within the limits of age characteristics; almost always they have symptoms of rickets, most often in

recovery period. The latent form of spasmophilia can be diagnosed using a number of symptoms: Khvostek's symptom - with a slight tapping of the cheek between the zygomatic arch and the corner of the mouth on the corresponding side, the mimic muscles of the face contract; Trousseau's symptom - when squeezing the neurovascular bundle on the shoulder, the hand convulsively contracts, taking the position of "obstetrician's hand"; Lust's symptom - tapping with a percussion hammer below the head of the fibula causes rapid abduction and plantar flexion of the foot.

Latent spasmophilia is common and under the influence of provoking factors (crying, vomiting, high fever, infectious disease, fear), it can turn into an explicit one.

Overt spasmophilia can manifest as laryngospasm, carpopedal spasm and eclampsia, sometimes combined.

laryngospasm("rodimchik") - acutely advancing narrowing of the glottis. It occurs suddenly when crying or fright and proceeds with partial or complete closure of the glottis. It is manifested by a sonorous or hoarse breath (“cock crow”), while a frightened facial expression, cyanosis, and cold sweat are noted. With a pronounced spasm of the larynx, complete cessation of breathing and loss of consciousness occur. The attack ends with a deep sonorous breath, breathing is gradually restored and the child falls asleep. Usually an attack of laryngospasm lasts from a few seconds to 1-2 minutes and is repeated several times a day. In the most severe cases, death is possible.

Carpopedal spasm observed more often in children after a year, manifested in the form of tonic convulsions of the hands, feet, face. The hands take the position of the "obstetrician's hand", the feet - the position of sharp bending. The spasm can last for several minutes, hours, days. With prolonged spasm, swelling appears on the back of the hands and feet. Often there is a spasm of the circular muscles of the mouth ("fish mouth"). In rare cases, there may be tonic convulsions of the respiratory muscles, smooth muscles of the bladder, intestines, bronchospasm.

A rare but most dangerous form of spasmophilia is eclampsia, manifested in clonic-tonic convulsions that occur with loss of consciousness. In mild cases, an attack is manifested by a sudden blanching of the face, numbness, twitching of mimic muscles. A severe attack also begins with twitching of the muscles of the face, then the convulsions spread to the neck, limbs, covering all large muscle groups, including the respiratory muscles. Breathing becomes intermittent, sobbing, cyanosis appears. From the very beginning of the attack, the child loses consciousness. There is an involuntary discharge of urine and feces. The duration of the attack is from a few seconds to 20-30 minutes, the convulsions gradually subside, and the patient falls asleep. Sometimes attacks follow one after another. During an attack

respiratory and cardiac arrest may occur. Eclampsia is more often observed in children of the 1st year of life.

Diagnostics. It is important to take into account the age of the child (up to 2 years), signs of rickets, season, indication of improper feeding. The diagnosis is confirmed by the presence of hypocalcemia in combination with hypophosphatemia, alkalosis in the blood.

Treatment. In case of an attack of laryngospasm and general convulsions in a child, it is necessary to provide emergency care (see section "Emergency care")

The child is hospitalized after the disappearance of seizures. With manifestations of spasmophilia, the child is prescribed a plentiful drink in the form of weak tea, berry and fruit juices. It is advisable to transfer a child who is bottle-fed to feeding with expressed donor milk. If this is not possible, it is necessary to limit the content of cow's milk in the diet as much as possible (due to the large amount of phosphates) and increase the amount of vegetable complementary foods.

It is mandatory to use calcium preparations (calcium gluconate, 10% calcium chloride solution). It is necessary to limit as much as possible or perform very carefully all procedures that are unpleasant for the child, which can cause a severe attack of laryngospasm.

3-4 days after the seizures, anti-rachitic treatment is carried out. Assign 10% ammonium chloride solution (to create acidosis).

Task

1. Fever (without spasm of peripheral vessels).

2. Algorithm of actions of a nurse:

a) call a doctor to diagnose and hospitalize the child.

b) lay, open;

c) wipe the skin with a sponge moistened with water at room temperature (20-24 ° vodka-vinegar rubdown for 2-3 minutes;

d) cold compress on the forehead, the area of ​​large vessels;

e) as prescribed by a doctor, give paracetamol at an age dose orally or enter a lytic mixture, which includes a 50% solution of analgin 0.1 ml / year and 1% solution of diphenhydramine 0.1 ml / year;

In the conditions of a medical organization and at home, there are patients in whom sputum and mucus block the path of air movement necessary for breathing. In some cases, these secrets can accumulate in the nose, mouth, larynx and trachea.

