Suction, Oxygen and Saturation Monitoring Leanne Turner Carol Lawrence Mandy Parker &

Why are we doing this training Liverpool long term suction pathway Audit results Issues with schools training Issues with equality of training Issues with machine maintenance Issues with maintenance training Issues with retraining Issues with poor technique Care Plans Impact on the child and family!!!

What will be covered today Professional responsibility Learning styles Teaching Suction- Training Pathway, package for training, assessment, good technique and suction maintenance Teaching Oxygen- Training Pathway, Package for training, assessment Teaching saturation monitoring OSCE assessment

Suction Teaching and assessment pathways NP suction Oral suction General Oral Suction/Oxygen training for school staff

Look at the Suction plan When do I need suction? When you can hear and feel secretions and I’m distressed by them When my saturations are low When I’m working harder with my breathing When I’m coughing but not clearing secretions How can you make suctioning easier for me? Explain to me what you are doing Talk to me as you do it so I know it is nearly over How do I get suctioned? Suction pressure– 150mmHg/ 20KPa I am suctioned via my tracheostomy. I use size 10 suction catheters down to a depth of 7.5. I sometimes require suction in my nose or mouth How often do I get suctioned when I’m well? This is vary variable as every day is different but if I’m unwell my secretions change in colour and are thicker What are my secretions like when I’m well? Loose white/clear secretions What machines can be used and where are they stored? Sam 12 - at home De Vilbiss - portable Contacts for suctioning   BME Alder Hey– Machine maintenance Telephone– 01512525293 Community nurses– Consumables/Training Telephone– 01512933593 Community respiratory Physiotherapist Telephone– 07824547864

Suction assessments and Care Plans Plans to reduce risk and effectiveness of technique Community respiratory physiotherapy team Suction and oxygen assessment Joint care planning with Oxygen nurse specialist Oxygen and Suction care plan This means:- Clear guidance for people teaching Child specific needs identified to personalise teaching

Stage 1 Training Suction awareness session Overview of anatomy Indications Hazards Respiratory Assessment Pressure setting Technique Practice of technique Machine maintenance including consumables STANDARDISED TEACHING PACKAGE NP & ORAL Presentation, Workbook (if required), OSCE & Competency Ax SUCTION MAINTAINENCE CHECKLIST STANDARD FOR BOTH

Stage 2 Training Mentoring of practice Monitoring Questioning/Challenging Correcting technique and improve knowledge Preparation for assessment using competency framework and OSCE as a guide

Assessment Suction competency framework- NP/Oral Practical Ax- OSCE assessment- NP/Oral COMPETENT VS GOOD QUALITY. We want good quality as this improves the child’s outcomes!!!!!!!!!!

What does good technique look like?

Common areas to look out for Hand washing No child preparation Depth Incorrect size catheter Repetitive catheter use Speed-NP Contamination Catheter at nose-NP Pressure Blind sweeping-Oral

Suction Maintenance Checklist Different Machines CQC Servicing Set ups- New equipment- new lids

Current New

Incidents with new lids Child without suction machine all day in school Child on holiday without suction machine for 4 days 2 children unable to set up and use machine on delivery of consumables Training Issue

Bending catheters make them hard to use Consumables. Where do you get them-CCNT/GP   How to store them- yankauer cover, catheters no pre attachment and avoid bending  Bending catheters make them hard to use Cover for infection control Wallace Tubing- change Weekly Filter- change 3 monthly Suction catheters- change after each use  Can use twice NP but must not touch anything in between. Never Mouth to Nose and avoid nose to mouth Yankauers- change daily Spares required to go into school/Respite/Out and about  Incase broken/ dropped

Leave on charge before going out Machine. Power light indicator.   Battery Charger/Car Charger-Importance of going out- no red.  Leave on charge before going out Checking power/Charging.  red light always flicks on when switched on but most not stay on Checking suction pressure- finger over end or kinking tube  Kinking tube handy for yankauer as no need to disconnect. Also infection control Adjusting suction pressure.  Do not press in the button just turn it otherwise it effects setting accuracy Ideal Pressure- 20KPa/150-160mmHg.- check and recheck Places where it might break (lid, right angle cold weather, tubing) Who to call if your machine is broken- BME/Community Equipment Stores/ CCNT  label will indicate who to ask. BME never in weekend so CCNT then

Never wash filters new or old system Cleaning. Bag- 40 degree washing machine.   Machine- wipe down warm soapy water  no excessive water just damp cloth. Care with filters as if wet or damp wont work Canister-full clean daily. New collection bottles do not wash filter connector. Empty when more than half full  Never wash filters new or old system Empty more than half full as will effect pressure if nearly full. Especially important when going out After use flushing- tap water.  sterile water no longer required.

Yearly update OSCE and Competency framework Suction Maintenance Checklist Retraining with identified training plan for individual after reassessment if not achieving competency