7.10
气管切开吸引术 I：程序前步骤
气管切开抽吸是医疗保健专业人员为维持气管切开插管患者气道通畅而执行的一项关键程序。当分泌物积聚在气道中导致呼吸困难时，需要执行此程序。以下是使用开放系统进行气管切开抽吸的分步程序指南。
所需设备
首先，收集所有必要的设备：无菌抽吸导管、无菌一次性容器、无菌手套、毛巾或防水垫、护目镜、面罩、所需的额外…
以下是在开放式系统中进行气管切开吸痰的分步操作前指南。
首先，准备好所有必要设备：吸引装置、无菌吸引导管、无菌一次性容器、无菌手套、防水垫、护目镜、口罩、清洁手套、根据需要配备的其他个人防护装备，以及连接100%氧气的复苏球囊，以节省时间。
进行手部卫生以避免病原体传播。
确认患者身份以避免错误，并通过拉上窗帘确保隐私。
评估疼痛情况，必要时给予镇痛药物。
向患者解释操作步骤，以帮助缓解其焦虑情绪。
根据患者的意识水平将其置于适当体位。
对于清醒患者，半卧位可增加舒适度并改善呼吸。对于昏迷患者，侧卧位有助于防止气道阻塞，并促进分泌物引流。
接下来，应在患者胸部放置一个防水垫，以防止线路被污染。
最后，打开吸引装置并调节至适当的压力。通过阻塞连接管的末端来测试装置是否正常工作。
View the full transcript and gain access to JoVE Core videos
Q1: What equipment is needed before starting tracheostomy suctioning?
Gather a suction unit, sterile suction catheter, sterile disposable container, sterile gloves, waterproof pad, goggles, mask, clean gloves, additional PPE as needed, and a resuscitation bag connected to 100% oxygen. Bringing all equipment to the bedside conserves time and energy during the procedure.
Q2: Why is hand hygiene important before tracheostomy suctioning?
Hand hygiene prevents the spread of pathogens and microorganisms to the patient. Performing hand hygiene before donning PPE based on transmission precautions is a critical first step in maintaining asepsis and protecting both the patient and healthcare provider during the suctioning procedure.
Q3: How should you position a conscious patient for tracheostomy suctioning?
Place a conscious patient in semi-Fowler's position to enhance comfort and breathing. This positioning allows better lung expansion and easier access to the tracheostomy tube while reducing patient anxiety. Semi-Fowler's position also facilitates secretion drainage and improves oxygenation during the procedure.
Q4: What position is best for an unconscious patient during tracheostomy suctioning?
Position an unconscious patient in the lateral position facing you. This positioning prevents airway obstruction and promotes secretion drainage, reducing aspiration risk while allowing you to monitor the patient's response. The lateral position also facilitates easier access to the tracheostomy tube during the procedure.
Q5: How do you test the suction unit before suctioning?
Turn on the suction unit and set the appropriate pressure based on patient needs and clinical guidelines. Test the unit by occluding the end of the connecting tubing to verify proper function and ensure the pressure is adequate for effective secretion removal without causing airway trauma or discomfort.
Q6: Why should you place a waterproof pad on the patient's bed?
A waterproof pad placed across the patient's chest prevents soiling of bed linens and protects both the patient and equipment from secretions. This maintains a clean environment and reduces the need for frequent linen changes during the procedure, promoting patient comfort and infection control.
Q7: What should you do to reduce patient anxiety before suctioning?
Explain the procedure to the patient, assess for pain, and administer analgesics if required before beginning. Ensuring privacy by closing curtains, identifying the patient correctly, and communicating clearly about what to expect helps alleviate anxiety and promotes cooperation during tracheostomy suctioning.