Title, year of publication and source
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Nasotracheal Suctioning - 2004 Revision & Update, 2004, RespiratoryCare(1010 AARC Clinical Practice Guidelines. Nasotracheal Suctioning-2004 Revision & Update. Respir Care. 2004; 49(9):1080-4.)
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ERNBG Guideline - Suction February 2006. Review: February 2006 Eastern Regional Neonatal Benchmarking Group Suctioning Guideline(99 ERNBG Guideline - Suction February 2006 Review due: February 200 6 Eastern Regional Neonatal Benchmarking Group Suctioning Guideline. [cited 2013 Nov 27]. Available http://guideline1.com/e/endotrachealsuctioning-guidelines-s83/. http://guideline1.com/e/endotrachealsuct...
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Evidence-based guideline for suctioning the intubated neonate and infant, 2009, Neonatal Network(22 Gardner DL, Shirland L. Evidence-based guideline for suctioning the intubated neonate and infant. Neonatal Netw. 2009;28(5):281-302. Review.)
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Endotracheal suctioning of mechanically ventilated patients with artificial airways, 2010, Respiratory Care( 66 American Association for Respiratory Care. AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respir Care. 2010;55(6):758-64.)
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Hyperoxygenation before, during and after the procedure
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Not stated |
Pre-oxygenation should not be performed unless SpO2 has dropped |
Data regarding hyperoxygenation in NB are limited. Therefore, care must be taken when using oxygenation on this population |
Pre-oxygenation is suggested if the patient presents a clinically relevant reduction in SpO2 with suctioning |
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Evidence level 2B
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In NB a 10% increase in FiO2 is recommended before suctioning, especially in hypoxemic NB |
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Hyperoxygenation should be maintained for at least 1 minute after suctioning, especially in hypoxemic patients |
Characteristics of the suctioning probe
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The probe should be sterile, flexible, with various lateral orifices and one frontal one |
The probe must be measured prior to the procedure to ensure that the probe does not overshoot the end of the ETT |
The diameter of the probe should be less than 50% of the ETT diameter |
The probe diameter should not occlude more than 70% of the light in the ETT in small children |
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Evidence level V
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Evidence level 2C
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The diameter of the probe should not exceed 50% of the internal diameter of the ETT |
Probes bigger than 6 F should not be used for suctioning in a 2.5 ETT |
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Evidence level V
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Suctioning time
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Must be limited to 15 sees. |
Must be limited to 10 - 15 secs. |
Must be limited to 15 secs. |
Must be limited to 15 secs. |
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Evidence level V
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Evidence level 2C
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Negative suction pressure
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60 - 80 mmHg |
50 - 100mmHg |
Must not exceed 100 mmHg |
80 - 100mmHg. |
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Evidence level V
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Suctioning should be applied only when removing the probe |
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Evidence level 3
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Saline instillation
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Not stated |
Use limited to NB whose secretions may obstruct airways |
Should not be performed routinely |
Should not be performed routinely |
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Evidence level IV
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Evidence level 2C
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Number of repetitions
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There is controversy regarding the excessive use of this procedure |
Normally, one or two attempts are sufficient for cleaning secretions |
Should not exceed three repetitions when suctioning |
Not stated |
Suctioning time
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When clinically indicated |
When the need for the procedure is identified |
When the need for the procedure is identified |
Only when there is secretion and not routinely |
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Evidence level I
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Evidence level 1C
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Absolute contraindication
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Not stated for intubated NB |
Not stated |
Not stated |
There is no absolute contraindication |
Biosafety standards
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CDC guidelines for standard precautions should be respected |
Not stated |
Not stated |
CDC guidelines for standard precautions should be respected |