Bemaj Pharmacy

What solution to use for suction machine?

Disinfecting Your Portable Suction Unit – It is best to follow the manufacturer’s guidelines when disinfecting your suction unit, but in general, the following steps apply:

Disconnect the unit from its power source. Disconnect the battery from the PC board when cleaning the interior chassis. Discard all disposable parts, including the canister, tubing, and catheters. Dispose biohazardous materials appropriately. Use a mild detergent or a mixture of bleach and water (1 part bleach/10 parts water) and rinse thoroughly. Follow the instruction manual when disinfecting the mechanics of the unit. Never submerge the suction unit. Use disinfectant wipes to clean all outer surfaces, including control knobs, screens and handles.

Don’t wait for the end of your shift to disinfect the suction unit. Do it immediately after each call to ensure it is clean and operational for the next patient.

What are the different types of suction machines?

Manual Suction Devices. Wall-Mounted Suction Devices. Portable Suction Devices. Makeshift Suction Devices.

What is a phlegm suction machine used for?

The store will not work correctly when cookies are disabled. Extra 2% Discount on all Prepaid Orders. was ₹9,500.00 Special Price ₹6,160.00 Availability: Out of stock A phlegm suction machine or aspirator can be used when an individual suffers from a moist cough and are unable to effectively clear secretions from the throat.

This device by Life-Line can also be used at home as health care product to help maintain airflow in your lungs. Life-Line’s phlegm machine is equipped with a highly efficient plunger pump that is well lubricated and durable for a long life. The suction pump is uni-directional (without generating positive pressure), which means it is designed to have an excess flow protection feature to prevent liquid from entering into the suction pump.

The hand switch and foot switch are connected with each other in a parallel manner, such that they can be selected and used as per one’s need. The foot switch can be used for low pressure control.

More Information

Battery	No
Importer	LifeLine Medical Devices, Gurugram- 122001
Country of Origin	India
SKU	SEN596-SMAC042
No of Contents	Suction Machine, 1 litre Jar, Silicone Tubing, 3 Filters, 1 Float/Stopper
Warranty	1 year factory Warranty from purchase date- Limited to manufacturing defects only. Any defective product will need to be sent to the manufacturer to avail warranty.
features	Has an efficient plunger pump that is well lubricated The suction pump is uni-directional Max vacuum: ≥0.75 MPa High flow and high vacuum Hand switch and foot switch are connected Foot switch can be used for low pressure control Overflow protection device safely and efficiently prevents liquid from entering into the pump Storage bottle: 1 litre × 1 Flow rate:≥15 L/min
Product Weight	3.2 kg
Dimensions	29 x 19.2 x 21.1 cm
Brand	Life-Line
Return Policy	3 Days Replacement in case of manufacturing defects The product you return must be unused and in the original condition with all the tags and receipts

I want to Reset Password using

What material is used for suction?

There are a variety of material for producing vacuum suction cups. Common materials are NBR (Nitrile butadiene rubber), NR (Natural rubber), SIR (Silicone), FKM or FPM or Viton® (Fluoro rubber), PU (Polyurethane) are common in material list of vacuum suction cup.

What pressure is used in suction machine?

Technique or Treatment – The patient should be educated about the procedure (if awake and interactive) and the possibility of discomfort. Ensure preoxygenation with 100% FiO2 was done with adequate pulse oximetry measurements. Preoxygenation is required because an airway suctioning procedure may be associated with significant hypoxemia.

• Suctioning of the lower airways should be done in a sterile manner with single-use gloves and suction catheters to prevent contamination and secondary infection.
• After preparation with appropriate equipment at the bedside and monitoring continuous heart rate and oxygen saturation (as available), the patient should be suctioned with the appropriately sized equipment for their airway.

The catheter should be introduced to a depth no more than the tip of the artificial airway to prevent trauma and bleeding from airway mucosa. Suction pressure should be kept at less than 200 mmHg in adults. It should be set at 80 mmHg to 120 mmHg in neonates.

1. The catheter size used for suction should be less than 50% of the internal diameter of the endotracheal tube.
2. A common conversion is that a 1 mm diameter is equal to a 3 French.
3. The use of normal saline while suctioning is not recommended by the American Association of Respiratory Care.
4. The duration of suctioning should be less than 15 seconds per suction attempt.

Following airway suction, the patient should be allowed to recover for at least 10 to 15 seconds and re-oxygenate as needed before re-suctioning occurs. Standard precautions should be followed while suctioning by the care provider. Open vs. closed Previously the standard of care for intubated patients was open suction, which involved disconnection from the ventilator and the use of a single-use suction catheter.

However, for the last two decades, the use of in-line (closed suctioning) is standard practice. In-line suctioning is considered safer and is associated with fewer adverse events. In-line suctioning, as the name implies, includes a suction catheter that is attached as a part of the ventilator circuit connected to the patient.

While advantages are seen with the use of in-line suction catheters, it has not been shown to reduce the incidence of ventilator-associated pneumonia. Superficial vs. deep Superficial suctioning implies going down with the suction catheter only up to the end of the artificial airway (endotracheal or tracheostomy tube), whereas deep suctioning implies going down with the catheter till resistance is met, which can theoretically be until the carina or primary bronchi are reached.

When should we not suction a patient?

Do Not Suction Too Long – Prolonged suctioning increases the risk of hypoxia and other complications. Never suction a patient for longer than 15 seconds. Rather than prolonged suctioning, withdraw the catheter, re-oxygenate the patient, and suction again.

How does a suction machine work?

how to use suction machines? – Suction machines work on the principle of negative pressure that creates a vacuum effect to pull out secretions from a person’s oral cavity. To create this negative pressure, several components of the suction machine work in conjunction. These include:

• Vacuum pump, which causes the negative pressure
• Connecting tubes, which connect the pump to the collection canister.
• Sterile patient tube that carries the secretions into the collection canister.
• Disposable canister that holds the secretions and prevents contamination of other parts of the suction machine.
• Filters, which prevent the inner parts of the suction machine from getting contaminated by viruses, bacteria, dust, and gases.
• Batteries and power cord to run the machine.

