1. Suction Devices in the Hospital
FOCUS Fall
Bally’s Las Vegas
Oct. 1-3, 2013
Andy Brown RRT-NPS
Clinical Product Manager
Precision Medical Inc.
Northampton, PA
Suction Devices in the Hospital
Myths and Facts

2. Welcome

3. Disclosure I am the Clinical Product Manager for Precision Medical
Precision Medical manufactures suction equipment
Home
Hospitals
I have no other conflicts of interest

4. A Brief History Of Suction
Airway suction was once described as a “surprisingly simple technique” (Thompson, 1936) .
In 1959, Boba et al studied the effects of endotracheal suctioning in paralysed patients. They reported that severe hypoxia resulted from suctioning for one minute.
Shumacker et al (1951), Keown (1960) and Marx et al (1968) reported cardiac arrest associated with endotracheal suction.
1 This was around the time that the vacuum cleaner was invented and people were looking for differrent applications in terms of the technology involved and equipment used, it is. However, there are many variables associated with suctioning which affect the degree of trauma to the patient. It is vital that medical, nursing and paramedical staff using this procedure appreciate the possible dangers accompanying it and modify their approach accordingly.
2 Using manometric techniques to measure blood oxygen saturation, they reported that severe hypoxia resulted from suctioning for one minute. The incidence and degree of hypoxia were not significantly different from those obtained during a similar period of apnea without suctioning.
3 Rosen and Hillard (1962) stated that deaths during suctioning procedures have not been reported as often as personal inquiries indicate that they happen. They feel that an important cause of sudden death during suction might be an increased venous return on a hypoxic or diseased heart. They also recognise that cardiac arrest may arise from the stimulation of respiratory tract reflexes, although the part they play in endotracheal suction was difficult to determine.

5. A Brief History Of Suction
Rosen and Hillard (1962) stated that deaths during suctioning procedures have not been reported as often as personal inquiries indicate that they happen.
“cardiac arrest may arise from the stimulation of respiratory tract reflexes,”
In 1984, Kergin et al., Using oximetry, again reported reduction in blood oxygen saturation during suctioning.
1 The non-infrequent occurrence of cyanosis during endotracheal suctioning, and occasional deaths attributable to the procedure, prompted studies of the subject

6. Gas System Risk Levels and Requirements
Level 1 Medical Piped Gas and Vacuum Systems.
Systems serving occupancies where interruption of the piped medical gas and vacuum system would place patients in imminent danger of morbidity or mortality.
Level 1 Vacuum System. A system consisting of central- vacuum-producing equipment with pressure and operating controls, shutoff valves, alarm warning system, gauges, and a network of piping extending to and terminating with suitable station inlets at locations where patient suction could be required.
Level 2 Medical Piped Gas and Vacuum Systems. Systems serving occupancies where interruption of the piped medical gas and vacuum system would place patients at manageable risk of morbidity or mortality.

7. Gas System Risk Levels and Requirements (Continued)
Level 3 Compressed Air System. A system of component parts, including, but not limited to, air compressor, motor, receiver, controls, filters, dryers, valves, and piping, that delivers compressed air <1100 kPa (<160 psi gauge) to power devices (hand pieces, syringe, cleaning devices, etc.) as a power source.
Level 3 Piped Gas Systems. Systems serving occupancies where interruption of the piped medical gas would terminate procedures but would not place patients at risk of morbidity or mortality.
Level 3 Piped Vacuum System. A Level 3 vacuum distribution system that can be either a wet system designed to remove liquids, air-gas, or solids from the treated area; or a dry system designed to trap liquid and solids before the service inlet and to accommodate air-gas only through the service inlet.

8. Medical Vacuum Outlet Table

9. Pressure versus Flow (Myth 1)

10. AARC Clinical Practice Guidelines Proper Suctioning Technique

11. Suction Devices - Aspirators
General Classification
Emergency – Portable and usually battery powered
Vacuum Regulators – Generally line powered but may be venturi style
Thoracic – Line powered (cmH2O), may be mobile
Surgical – Line powered
Wound

12. Suction Devices - Aspirators
Purpose
Removal of obstructions from the airway
Secretions
Vomitous
Blood
Removal of blood or fluids from open wounds or from a surgical field
Evacuate air or fluid from the pleural space

13. Suction Devices – Emergency Aspirator
Useful in pre-hospital or within the hospital where line vacuum is not available
Components
Battery powered unit with electrical backup/charger
Suction tubing
Collection canister
Carrying case
Catheters

14. Diaphragm Pump

15. Rotary-Vane Pump

16. Vacuum Regulators
Typically line powered units (venturi) more commonly found in institutions used for multiple applications
Continuous
Continuous/Intermittent
Thoracic
Surgical

17. Vacuum Regulators

18. Continuous Vacuum Regulator Use
Used for continuously removing air or fluid from the patient
Continuous suction is the most common form of suction used on patients
Airway
Thoracic
Pleural
Surgical

19. Intermittent Vacuum Regulator Use
A client’s condition may warrant special interventions to decompress the gastrointestinal tract. GI intubation is one of these interventions. Paralytic ileus is one of the conditions that would warrant intubation
Conditions may warrant the use of intermittent suction and gastric drainage.
Necrotizing enterocolitis (NEC)
Obstruction
GERD
Inflammatory bowel disease
Post surgical aspiration prevention
Trauma

20. Facilitating Tube Drainage
Because gastric and intestinal fluid must move against gravity to be removed suction is required
Low Suction
High Suction
Intermittent Suction
Constant Suction
Proper functioning