SUCTIONING

PADA PASIEN DENGAN

VENTILASI MEKANIK

Oleh : Indra Ramdani, S. Kep

PENDAHULUAN
Untuk menjamin oksigenasi paru yang baik pada
proses pernafasan harus terdapat suatu jalan
nafas yang baik.

Sumbatan jalan nafas dapat terjadi oleh adanya

benda asing maupun benda-benda yang berasal
dari diri sendiri.
PENGERTIAN
Suctioning adalah suatu metode untuk
melepaskan sekresi yang berlebihan pada jalan
napas bagian atas.

Suctioning dapat diterapkan pada nasal

(nasofaringeal), oral (orofaringeal) dan trakheal
melalui endotrakheal atau trakheostomi tube.
INDIKASI

• THERAPEUTIK
• DIAGNOSTIK
INDIKASI

•MEMPERTAHANKAN KEPATENAN JALAN

NAFAS
•MENGELUARKAN SEKRESI PADA JALAN
NAFAS :
- suara nafas
- Peningkatan RR
- terlihat sekresi pada ETT/TC
- penurunan saturasi O2
- peningkatan Peak Inspiratory Press (Vol) /
penurunan TV (Press)
Cont..

- batuk tidak efektif

- suspek aspirasi gaster
- bronchoscopy/endoscopy
Potential indications for tracheal or
endotracheal suctioning (Woodrow 2000)
include:
● Raised respiratory rate.
● Inability to clear secretions effectively.
● Reduced air entry on auscultation.
● Audible secretions.
● Spontaneous but ineffective cough.
● Reduced oxygen saturation levels.
DIAGNOSTIK

- Sample sputum (kultur bakteri)

KOMPLIKASI
• Hipoksia/hipoksemia
• Trauma mukosa trakheal/bronkhial
• Cardiac/respiratory arrest
• Perdarahan
• Cardiac dysrhythmias
• Pulmonary atelectasis
• Bronchospasme/bronchokonstriksi
• Peningkatan ICP
• Interruption of mechanical ventilation
• Peningkatan kolonisasi bakteri
TIPE SUCTION

OPEN SUCTION SYSTEM:

Regularly using system in the intubated patients .

CLOSED SUCTION SYSTEM:

This is used to facilitate continuous mechanical
ventilation and oxygenation during the suctioning.
Closed suctioning is also indicated when PEEP
level above 10 cmH2O
TIPE SUCTION
OPEN SUCTION SYSTEM

CLOSED SUCTION SYSTEM

UKURAN SUCTION

Tidak lebih dari ½ diameter ETT/TC

(Bersten et al. 2003)

Diameter tracheal tube x 3

2
Contoh :
ETT no. 8
8 x 3 = 24/2 = 12 FG suction cath
TEKANAN SUCTION

• Dewasa 100-150 mmHg

• Anak 100-120 mmHg
• Infant 80-100 mmHg
• Neonates 60-80 mmHg
(AARC Clinical Practice Guideline)
PROSEDUR SUCTIONING
Necessary equipment:

•Vacuum source
•Calibrated, adjustable regulator
•Collection bottle and connecting tubing
•Disposable gloves
- Sterile (open suction)
- Clean (closed suction)
•Sterile suction catheter
•Sterile water and cup (open suction)
Cont…

•Goggles, mask, and other appropriate equipment

for standard precautions (Siegal et al., 2007)
•Oxygen source with a calibrated metering device
•Pulse oximeter
•Manual resuscitation bag equipped with an
oxygen-enrichment device for emergency backup
use
•Stethoscope
Optional equipment

•Electrocardiograph
•Sterile sputum trap for culture specimen
Patient Preparation

•Explain the procedure to the patient (If patient is

concious).
•The patient should receive hyper oxygenation by
the delivery of 100% oxygen for >30 seconds prior
to the suctioning
•Position the patient in supine position.
•Auscultate the breath sounds.
Procedure

•Perform hand hygiene, wash hands.

•Turn on suction apparatus and set vacuum
regulator to appropriate negative pressure.
•Goggles, mask & apron should be worn to prevent
splash from secretions
•Preoxygenate with 100% O2
•Open the end of the suction catheter package &
connect it to suction tubing (If you are alone)
•Wear sterile gloves with sterile technique
•With a help of an assistant open suction catheter
package & connect it to suction tubing
Cont…

•With a help of an assistant disconnect ventilator

•Kink the suction tube & insert the catheter in to the ET
tube until resistance is felt
•Resistance is felt when the catheter impacts the carina or
bronchial mucosa, the suction catheter should be
withdrawn 1 cm out before applying suction
•Apply continuous suction while rotating the suction
catheter during removal
•The duration of each suctioning should be less the 15 sec.
•Instill 3 to 5 ml of sterile normal saline in to the artificial
airway, if required
•Assistant resumes the ventilator
•Give four to five manual breaths with bag or ventilator
Cont…

•Continue making suction passes, bagging patient between

passes, until clear of secretions, but no more than four
passes
•Return patient to ventilator
•Flush the catheter with hot water in the suction tray
•Suction nares & oropharynx above the artificial airway
•Discard used equipments
•Flush the suction tube with hot water
•Auscultate chest
•Wash hands
•Document including indications for suctioning & any
changes in vitals & patient’s tolerance
CLOSED SUCTIONING PROCEDURE

•Wash hands
•Wear clean gloves
•Connect tubing to closed suction port
•Pre-oxygenate the patient with 100% O2
•Gently insert catheter tip into artificial airway without
applying suction, stop if you met resistance or when
patient starts coughing and pull back 1 cm out
•Place the dominant thumb over the control vent of the
suction port, applying continuous or intermittent suction
for no more than 15 sec as you withdraw the catheter into
the sterile sleeve of the closed suction device
Cont…

•Repeat steps above if needed

•Clean suction catheter with sterile saline until clear; being
careful not to instill solution into the ETtube
•Suction oropharynx above the artificial airway
•Wash hands
MONITORING
The following should be monitored prior to, during, and
after the procedure:
•Breath sounds
•Oxygen saturation
- Skin color
- Pulse oximeter
- Respiratory rate and pattern
•Hemodynamic parameters
- Pulse rate
- Blood pressure, if indicated and available
- Electrocardiogram, if indicated and available
Cont….

•Sputum characteristics
( Color, volume, consistency, odor)
•Cough characteristics
•Intracranial pressure, if indicated and available
•Ventilator parameters
- Peak inspiratory pressure and plateau pressure
- Tidal volume
- Pressure, flow, and volume graphics, if available
- FIO2
OUTCOMES
• Improvement in breath sounds
• Decreased peak inspiratory pressure; decreased
airway resistance or increased dynamic
compliance; increased tidal volume delivery
during pressure-limited ventilation
• Improvement in arterial blood gas values or
saturation, as reflected by pulse oximetry (SpO2)
• Removal of pulmonary secretions
KESIMPULAN
• Suctioning--- clearing airway
• Closed suction lebih direkomendasikan pada
pasien dengan ventilator
• Suctioning- sesuai indikasi, bukan rutin
• Kaji sebelum, selama dan sesudah tindakan