Once all these parts portable machine setup has been done, you can start using the machine. Here is how suction machine use is done:

1. Wash and disinfect your hands.
2. Turn on the machine and connect the connecting tubes.
3. Connect a clean and dry suction catheter to the connecting tubes.
4. The patient should be laid flat on their back. If the patient prefers a seated position, you may try that. Place a rolled towel under the shoulders.
5. Use sterile or distilled water to lubricate the catheter and test the machine’s functioning.
6. Insert the catheter into the tracheostomy tube carefully. Ideally the length of the catheter and the tracheostomy tube must be the same.
7. Place your thumb over the suction vent and remove it within 5-10 seconds.
8. Allow the patient to rest and resume the suctioning if required.
9. Once the procedure is over, turn off the machine and discard the catheter.

One of the most critical elements of usage of this machine suction machine is its cleaning process. Several parts of this machine are single-use and need to be disposed of after use. As a mandate, the parts that are not single-use need to be cleaned frequently.

This is essential for freeing the suction machine and its parts of hazardous contaminants. You should wear personal protective equipment (PPE) to ensure your safety against contaminated waste. The waste and the single-use parts should be disposed of according to your area’s protocols for the disposal of medical waste.

Never allow substances such as grease or oil to enter the suction machine’s components. Never run the parts through too much water or use abrasive machine cleaners.

What is the best suction surface?

Suction cups adhere best to smooth, non-porous surfaces such as tile, glass, fiberglass or metal. To ensure a firm bond, surfaces should be totally free of dirt and soap film before attaching the suction cup.

What is the difference between suction and vacuum?

Written by Bryan Potok on October 15, 2022 Last updated on October 15, 2022 Both elevated vacuum suspension and suction suspension use a difference in atmospheric pressure to attach the socket to the residual limb, according to Ohio Willow Wood. As air is expelled from the prosthetic socket, your residual limb is pulled toward the socket wall and held in place by the force of negative air pressure as the vacuum effect is created.

1. Suction suspension normally uses a passive expulsion valve to allow air to exit from the prosthetic socket but only creates a negative pressure differential when the prosthetic leg begins to move.
2. Vacuum suspension uses an active pump to create a negative pressure differential that doesn’t depend upon the prosthetic leg position.

In a suction socket you still have some movement, but with elevated vacuum you eliminate almost all pistoning. Suction suspension basically is just a sealed chamber. Suction suspension is created during swing phase of gait, which creates the negative pressure required to suspend your prosthetic leg.

• To weight bear, you have to reseat your residual limb into the socket, creating forces on your limb.
• But with elevated vacuum, you’re under vacuum continuously, so there is no pressure because your residual limb is held to the socket wall.
• Elevated vacuum systems are the preferred method for those amputees with sensitive skin or vascular disorders including diabetes.

The vacuum pump prevents your residual limb from significantly changing size during the day and the continuous vacuum aids in circulating fluid in and out of your residual limb at a constant rate. Whereas suction suspension allows fluid to leave your residual limb, but does not influence fluid to return like vacuum.

What are the three suctioning techniques?

Nasal suction (suctioning in the nose) Oral suction (suctioning the mouth) Nasopharyngeal and oropharyngeal suction (suctioning the throat)

Can you suction out mucus?

Mucus suction is done by placing a sterile tube into a patient’s mouth or nose or specific equipment that is inserted into the patient’s airway to remove mucus from the respiratory tract. This procedure may be necessary for patients with thick mucus that they cannot expel on their own or in the case of decreased lung function, where patients are unable to cough normally or productively enough to remove the mucus.

1. To remove mucus from the upper respiratory tract.
2. To stimulate productive coughing that expels mucus.
3. To prevent aspiration of foreign objects into the lungs.
4. To collect samples for testing in the laboratory.

To investigate the cause of abnormal lung sounds, such as rhonchi, or other symptoms that may be caused by the collection of mucus. Advantage This procedure allows patients to breathe more easily and reduces the chances of oxygen deprivation due to blockage caused by mucus. Indications Mucus suction may be recommended in the following situations:

1. Patient breathes noisily.
2. Patient seems fidgety and/or restless.
3. Patient’s pulse and respiration rates are elevated.
4. Patient is beginning to turn blue due to lack of oxygen (cyanosis).

Methods of Suction

Suctioning mucus through the nose and mouth

• A nasopharyngeal airway or nasal airway is a flexible tube with a flared end that is designed to be inserted into the nasal passageway, allowing convenient access to the nasopharynx, which connects the back of the nose to the back of the mouth. Suctioning mucus through the nasopharyngeal airway is often done in the cases where a patient often bites down on the oropharyngeal airway.
• An oropharyngeal airway or oral airway is a tube inserted through the mouth and into the oropharynx, the part of the throat at the back of the mouth.

Suctioning mucus through an endotracheal or tracheostomy tube

Suctioning through an endotracheal or tracheostomy tube allows removal of mucus from the lower respiratory tract, especially in patients who are not conscious and are unable to expel the mucus on their own. An endotracheal tube may be inserted through the mouth (orotracheal) or nose (nasotracheal) and will be passed through the epiglottis and vocal cords into the trachea.

1. The nurse will assess the patient’s condition before suctioning mucus. The nurse will observe the patient’s breathing and respiration rate, the color of their skin, nails and lips (for signs of cyanosis), whether the patient is listless, the characteristic of the mucus (the amount and texture), and if the patient has vomited or regurgitated any food that is still remaining in the patient’s mouth.
2. The patient should not eat for at least two hours before mucus suctioning to prevent aspiration.