If the evacuation of the secret from the oral cavity can be performed by mechanical emptying of the respiratory tract with a napkin that is worn on a finger or spatula, then it is almost impossible to perform a similar mechanical emptying of the nose, larynx and trachea.

This problem is especially relevant for patients with strokes and swallowing dysfunction, with other neurological pathologies, after a number of surgical interventions. In this regard, the most appropriate would be the use of devices that aspirate (suck off) sputum.

Currently, the range of such devices is quite large. One example is the ATMOS series of aspirators, which can be used in a medical organization and at home. These devices have small overall dimensions and weight, the ability to operate from a mains or battery, high aspiration rate, ranging from 16 to 25 l/min.

The aspiration procedure requires special and rather simple training of a nurse and / or relatives of the patient. It is advisable to perform the first aspiration procedures for a particular patient not by one, but by two medical workers in order to be able to warn the patient about possible discomfort, support and calm him, and give him the opportunity to adapt.

If necessary, one medical worker will be able to carry out the aspiration procedure, and the second one will measure the pulse, blood pressure, support the patient during the manipulation, etc.

The causal factors leading to an increase in the population of patients with tracheostomies are combined injuries of the hollow organs of the neck, post-intubation stenosis of the larynx and trachea, various surgical interventions on the organs of the neck, malignant neoplasms of the upper respiratory tract, severe somatic diseases that disrupt vital functions - breathing and eating, requiring prosthetics of the respiratory and digestive tract.

Despite the success of laryngotracheal surgery, a significant number of patients are forced to use a tracheostomy constantly due to the impossibility or ineffectiveness of surgical restorative treatment.

The presence of a tracheostomy is a source of danger for the patient, and in the absence of proper care and medical monitoring, it can pose a direct threat to life. In tracheostomy patients, along with aspiration, in some cases, periodic replacement of tracheostomy tubes and their cleaning are required.

Nasotracheal and orotracheal aspiration

Target: release of the nose, mouth and trachea of ​​the patient from mucus, sputum, preventing normal breathing.

Indications: violation of the evacuation of mucus and sputum from the respiratory tract.

Possible Complications

Would need: vacuum suction (aspirator), sterile suction catheter, gloves (sterile for the hand that manipulates the sterile catheter), garbage bag, protective mask, goggles, disposable apron, gown, sodium chloride solution 0.9%, sterile gel - lubricant (for example, "Katejel"), a garbage bag, if necessary, a nebulizer for subsequent inhalation.

• The patient is placed in the “sitting” or “half-sitting” position (half-Fowler position), the essence of the procedure is explained to him, instructions are given on how to behave, attention is drawn to the fact that each aspiration takes no more than 10-15 seconds and is not dangerous. If necessary, removable dentures can be temporarily removed.

• Ask the patient to take 5 deep breaths, using oxygen if possible.

• Lubrication gel should be applied to the tip of the catheter to improve the passage of the catheter into the nose and mouth of the patient, while inhaling, insert the catheter into the mouth, and later into the nose of the patient (if nasal breathing is difficult and the mouth is filled with mucus, the patient may be afraid that he will suffocate, therefore aspirations begin from the oral cavity) to a depth of no more than the distance from the tip of the nose to the earlobe of this patient and turn on the aspirator.

• Remove the catheter using rotating movements without stopping aspiration, while trying not to touch the palate, uvula, tongue of the patient, so as not to cause nausea and vomiting.

• Perform auscultation of the lungs to make sure that breathing is carried out to all parts of the lungs. If a patient with obstructive pulmonary disease develops dry wheezing, then it can be recommended to inhale a bronchodilator solution through a nebulizer.

Tracheostomy aspiration

Target: release of the lower part of the larynx and trachea of ​​a patient with a tracheostomy from mucus, sputum, which prevent normal breathing.

Indications: violation of the evacuation of mucus and sputum from the respiratory tract in a tracheostomy patient.

Possible Complications: bleeding from the nose or nasopharynx, damage to the trachea, hypoxia, cardiac arrhythmia (including brady- or tachycardia), suffocation, nausea, vomiting, cough, infection in the respiratory tract.

Would need: vacuum suction (aspirator), sterile suction catheter, gloves (sterile for the hand that manipulates the sterile catheter), garbage bag, protective mask, goggles, disposable apron, gown, sodium chloride solution 0.9%, sterile gel -lubricant (for example, "Katejel"), a garbage bag, if necessary, a nebulizer for subsequent inhalation and a pressure gauge to control the air in the cuff of the tracheostomy tube.

