measuring maximum length of insertion for suctioning

[donedeal]

From the NR practical exam sheets, Ventilatory Mgt: adult.

"Marks maximum length of insertion length with thumb and forefinger"

pertaining to suctioning an ET tube.

How does one measure the maximum length of insertion of a catheter for suctioning the ET tube?

The Brady book states", insert until resistance is felt. There is nothing mentioned about measuring beforehand.

Thanks!

[Eydawn]

I believe that it is assumed to be the same measurement for an OPA. Use your thumb and forefinger to measure from the corner of the mouth to the angle of the jaw...

Anyone else?

Wendy

CO EMT-B

[Eydawn]

Wups! Never mind, I misread what was being asked.... :oops: :oops:

Wendy

CO EMT-B

[reaper]

I had brought this up in the last practical I was at. The proper technique is insert till you feel resistant. Just tell that to the examiner and you should be fine.

[VentMedic]

If you read 4 different text books you'll get 4 different answers. I can also guarantee the answers will differ from an RN or RRT exam also.

The two most common are:

Until you feel resistance

and

1 cm past the end of the ETT

Even with the resistance felt, you should pull back before applying suction. You don't want to suck up lung tissue or tear it to where blood will be your primary secretions.

I never advocate "until you feel resistance" with a pedi or infant. For those you measure to the mm. Leaving skid marks on their carina is something you want to avoid.

[Richard B the EMT]

I believe that it is assumed to be the same measurement for an OPA. Use your thumb and forefinger to measure from the corner of the mouth to the angle of the jaw...

Building on Wendy's entry, I was always taught to do the measure holding the device against the patient, but with that type measurement as the parameter.

[Dustdevil]

There was a measuring technique taught for approximation years ago. I don't even remember if it was in medic or RT school. It seems like it was measuring from the mouth to the suprasternal notch, or something like that. I haven't heard it anywhere in years though. And a twenty minute Google search doesn't turn anything up. No old textbooks with me right now, so I can't look it up.

[VentMedic]

Building on Wendy's entry, I was always taught to do the measure holding the device against the patient, but with that type measurement as the parameter.

ETTs are different lengths based on the size. Thus, whatever physical landmarks you use on the patient will still vary according to the size of the tube.

Look at the ETT in reference to the stylet before you intubate and then use the stylet as your guide.

Dust, you may be thinking of the distance for NT sx. Or, to the way we used to confirm tube placement was to palpate the cuff at the sternal notch.

I don't think anything like the Chula formula will be on a Paramedic exam.

[tniuqs]

The Brady book states", insert until resistance is felt. There is nothing mentioned about measuring beforehand.

Brady is correct, don't use excessive force cause your banging the carina upon insertion (everyone is different lenghthsie ETT to carina) ... if one can get further thats good but most likely your entering the R mainstem .. the "old" twist cath left or right to enter left mainstem is BS.

Actually roll it between your fingers (I doubt very much your using In-Lines a closed system or Whisle tips) well on most trucks, more like the standard suction cath in a bag .... hey that reminds me of my last MRE meal...opps sorry.

Big point being watch for Bradycardias ..... remember why ? not going to give you ALL the answers here.. te he.

AND above all "flare" or use "intermittent" suction (NOT GI settings on most units, do it by feel) as the murphy eye can adhear to the trachea wall and cause Tracheal "hickies" this best observed in a good autopsy post ICU .... and multiple suctionings.

Now the question:

What negative suction pressure setting will now surface ... So to that end:

I use STEWS law:

If your suctioning concrete use what you need to do the job .... point being that an arbitrary "say like minus 180mmhg setting on the suction unit" IT does not know what your dealing with and you may not be using enough ... just tickling, causing a cough reflex and increasing ICPs for no reason.

If you have to suction a head injury PT, use Lido 50 mgs IV ! (NOT via ETT thats just stupid) and Fentanyl too (please, allow some time to become therpeputic) Studies prove this to is a good therapy to decrease noxious stimuli and decrease possibilities of increasing ICP ... a very good study.

If your trying to suction Pulmonary oedema .... your sandpapering your @#! use PEEP, suctioning PE is just causing more problems ... changing a balance of osmotic vs hydrostatic pressures ... your doing harm.

cheers

[VentMedic]

AND above all "flare" or use "intermittent" suction (NOT GI settings on most units, do it by feel) as the murphy eye can adhear to the trachea wall and cause Tracheal "hickies" this best observed in a good autopsy post ICU .... and multiple suctionings.

We don't have to wait for the autopsy. A quick bronoscopy will tell volumes about the "traumatic intubation". Being a teaching hospital we love to photograph and/or save to CD all those great examples of what over zealous intubators can do to the respiratory tract. It also helps when vocal cord paralysis is noted after extubation and the patient wants a settlement.

The damage a suction catheter can do in unskilled hands is pretty amazing too.