Procedure

1. Patient will be placed to lie on the back. Staff will be wrapping patient’s body and held down while turning patient’s face to the side.
2. The suctioning tube will be attached to the suction machine and pressure will be adjusted as appropriate. The pressure will be checked by the nurse placing a finger over the tip of the tube.
3. Nasal secretion is sucked by gently inserting finger tip or MU-Tip (Mahidol University-Tip) into patient’s nostril until MU-Tip/finger tip is placed against the inner wall but not scratch the inner part of the nose.
4. While suctioning, MU-tip/finger tip will be gently moved back and forth to make sure secretion is sucked as much as possible. When MU-Tip/finger tip is moved, the nurse will be careful not to let the tip hit the inner part of the nose. When nasal suction is done, another tube for oral suction will be connected.
5. If mucus is found too sticky, 0.9% normal saline solution will be dropped into the nostril before suction or 0.9% normal saline solution will be dropped into other nostril while suctioning the other side with MU-Tip/finger tip.
6. Each session of oral suction should not be longer than 10 seconds to prevent larynx constriction and oxygen deficiency (if patient is on tracheostomy tube, suction through the tube first.)
7. The patient should deeply inhale oxygen three to four times and the nurse will observe the breathing patterns and notice the sound as well as the appearance of any mucus to decide whether or not suction must be repeated.

Risks and Complications

1. Mucus that can cause blockage of the respiratory tract.
2. Lack of oxygen, slowed pulse, collapsed lung.
3. Body does not receive enough oxygen.
4. Irritation to the lining of the respiratory tract.
5. Respiratory infection.
6. Injury or redness of the skin around the tube inserted into the airway.
7. Impact to the airway, such as perforation or necrosis.
8. High pressure in the skull.
9. Vomiting, aspiration.

Caution

1. To prevent irritation of the lining of the respiratory tract, when inserting the tube, be sure to open one side of the connector to prevent too much air from being sucked out and until the tube is placed in the appropriate location, then close it. When suctioning turn move the tube all around and slowly move it back out.
2. If the mucus is very thick, drop three to five milliliters of normal saline solution into the endotracheal tube to dissolve the mucus, making it easier to suction out.
3. To prevent oxygen deprivation, make sure that the patient is given oxygen for 30 seconds to 2 minutes or use an ambu bag attached to oxygen and squeeze 3 to 6 times before suctioning. Then provide oxygen after mucus is suctioned as well to help expand the lungs and prevent collapse.
4. To prevent lung atelectasis from repeated suctioning, only suction when there is mucus or when absolutely necessary and don’t suction for longer than 5 to 10 seconds each time, and wait 3 minutes between sessions.

Successful Procedure Mucus is successfully removed from the respiratory tract. What If This Procedure is Not Performed? The respiratory tract is blocked causing oxygen insufficiency. Alternative Nasal rinsing and suctioning mucus with bulb syringe.

Can you suction phlegm out of throat?

What is the purpose of tracheostomy suctioning? – Tracheostomy suctioning removes thick mucus and secretions from the trachea and lower airway that you are not able to clear by coughing. Suctioning is done when you wake up in the morning and right before you go to bed in the evening. Suctioning is also done after any respiratory treatments. In addition, suctioning may be needed when you:

Have a moist cough that does not clear secretions. Are unable to effectively clear secretions from the throat. Are having difficulty breathing or feel that you can not get enough air.

What machine removes phlegm from lungs?

Airway Clearance Devices vs. Techniques – Airway clearance can be performed using a hand-held device, a respiratory vest, or manually with the help of a caregiver. To understand the different types of airway clearance devices and techniques that are available, we’ve compiled some information below. Breathing techniques, such as pursed-lip breathing and abdominal breathing, are performed using controlled exercises that patients can try at home to help loosen and mobilize mucus. According to the American Thoracic Society, a common breathing technique is known as the “huff cough.” This involves a repeated cycle of inhaling air through your nose and then exhaling it back out through your mouth—simultaneously pulling your abdomen inward and making a “huff” sound, Oscillating Positive Expiratory Pressure (OPEP), a device you hold in your hand, creates resistance and vibrations that help loosen and clear mucus from the airways. After a series of breaths through an OPEP device, patients will “huff cough” to clear mucus from their lungs, A traditional approach to airway clearance is Manual Chest Physiotherapy, also known as Manual CPT, which involves the assistance of a therapist or caregiver who manually claps on your chest wall in various positions, The repeated clapping helps to loosen mucus and move it toward the larger airways. HFCWO therapy is an airway clearance device that works similarly to manual CPT, but rather than relying on someone else to help, you can perform your therapy independently. The SmartVest Airway Clearance System offers HFCWO therapy in a convenient and comfortable garment worn around the chest wall that is connected to a generator. The device delivers rapidly repeating pulses of air that alternately squeeze and release the upper body, propeling mucus from the lungs and moving it toward major airways where you can easily cough it out. SmartVest offers 360° lung coverage and is clinically proven to clear the lungs of excess mucus, which can reduce the risk of respiratory infections and hospitalizations,

What is the name of suction device?

A suction machine, also known as an aspirator, is a type of medical device that is primarily used for removing obstructions — like mucus, saliva, blood, or secretions — from a person’s airway. When an individual is unable to clear secretions due to a lack of consciousness or an ongoing medical procedure, suction machines help them breathe by maintaining a clear airway.

Removing respiratory secretions when the patient is unable to Assisting a patient that is vomiting while seizing or unconscious Clearing blood from the airway Removing a foreign substance from a patient’s windpipe and/or lungs (pulmonary aspiration)

Since they can be used in conjunction with other medical technologies to treat a variety of life-threatening conditions, aspirators have become a mainstay in both pre-hospital and in-hospital settings, Given their ubiquity, it’s common to have questions about their uses and functions.

Which tube is used for suction?

Introduction – Endotracheal intubation prevents the cough reflex and interferes with normal muco-ciliary function, therefore increasing airway secretion production and decreasing the ability to clear secretions. Endotracheal tube (ETT) suction is necessary to clear secretions and to maintain airway patency, and to therefore optimise oxygenation and ventilation in a ventilated patient.

What are the different types of suction tips?

(A) Suction tip 1 is straight (bottom). Suction tip 2 is sharply curved (middle). Suction tip 3 is slightly curved (top).

Is suction positive or negative pressure?

Suction lift in a pump refers to the pressure (negative pressure) on the suction side of the pump. The pressure can be measured from the centre line of the hydraulic part of the pump down to the water surface on the suction side of the pump. In theory, it should be possible to suck water from a depth of 10.33 m, however, this would require an absolute vacuum.