Algorithm for performing manipulation

• The patient is placed in the “sitting” or “half-sitting” position (half-Fowler position), the essence of the procedure is explained to him, instructions are given on how to behave, attention is drawn to the fact that each aspiration takes no more than 10-15 seconds and is not dangerous.

• The medical worker or relative of the patient puts on a gown and / or a disposable apron, disposable gloves, a mask, goggles.

• The suction catheter is attached to the aspirator, the aspirator is set to a suction power of 80-120 mm Hg. Art. or up to 0.4 bar in adults and up to 0.2 bar in children and adolescents.

• Drop a few drops of 0.9% sodium chloride solution into the tracheostomy tube to thin the secretion.

• Insert the tip of the catheter to a depth not exceeding the length of the tracheocannula.
• Remove the catheter using a twisting motion while continuing to aspirate.
• If necessary, repeat aspiration using a different catheter to prevent spread of infection.
• Have the patient rinse their mouth with water or mouthwash.
• After aspiration, flush the tubing system with an antiseptic solution.
• Assess the volume of the aspirate and write it down in a temperature sheet or diary of observations of the patient.

• Perform auscultation of the lungs to make sure that breathing is carried out to all parts of the lungs. If a patient with obstructive pulmonary disease has dry wheezing, then it can be recommended to inhale a bronchodilator solution through a nebulizer attached to a tracheostomy tube.

• Remove disposable apron, mask, gloves, wash your hands.

Cleaning the tracheal cannula

Target: cleaning the tracheocannula from mucus, sputum, blood for its further use.

Indications: contamination of the tracheocannula with mucus, sputum, blood and other foreign components that create conditions for disturbing the movement of air through it.

Possible Complications

Would need: spare tracheal cannula (in case of damage to the tracheal cannula to be replaced), cleaning container, cleaning brush (brush), antiseptic, tracheostomy oil or ointment, tap with running water.

Algorithm for performing manipulation

• Remove the tracheal cannula using running water and a brush to remove surface debris.

• Place the inner and outer tracheal cannulas in a container with a washing antiseptic solution, leave them for 10 minutes.

• Rinse the cannulas of the cleaning solution under running water.
• Treat the tracheostomy with tracheostomy oil or ointment.
• Insert the cannula into the stoma.

• If bleeding occurs as a result of trauma to the trachea due to inaccurate manipulations, it is advisable to consult the patient with an otorhinolaryngologist. If the bleeding is profuse, then before examining a specialist, the patient is placed on the stomach with the head end lowered to prevent blood from entering the bronchial tree.

• If suffocation occurs during the installation of a tracheostomy, it is advisable to ask the patient to cough up to eliminate the phenomenon of blockage of the airways, if coughing does not bring a positive result, then you need to remove the internal cannula to check its patency.

• Wash your hands.

Trache cannula replacement

Target: change of a tracheal cannula that has become unusable.

Indications: unsuitability of the tracheocannula for further use.

Possible Complications: bleeding from the trachea, damage to the trachea, blockage of the tracheostomy tube and the development of hypoxia.

Would need: tracheal cannula, fixing bandage, sterile tracheostomy wipes (1-, 2- or 3-layer), 10 ml syringe, oil or ointment for tracheostomy, 0.9% sodium chloride solution, gauze wipes.

Algorithm for performing manipulation

• The patient is placed in the “sitting” or “half-sitting” position (half-Fowler position), the essence of the procedure is explained to him, and instructions are given on how to behave.

• In the first step, the airway is aspirated during the cannula change to secure the airway.

• The cannula is removed. If it is blocked, careful attempts are made to remove the block and remove the cannula.

• The tracheostomy is cleaned with sterile wipes soaked in 0.9% sodium chloride solution or special wipes for cleaning the tracheostomy.

• It is necessary to check the reliability of fixation of the tracheostomy cannula so that it does not fall out of the stoma, but is removed only when necessary.

• To replace the cannula, sterile wipes with a Y-shaped incision are placed under her ears. Oil or ointment for treating the tracheostomy tube is placed on the surface of the cannula. It is necessary to stretch and hold the tracheostomy opening with two fingers, then insert the cannula, following its curves and being careful. Attach the fixation straps to the neck and check the fixation of the cannula. The cannula fixing bandages should be stretched between the skin of the neck and the ties so that 1 finger can be inserted.

• Wash your hands.

Thus, performing nasotracheal, orotracheal, and tracheostomy suction with special devices, as well as caring for a tracheostomy, are essential skills for a nurse, which she can teach to relatives of the patient who provide care at home.