2. RC 275 Manual Ventilation Secretion removal

3. The ABCs of Life: Airway,Breathing, & Circulation The Respiratory Care Practitioner enables all three!

4. Manual Ventilation Devices: Bag-Valve-Mask Devices Are usually self inflating for adults Neonatal bags are usually flow inflated May be reusable or disposable

5. High FIO2 Achieved By: Use an O2 flow of at least 15 LPM Use a reservoir device with the BVM Allow Adequate bag re-filling time

6. AHA Recommendations for Adult BVMs (Resuscitator Bags) Self-inflating Non-jam inspiratory valve at 15 LPM Suitable for manikin practice No pop-off valve (or ability to override if present 15/22 mm fittings for connectors High FIO2 capability True non-rebreathing valve Satisfactory performance in all environments Adult and pediatric models

7. Puritan-Bennett PMR BVM

8. Laerdal BVMs (reusable)

9. Technique Use an oropharyngeal or nasopahryngeal airway Best if done with two people One secures the airway by positioning and sealing the mask The other squeezes the bag with both hands

10. The mask can be removed from a BVM allowing a direct connection to an ET tube

11. Demand Valve Powered by 50 psi O2 FIO2 100% Patient can trigger flow or operator can Usually easier to ventilate with if only one person May cause gastric insufflation Should be used with oral or nasal airway May be attached to ET tube

12. Let’s give it a shot!

13. Airway Suctioning Indicated when normal clearance mechanisms are impaired and/or overwhelmed

14. Yankauer (“tonsil sucker) – for oropharyngeal suctioning Is inserted into mouth “upside down” and then rotated once past tongue May also stimulate a spontaneous cough

15. Tracheal Suction Catheters A, B, and D are whistle tips C is Argyle aero-flow Should minimize mucosal invagination E is Coude’ for getting into left main stem bronchus Note side holes on all

16. Inline Tracheal Suction Catheter A closed system used on ventilator patients Attaches between ventilator circuit and ET tube

17. Suctioning: Equipment Needed Suction catheter Outside diameter of catheter should be no more than ½ the internal diameter of the airway Catheter size (French) = ID (in mm) X 3 2

18. Suctioning: Equipment Needed (cont.) Vacuum source– for adults set at 80-120 mmhg (some say up to 150 mmhg) Sterile gloves (may use one or two) If using two, only the one handling the distal end of the catheter is sterile! Sterile water Pour some in tray and check vacuum and catheter patency

19. Suctioning: Technique Use sterile technique Always wash hands first! Hyperoxygenate and/or hyperinflate patient Insert catheter until resistance is felt Apply suction while withdrawing catheter Apply suction for no longer than 15 seconds each attempt Flush catheter with sterile water in between attempts Hyperinflate/hyper- oxygenate after each pass

20. Maintain asepsis throughout Monitor patient throughout Note quality and quantity of secretions for charting

21. Nasotracheal suctioning Same preparation and similar procedure to endotracheal tube suctioning Use lubrication on distal six inches of catheter Insert tip into nostril in a posterior and medially direction Do not aim catheter up! May use catheter as a stethoscope while advancing towards trachea

22. Suctioning: Complications Hypoxemia Atelectasis Mucosal trauma Arrhythmias Increased ICP Laryngospasm and/or bronchospasm Hypotension Contamination and/or infection

23. By using good, aseptic technique, you will minimize the occurrence and severity of any complications

24. It’s showtime!