What are normal suction pressures?

Checking that the Suction and Discharge Pressures Are Within the Normal Ranges

Check the suction pressure for the indoor unit while the air conditioner is running properly. The normal range of the suction pressure is 0.8–1.2 MPa. If the suction pressure is greater than 1.2 MPa, connect a rubber hose for the pressure gauge to the gas pipe needle valve for the outdoor unit, and rotate open the pressure gauge to slowly release refrigerant. Start the compressor. Check that the suction and discharge pressures are within the normal ranges. Otherwise, go to the next step.
Table 1 Mapping between the saturation pressure and the saturation temperature for R410A

Temperature (°C)	Saturation Pressure – Gauge Pressure (MPa)	Temperature (°C)	Saturation Pressure – Gauge Pressure (MPa)	Temperature (°C)	Saturation Pressure – Gauge Pressure (MPa)
0	0.7	19	1.31	38	2.21
1	0.73	20	1.35	39	2.27
2	0.75	21	1.39	40	2.33
3	0.78	22	1.4	41	2.39
4	0.81	23	1.47	42	2.45
5	0.84	24	1.51	43	2.51
6	0.87	25	1.56	44	2.57
7	0.9	26	1.60	45	2.63
8	0.93	27	1.65	46	2.7
9	0.96	28	1.69	47	2.76
10	0.99	29	1.74	48	2.83
11	1.02	30	1.79	49	2.9
12	1.05	31	1.84	50	2.97
13	1.09	32	1.89	51	3.04
14	1.12	33	1.94	52	3.11
15	1.16	34	1.99	53	3.19
16	1.19	35	2.04	54	3.26
17	1.23	36	2.1	55	3.34
18	1.27	37	2.15	–	–

/ol> Huawei Proprietary and Confidential Copyright © Huawei Technologies Co., Ltd. : Checking that the Suction and Discharge Pressures Are Within the Normal Ranges

Why is suction pressure negative?

Comparison of the effects of two levels of negative pressure in open endotracheal tube suction on the physiological indices among patients in intensive care units Iran J Nurs Midwifery Res.2014 Sep-Oct; 19(5): 473–477. PMCID: PMC4223963 1 Department of Adult Health Nursing, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran Find articles by 2 Department of Operation Room, Yasuj University of Medical Sciences, Yasuj, Iran Find articles by 3 Department of Critical Care Nursing, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran Find articles by

1 Department of Adult Health Nursing, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran 2 Department of Operation Room, Yasuj University of Medical Sciences, Yasuj, Iran 3 Department of Critical Care Nursing, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Address for correspondence: Dr. Hojatollah Yousefi, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Hezarjerib Ave., Isfahan, Iran. E-mail: Received 2013 Jul 23; Accepted 2013 Dec 8. : © Iranian Journal of Nursing and Midwifery Research This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Most of the patients admitted in the intensive care units (ICUs) require an endotracheal tube and mechanical ventilation. In order to clear and maintain patency of the airways, endotracheal suctioning is required. Therefore, the least detrimental way of endotracheal tube suctioning which can diminish the complications should be selected. The present study aimed to compare the effect of two levels of negative pressure (100 mmHg and 200 mmHg) in open endotracheal tube suction on the physiological indices among patients in the ICUs. In this single-blind clinical trial, 60 patients meeting the inclusion criteria were selected by convenience sampling and randomly allocated in two groups. First group of patients were suctioned with negative pressure of 100 mmHg and the second group with 200 mmHg. Effects of two levels of suction pressure on oxygen saturation (SPO2) and heart rate (HR) values were measured and recorded at four time points. Repeated measure analysis of variance (ANOVA), Chi-square test, and independent t -test were adopted to analyze the data. In the two groups consisting of totally 60 subjects (30 in each group), 34 subjects were males and 26 were females, with a mean age of 60.63 years (minimum 18 years and maximum 75 years). Repeated measure ANOVA showed a significant difference in the mean SpO2 and HR before, during, and 5 and 20 min after suction within each group ( P < 0.05), but not between the two groups ( P > 0.05). The present study revealed that with regard to the detrimental effect of endotracheal tube suctioning on arterial oxygen saturation and HR, suctioning with negative pressure of 200 mmHg is considered to be a low-risk procedure compared to suctioning with negative pressure of 100 mmHg, if standard procedures in open suction system are followed. Keywords: Intensive care unit, physiological indices, suction Protection of airways and maintaining their patency for proper respiration in the intensive care unit (ICU) is the first priority. Endotracheal tube is the most common artificial airway. Existence of an artificial airway weakens the cough reflex and imposes dysfunction of hairy cells leading to accumulation of secretions as well as a disturbance in discharge of these secretions form the airways. As these patients are incapable of discharge of the secretions, they need periodical suctioning. Suctioning the intubated patients under ventilation is a routine nursing intervention, and is counted as a crucial care among these patients. The most common endotracheal suctioning method in clinical setting in Iran is open system suction which needs patients’ disconnection from ventilation device during suctioning. Although endotracheal tube suction facilitates discharge of secretions and airway patency, it can lead to numerous complications. Major complications of endotracheal suction include hypoxia, change in heart rate (HR) and blood pressure (BP), cardiac arrhythmia, and cardiac and respiratory arrest. The most common complication is hypoxia, which can cause changes in HR, cardiac arrhythmia and hemodynamic imbalance, and heart arrest and death. Therefore, the level of arterial oxygenation and patients’ vital signs should be monitored before, during, and after suctioning. Studies emphasize on allocation of a safe pressure to remove secretions with the lowest risk of hypoxia, atelectasia, and tracheal tube injury. Negative pressure is appropriate to remove secretions; therefore, the level of pressure in suction can affect the amount of removed secretions. Use of inadequate pressure leads to ineffective secretion removal and unclean airway. Suction with excessive negative pressure for a long time results in damages to tracheal tube, hypoxia, and cardiac arrhythmia, which can be modified by oxygenation with high concentration. The size of suction catheter, the level of negative pressure, and length of suction time can directly affect endotracheal suction efficacy and potential complications. Tenaillon claimed that negative pressure of 200-300 mmHg is safe for endotracheal suction, while Pedersen et al,, with a more precautionary approach, determined 200 mmHg negative pressure as the upmost safe pressure. Morrow et al, showed that increase of negative pressure from 200 mmHg to 360 mmHg increases the amount of suctioned secretions, but leads to an increase in negative pressure of lungs. In another study, Seymour et al, used negative pressure of 200 mmHg. Yazdannik et al, used two levels of negative pressure (100 mmHg and 200 mmHg) and measured the level of O2 saturation before and 1, 3, and 20 min after closed system suction. They concluded that negative pressure of 200 mmHg had no destructive effect on oxygenation of patients under ventilation hospitalized in the ICU. It was relatively safe and did not result in cardiovascular complications. Lasocki et al, showed that open system endotracheal suction with negative pressure of 200 mmH 2 O led to a reduction in parabolic pressure of arterial oxygen. Therefore, recommendation of upmost negative pressure is based on experiments, as no clinical study supports a precise margin for it. As observed, there are controversial studies and viewpoints in use of upmost safe negative pressure in open system endotracheal suction. Therefore, this study aimed to compare the effect of two levels of negative pressure in open endotracheal tube suction on the physiological indices among patients in the ICUs. This is a clinical trial. After obtaining an introduction letter from School of Nursing and Midwifery, the researcher referred to the management of Al-Zahra Hospital and started sampling after explanation about the study objectives to the authorities. Then the informed consent was obtained from the subjects or their fellows. The study population consisted of all intubated patients hospitalized in the ICU of Alzahra Hospital affiliated to Isfahan University of Medical Sciences in 2013. The subjects comprised all adult male and female intubated patients connected to ventilators in the ICU. The subjects ( n = 30 in each group, total N = 60) were selected through convenient sampling and assigned to two groups through random allocation. Inclusion criteria were hospitalization in the ICU, being orally intubated and connected to ventilator, age of 18–75 years, no history of blood coagulation diseases or thrombocytopenia, and having a stable hemodynamic status (HR ≤120, SPO 2 ≥90). In case of endotracheal tube removal or disconnection from ventilator, the patients were excluded. Data collection tool was a data collection form including three sections. The first section contained demographic characteristics like subjects’ age and sex. The second section included patients’ clinical characteristics such as length of hospitalization in the ICU, cause of hospitalization in the ICU (diagnosis), intubation time length, endotracheal tube size, and the mode of ventilation. The third section contained subjects’ arterial O 2 saturation measurement results and HR which were filled in different stages through imposing negative pressure. After getting a letter of introduction from the nursing school, subjects meeting the inclusion criteria were selected through researcher’s daily referral to the ICU. The subjects were explained about the research goal and a written informed consent was obtained from patients’ parents. Finally, patients’ demographic information form was filled by use of their medical file records (and if needed, by taking help from patients’ accompanying person). The patients were randomly assigned to two groups (group 1 and group 2). Firstly, the first section of data collection form was filled through referring to hospital medical files and observation of endotracheal tube as well as ventilator settings. Then, the patients’ need of endotracheal tube suction was assessed, and if needed, suction was administered. Groups 1 and 2 were suctioned twice by 100 and 200 mmHg negative pressure, respectively, based on a standard method and appropriate catheter. patients’ arterial O 2 saturation and HR were measured just before, during, and 5 and 20 min after suctioning with the endotracheal tube, and recorded in the third section of data collection form by a co-researcher (the study was single blinded). With regard to the content validity of the data collection tool, an initial draft was prepared by referring to articles and scientific texts in the related context, and then was revised by the academic members of the nursing and midwifery school, and the final data collection form was prepared. A single monitoring device (Pooyandegan Rah Saadat Co., Ltd. Tehran; Iran) to monitor the vital signs and a central endotracheal suction system (open suction system), which were weekly calibrated by related experts, were adopted. The present study was conducted on 60 subjects in two groups that were suctioned by 100 mmHg negative pressure ( n = 30) and 200 mmHg negative pressure ( n = 30), respectively. There were 34 male (56.7%) and 26 female (43.3%) subjects, with a mean age of 60.63 years (range 18-75 years). With regard to the type of disease, 31.7% had gastrointestinal diseases, 26.7% had brain diseases, 13.3% had renal diseases, 8% had multiple traumas, 5% had intoxication, 5% had cardiac diseases, and 10% had other diseases. Among the subjects, 58.3% had Synchronized Intermittent Mandatory Ventilation (SIMV) mode of ventilation, 35% had Continious Positive Air Pressure (CPAP) mode, and 6.7% received ventilation with Assist-Control Ventilation (ACV) mode. Subjects’ mean length of hospitalization in the ICU was 3.85 (1.66) days, which ranged 1-7 days. Mean length of subjects’ intubation longevity was 3.33 (1.29) days, which ranged 1-6 days. Independent t -test was used to c ompa re subjects’ age, intubation time length, hospitalization length, and endotracheal tube size in the two groups, and showed no significant difference ( P > 0.05). Chi-square test was used to determine homogeneity of subjects’ sex, hospitalization reason, and mechanical ventilation mode, and showed no significant difference in the distribution frequency of the above-mentioned items in the two groups ( P > 0.05). Repeated measure analysis of variance (ANOVA) showed a significant difference in the SPO 2 mean scores at different time points (before, during, and 5 and 20 min after suction) in each group of 100 mmHg and 200 mmHg negative pressures ( P < 0.001), but the difference was not significant between the two groups ( P = 0.779). Independent t -test showed no significant difference in mean values of SPO 2 before, during, and 5 and 20 min after suction in the two groups ( P = 0.362, P = 0.53, and P = 0.302 and P = 0.139, respectively), which indicates that the groups had similar changes in SPO 2, The highest difference in SPO 2 was during suction, which had a descending trend and was observed more in the group receiving negative pressure of 200 mmHg. Mean values of SPO 2 showed a significant reduction during suction compared to before suction in the two groups ( P < 0.001), which was more in the group receiving negative pressure of 200 mmHg. In group 1, mean values of SPO 2 at time points of 5 and 20 min after suction showed an increase compared to before suction, which was not significant ( P = 0.101 and P = 1.000, respectively). In group 2, mean values of SPO 2 at time points of 5 and 20 min after suction showed an increase, which was not significant ( P = 0.11 and P = 0.20, respectively), Comparison of mean and SD of arterial O 2 saturation in repeated measure ANOVA in the two groups of open suction with negative pressures 100 mmHg and 200 mmHg, respectively Repeated measure ANOVA in the two groups of 100 mmHg and 200 mmHg negative pressures showed a significant difference in HR values at different time points (before, during, 5 and 20 min after suction) in each group ( P < 0.001), but no significant difference between the groups ( P = 0.702). Independent t -test showed no significant difference in HR values before, during, and 5 and 20 min after suction ( P = 0.954, P = 0.275, and P = 0.792 and P = 0.974, respectively), and the groups had similar changes in HR values. Mean HR values showed a significant increase during suctioning compared to before in both the groups ( P < 0.001), and the increase was more in the group administered 200 mmHg negative pressure. In group 1, mean HR values showed a reduction at 5 and 20 min after suctioning compared to before suctioning, which was not significant ( P = 1.000, P = 1.000). In group 2, mean HR values showed a reduction at 5 and 20 min after suctioning, which was not significant ( P = 1.000, P = 1.000), Comparison of mean and SD of HR/min in repeated measure ANOVA in the two groups of open suction with negative pressures 100 mmHg and 200 mmHg, respectively The results of repeated measure ANOVA showed a significant difference in pulse oximetry and HR before, during, and 5 and 20 min after suctioning in each group ( P < 0.05), but the difference was not significant between the two groups ( P > 0.05). This finding is consistent with the results of the study by Yazdannik et al, comparing two levels of suctioning pressures (100 mmHg and 200 mmHg negative pressure) in closed system suction in patients hospitalized in the ICU. These findings reveal no difference between the two groups concerning arterial O 2 saturation and HR in the four above-mentioned time points with two levels of negative pressure. Therefore, with regard to the above-mentioned results, application of 200 mmHg negative pressure, when standard protocol of this procedure is precisely followed, is recommended in patients with stable hemodynamic status hospitalized in the ICUs. Our results also showed a significant reduction in arterial O 2 saturation values during suction compared to before suction in each group ( P < 0.001) and a significant increase in mean HR values during suction compared to before suction in each group ( P < 0.001). In a literature review study conducted by Pagotto et al,, out of six studies on arterial O 2 saturation changes during suctioning process, five reported a notable reduction in arterial O 2 saturation during open system suctioning process. This literature review study also points to the study of Cereda et al, which reported a notable increase in HR during open system endotracheal suctioning which is consistent with the above results. Etemadifar et al, showed a significant reduction in mean arterial O 2 saturation during suction compared to before suction ( P < 0.001) and a significant increase in HR during suction compared to before suction ( P < 0.001), which is consistent with results of the present study. Lee et al, showed a significant increase in HR immediately after suctioning ( P < 0.05). The arterial O 2 saturation levels changes and HR values after endotracheal suction seem to have originated from disconnection of the patient from ventilator, obstruction of airways which resulted from inserting the catheter in endotracheal tube, stopping of oxygenation to the patient during endotracheal tube suctioning, and lowered respiratory volume due to application of negative pressure suctioning, especially 200 mmHg negative pressure suctioning. It is recommended to administer suction if needed and to hyperoxygenate the patient before and after suction, and to conduct suctioning for a fewer times with an endotracheal catheter of appropriate size. Our results showed an increase in mean arterial O 2 saturation 5 and 20 min after suction compared to before suction in each group, which was not significant, and returned to before suction level at the 20 th min post suction, which is consistent with the report of Yazdannik et al, Increase of SPO 2 on the 5 th and 20 th min after suction seems to be due to administration of 100% oxygenation 2 min before and after suctioning. Not only a reduction was not observed in SPO 2 in 200 mmHg negative pressure suction, but also an increase was seen, possibly due to better discharge of secretions from the airways and improvement of ventilation. Therefore, the researcher recommends administration of 100% oxygenation before and after open system suction based on patients' clinical conditions to prevent the negative effects of negative pressure suction. Lasocki et al, showed an average of 18% reduction in O 2 parabolic pressure compared to baseline values in open system suction with 200 cm H 2 O negative pressure which continued until 15 min after suctioning, and is consistent with the present study. The results of this study showed that hyperoxygenation of the patients based on standard protocol of this care (in case of patients' need) in open system suction before and after this procedure, selection of catheter size appropriate to patients' tracheal tube, paying attention to permitted suction timing (10-15 s), and appropriate number of suctions should be considered. Also, 200 mmHg negative pressure suction is applicable as a safe and low-risk negative pressure for ICU hospitalized patients. With regard to the limitations to the present study, further comparative studies to define the effect of various open system suction negative pressure levels on patients' vital signs, the amount of the secretions removed from the endotracheal tube, ventilation-associated pneumonia, and mortality among patients hospitalized in the ICU are suggested. This article has been extracted from a dissertation approved by Isfahan University of Medical Sciences No.392012 and IRCT No.2013041713039N1. We greatly appreciate the Vice-Chancellor for research in Isfahan University of Medical Sciences, as well as the nursing staff in the ICUs of Alzahra hospital and all patients who cooperated with us in this study. Source of Support: Isfahan University of Medical Sciences Conflict of Interest: Nil.1. Irwin RS, Rippe JM. Philadelphia: Lippincott Williams and Wilkins; 2008. Irwin and Rippe's intensive care medicine.2. Urden LD, Stacy KM, Lough ME. Philadelphia: Mosby; 2011. Thelan's critical care nursing: Diagnosis and management; p.602.3. Mohammadi N, Parviz S, Peyravi H, Hosseini AF. Effect of endotracheal suctioning education for nurses on patients' hemodynamic parameters. Hayat.2012; 18 :38–46.4. El Masry A, Williams PF, Chipman DW, Kratohvil JP, Kacmarek RM. The impact of closed endotracheal suctioning systems on mechanical ventilator performance. Respir Care.2005; 50 :345–53.5. Zolfaghari M, Nasrabadi AN, Rozveh AK, Haghani H. Effect of open and closed system endotracheal suctioning on vital signs of icu patients. Hayat.2008; 14 :13–20.6. Subirana M, Solà I, Benito S. Closed tracheal suction systems versus open tracheal suction systems for mechanically ventilated adult patients. Cochrane Database Syst Rev.2007; 17 :CD004581.7. Nazmiyeh H, Mir Jalili MR, Emami Maibodi R. Comparison of the effects of open and closed Endotracheal suction on Cardiovascular and Ventilation parameters for patients undergoing mechanical ventilation. Journal of Rafsanjan University of Medical Sciences.2010; 9 :97–106.8. Rolls K, Smith K, Jones P. NSW Health, Sydney, Cumberland: NSW Health; 2007. Suctioning an adult with a tracheal tube. NSW Health Statewide Guidelines for Intensive Care.9. Morris L, Afifi S. New York: Springer Publishing Company; 2010. Tracheostomies: The complete guide.10. Maggiore SM, Volpe C. Réanimation. Vol.20. springer; 2011. Endotracheal suctioning in hypoxemic patients; pp.12–8.11. Harada N. Closed suctioning system: Critical analysis for its use. Jpn J Nurs Sci.2010; 7 :19–28.12. Yazdannik AR, Haghighat S, Saghaei M, Eghbali M. Comparing two levels of closed system suction pressure in ICU patients: Evaluating the relative safety of higher values of suction pressure. Iran J Nurs Midwifery Res.2013; 18 :117–22.13. Lasocki S, Lu Q, Sartorius A, Fouillat D, Remerand F, Rouby JJ. Open and closed-circuit endotracheal suctioning in acute lung injury: Efficiency and effects on gas exchange. Anesthesiology.2006; 104 :39–47.14. Pedersen CM, Rosendahl-Nielsen M, Hjermind J, Egerod I. Endotracheal suctioning of the adult intubated patient-what is the evidence? Intensive Crit Care Nurs.2009; 25 :21–30.15. Pagotto IM, Oliveira LR, Araújo FC, Carvalho NA, Chiavone P. Comparison between open and closed suction systems: A systematic review. British Journal of Intensive Care.2008; 20 :331–8.16. Cereda M, Villa F, Colombo E, Greco G, Nacoti M, Pesenti A. Closed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation. Intensive Care Med.2001; 27 :648–54.17. Etemadifar S, Nemati S, Aslani Y, Mehr- Alian HA. Effects of Intratracheal Suctioning on Hemodynamic Parameters and Arterial Oxygen. Iran Journal of Nursing.2008; 21 :31–9.18. Lee C, Ng K, Tan S, Ang R. Effect of different endotracheal suctioning systems on cardiorespiratory parameters of ventilated patients. Ann Acad Med Singapore.2001; 30 :239–44. : Comparison of the effects of two levels of negative pressure in open endotracheal tube suction on the physiological indices among patients in intensive care units

What materials do suction cups work on?

Suction cups adhere best to smooth, non-porous surfaces such as tile, glass, fiberglass or metal. To ensure a firm bond, surfaces should be totally free of dirt and soap film before attaching the suction cup.

What is the proper method to clean an instrument suction lumen?

Best Practices for Reprocessing Lumened Instruments – Outpatient Surge CHALLENGING CHANNELS Lumened instruments of all shapes and sizes are some of the most difficult instruments to reprocess. L umened instruments come in all shapes and sizes — from the tiny ophthalmic cannulas to laparoscopic instruments to gastrointestinal endoscopes.

1. They all have one thing in common: They’re difficult to clean and can cause dangerous consequences if contaminated.
2. Just turn to the recent deadly duodenoscope outbreak as an example ().
3. It’s a detailed practice, but lumened instruments can be reprocessed correctly if you follow the right steps and take advantage of technology aimed to make the job easier.1.

Pre-clean at the point of use Many don’t realize how important pre-cleaning at the point of use is. Keep instruments moist after use to ensure that blood, tissue and other body fluid doesn’t dry and make the instrument harder to clean. After it’s used, wipe the instrument down in the OR with a moistened towel or sponge to remove gross soil.

After surgery, the lumen of the instrument should be flushed using a syringe and an enzymatic detergent, which helps start breaking down bioburden. Instruments with lumens should be flushed after use and either kept under a moist towel or soaked in a neutral pH enzyme detergent until they head down to central sterile processing.

To make this job even simpler, and keep instruments moist without having to fill a basin for soaking, new gel and foaming enzymatic detergents specifically designed for pre-cleaning can be applied quickly to instruments after they are used. These form protective barriers to keep instruments moist for longer. SCRUBBING RULES Make sure your brush is the correct size to clean the instrument’s lumen and that it is cleaned after use. After they arrive from the OR, a neutral pH enzyme detergent should be drawn into the lumen. The instrument can then be submerged horizontally in enzymatic detergent for a specified time listed in the manufacturer’s instructions for use (IFU), typically 5 to 10 minutes.

• Make sure you have the proper concentration of detergent, as well as the correct temperature of the water.
• Automatic sink-filling systems aim to automate this process, reducing waste and ensuring instruments have a proper soak.
• Next, instruments must be scrubbed using the correct brush.
• Information on the size and style of the brush is usually found in the manufacturer’s IFU.

The brush size should be the same diameter as the lumen — too small and it won’t create enough friction to clean the inside of the lumen; too large and the bristles will bend or not fit correctly inside. Another option is pull-through channel brushes that are designed for hard-to-clean narrow channels.

Scrubbing should be done under water — the tech wants to minimize contact with the debris being pulled out of the lumen. Also note that brushes should be checked for wear and tear, which affects their ability to clean inside the lumen. Reusable brushes should be cleaned after each use and should be either disinfected or sterilized daily, according to the manufacturer’s IFU.

For endoscopes, techs follow a similar process except that a leak test should also be performed, following manufacturer’s IFU. WHEN CLEANING ISN’T ENOUGH When to Consider Other Options Sometimes, lumened instruments are just too difficult to clean, even if you follow the correct process.

For example, AORN recommends the use of disposable ophthalmic instruments with cannulas when possible since the tiny lumens can be a risk. While I advocate minimizing waste, consider disposables for items like tiny plastic tubing that are too hard for busy techs to properly reprocess. Another common problem I see is facilities that reprocess first-generation laparoscopic instruments, which don’t come apart and are difficult to clean.

I often see these instruments sent out for repair that, when taken apart, are caked with debris that’s been missed for weeks or even months. If your docs are using these first-generation instruments, I strongly suggest considering new models that are designed to come apart for easy cleaning.

• Donna Swenson BS, CRCST, CHL, ACE 3.
• Flushing the lumen Once scrubbing is complete, the lumen must be flushed with copious amounts of water to remove any remaining detergent and debris.
• For most instruments, you have the option of manual flushing using a syringe, or you can do mechanical high-pressure flushing using a variety of devices.

While a syringe may be sufficient, I recommend finding a mechanical option since it’s usually more effective. New independent devices can flush lumens with high-pressure water and/or detergent with the added convenience of being hands-free. These devices feature a variety of connector attachments that allow a tech to attach the lumen to the device that pushes high-pressured fluid through it for a set amount of time to ensure it’s clean.

Another affordable option is water pistols, which work well for small facilities. These require a more hands-on approach from the tech since they need to depress the trigger to flush the lumen, but deliver a similar outcome. For even more thorough cleaning, instruments can be placed into an ultrasonic washer following manual cleaning.

While expensive, ultrasonic washers are able to remove fine debris that might be difficult to remove during manual cleaning. New ultrasonic cleaners feature channel adapters for lumened devices, allowing them to be flushed with detergent while removing any trace contaminants.

1. Ensure the washer is drained, wiped down and refilled with fresh water at least daily or when the solution becomes cloudy or turbid-looking.4.
2. Cleaning verification Cleaning verification is by far the most missed step in cleaning lumened instruments, yet it is the one that lets you know if the process is working.

To check lumened instruments, you have several options. Some suggest simply running water through the lumen to check for any discoloration or debris, or using a moistened brush or pipe cleaner pulled through the channel. For a more detailed look inside the lumen, inspector scopes can be inserted to check for missed debris.

Techs should perform a visual inspection of all lumened instruments after cleaning. For a more precise look at your cleaning, lumen cleaning verification products should be used periodically to test for traces of missed protein. These tests feature indicators that are pulled through the lumen and test for the presence of residual soil (protein, for example).

These tests come in different formats and are available for nearly all lumened instruments, including endoscopes. If you’re currently not performing these tests, start by first testing all of your lumened instruments after cleaning to get a baseline feel of your process.

1. If you’re consistently getting clean checks, then you can turn to societies such as the American Society for Quality () for random sampling tables that determine how often these chemical verification checks should be performed, based on the number of instruments you process and use.
2. If you’re consistently seeing problems after performing cleaning checks, it’s time to analyze your process.

Are you only performing manual cleaning and flushing? Then it may be time to invest in new automated technology. Is the instrument older and hard to clean? Look for updated models or implement a stricter policy for that device. LOW-TEMP STERILIZATION Is Low-Temp the Way of the Future? SENSITIVE SCOPES As more focus on preventing outbreaks linked to tricky scopes, low-temperature sterilization is coming to the front and center. Following the recent duodenoscope outbreak, which left several patients dead due to problems with the cleaning of these tricky devices, some have been making the push for low-temperature sterilization for gastrointestinal scopes.

1. Low-temperature sterilization uses a variety of sterilants, including ethylene oxide or hydrogen peroxide, to kill nearly all microbes on the scopes.
2. Sterilization provides a higher level of assurance that the microorganisms have been killed when compared to high-level disinfection.
3. Many are now considering sterilization for notoriously hard-to-clean scopes such as duodenoscopes, with the hope it will prevent outbreaks.

It’s important to note that low-temperature sterilization doesn’t negate the need for manual cleaning — your staff will still need to pre-clean, scrub and flush the scopes. While, in theory, low-temperature sterilization could cut your risk of contamination, it can also create a false sense of security since sterilization, like high-level disinfection, is dependent on other steps in the process.

If an instrument isn’t properly cleaned then it might not be possible to disinfect or to sterilize the device. Sterilization isn’t foolproof, but it is seriously being considered as the next step in endoscope reprocessing. Currently, some societies are considering a change in their guidelines that would recommend that all gastrointestinal scopes be sterilized.

If you’re considering adding low-temperature sterilization to your facility, consider several factors. No sterilant is considered better than another. While ethylene oxide is extremely effective, it requires a long exposure time and is a human carcinogen.

Hydrogen peroxide is thought to be a more practical and popular option, yet it is very sensitive to humidity. Before purchasing, weigh the pros and cons of each unit in addition to looking at its compatibility with your devices, its size and the cost. — Donna Swenson BS, CRCST, CHL, ACE 5. Disinfection and sterilization What about the lumened instruments that can be steam-sterilized? After passing cleaning verification, package them with their tray, wrap or place them in rigid sterilization containers and place them into the autoclave.

Some instruments require low temperature sterilization, so check with the manufacturer’s IFU. After testing, flexible endoscopes are ready for high-level disinfection or, in some cases, low-temperature sterilization (see “” ). You can use an automated endoscope reprocessor (AER) to high-level disinfect scopes, or you can do so manually.

If you have a decent volume of cases, consider an AER, which can really help standardize and improve your scope reprocessing. These machines perform a variety of tasks, including flushing channels and testing for leaks, making the process more efficient and effective. Still, it’s important to note that as with all sterilization and high-level disinfection processes, you must first properly clean the instrument in order for the process to work.

: Best Practices for Reprocessing Lumened Instruments – Outpatient Surge


Chukwudi Eze