00:04
So once we've got
that wall suction on,
this is where that sterile
technique comes in.
00:09
Okay, so to begin the skill,
we're going to use sterile technique
to open the suction catheter kit.
00:16
Then we're going to go ahead and
perform our hand hygiene again.
00:20
Now once we open up our
suction catheter kit,
we've done our hand hygiene.
00:24
Now we've got to pour the
sterile saline solution
into that sterile suction catheter
kit or the sterile container.
00:32
Now many times the saline solution
is a stand alone equipment.
00:37
So therefore here you notice we
have not don sterile gloves yet.
00:41
Same thing here is we're going to
go ahead and open up the lubricant
and then apply it to the sterile catheter
inside that suction catheter kit.
00:50
Now it's really important here that we
maintain sterility of the suction catheter.
00:56
Now that we have got
our equipment ready,
we can go ahead and
don sterile gloves.
01:02
Now we want to assign our
dominant hand as sterile
and our non-dominant
hand as non-sterile.
01:07
We'll kind of talk about
why we're going to do that.
01:11
Now with my sterile hand,
this is the one I'm going
to pick up my catheter
and then with my non-dominant
non-sterile hand,
then we're going to have the
suction tubing in that hand
and we're going to
attach these together.
01:24
So with the catheter
in my sterile hand,
I'm going to dip a catheter
into the sterile saline solution
and suction a small amount
of saline into that catheter
to make sure suction is
working appropriately.
01:38
Now here after we've done this,
we want to go ahead and also
lubricate the catheter for insertion
while maintaining sterility
of the suction catheter.
01:48
Lubrication is important
before we insert.
01:51
Now if the client is
conscious and able,
instruct them to cough and breathe deeply
before inserting the suction catheter.
01:59
Now here's where
the part comes in
that maybe a little
uncomfortable for your patient.
02:04
If they can help
it or if it's okay,
make sure you have the
patient tilt their head back
and expose the nostril or the oral
cavity that you're going to go into.
02:13
Now when we advance the
catheter and we insert it,
at this point,
we do not apply suction here.
02:20
So when we advanced the catheter just going
down into the nasal pharyngeal cavity,
you do not apply suction
here, not yet.
02:29
Now if the patient
begins to cough,
that could indicate we're
an area we don't want to be.
02:34
So make sure you stop and do
not advance the catheter here.
02:38
Now once we've advanced
that catheter safely,
now's the time to apply
suction to either the mouth
or the nasal cavity to
remove those secretions.
02:52
Hi, guys, you may wonder,
"Okay, what is she
wearing on her face?"
Well, I've got a face shield on
today as a big reminder for you
that anytime that you suction
the respiratory tract,
we need to make sure that we protect
our eyes, our nose and our mouth.
03:09
So again, anytime you do
a respiratory suction,
make sure you protect yourself
with the appropriate PPE.
03:16
Now, I'm going to go ahead and
show you how we do this skill.
03:21
So we just talked about
appropriate PPE for your patient.
03:25
Now let's go and we're
here with our patient now
and assess our patient
before we get started.
03:30
So remember, as a nurse, we like to
go back to that assessment piece.
03:34
So again, before you start
to insert a catheter,
it's a great idea to
assess the patient's nares
if we're doing nasal suctioning,
or their oral cavity if
we're doing oral suctioning.
03:45
Now when we're talking
about the nares,
one thing we can do to assess
is simply take our pin light
and also look for ourselves.
03:55
So we want to look up there,
see if there's any obstruction.
03:58
Also, it's a great idea to ask your patient
if they have a deviated septum for example,
we want to avoid that nostril.
04:05
Also, one thing we can
have our patients do
is take one finger and block one
nostril and have them breathe in
and see which one's more
comfortable for the patient.
04:15
Also,
if we assess the oral cavity,
we want to check for any
lesions or anything like that
before we insert the catheter.
04:22
So now we've evaluated where we're
going to go with that catheter.
04:25
Make sure we check your
patient's breathing, right?
Because we're going
to do suctioning here,
and that can compromise
the respiratory status.
04:32
Now this is important because this
is going to help us get a baseline.
04:36
Now when we suction,
we need to be really mindful
that we don't hinder again
their respiratory status.
04:42
So it's a great idea to
check on your patient,
see how their breathing is,
also to get an oxygen saturation
to see where they're at.
04:49
This again just gives
us a great baseline.
04:53
Now before we get started,
don't forget to protect your patient.
04:56
So if you've got a towel or maybe like
an absorbent pad like I have here.
05:00
Great idea, just in case you
get any mucus or some secretions
on the patient's linen,
we want to protect that.
05:16
Okay, so now I've got
my patient protected.
05:18
And before we get started,
this may seem a little funny, but make
sure you turn on your wall suction.
05:24
So we're going to go to our unit
and make sure this is turned on.
05:28
The reason why we want to do this
because if you start to get sterile,
you don't want to have
to stop and think,
"Oh, no, I haven't turned
on my suction yet."
So make sure you check that, that it's
working properly before you get started.
05:41
So let's go ahead and
dive into our skill.
05:43
So first, let's go ahead and
open up our suction catheter kit.
05:47
Now if you guys remember, we're going
to use sterile technique on this
because again, we're talking
about the respiratory tract.
05:53
Now, anytime you're talking about
sterile equipment, if you remember,
it's typically
enclosed in a package.
05:59
Also one tip that's
really helpful.
06:01
If you're opening up
something that's sterile,
usually, there's going to be a list
on there of what's inside the package,
if there's multiple
equipment needed.
06:10
So just know that,
so that's really helpful.
06:13
So I'm going to go ahead and open
up my sterile suction catheter kit.
06:17
And no, we don't want to touch
the inside with our bare hands.
06:27
So I'm going to place
that to the side
and you may see a
pair of gloves here.
06:31
So for us to add anything to it,
I am going to have to remove those,
you may think, okay,
hold on a minute,
she just told me not to
touch the inside of that.
06:39
But these are the gloves that we would put
on if we're going to do this procedure.
06:45
Also, notice they're
enclosed in a package,
the package is going
to be on the table.
06:51
Also,
the gloves itself are sterile.
06:53
And these are encased
in this package.
06:55
So don't worry about that.
06:56
So let's go ahead and
remove the gloves.
06:59
So if we can,
we want to pinch in the middle
or be really careful not
to tear the package here
and get rid of those.
07:08
So now that that's open,
we do not want to touch inside that.
07:12
Now there's some variation here.
07:14
We talked about
some steps earlier,
that you know, there's a variation on how
nurses are going to do everything right.
07:21
And that's okay, as long as with this
particular skill, you maintain sterility.
07:26
And again, so each nurse kind
of does it a certain way.
07:30
However, me as a nurse,
this is how I like to do it
just to try to prep everything I can
before I put on my sterile gloves.
07:38
So I'll show you how I do this.
07:40
So first, we want to go ahead
and prep our sterile saline.
07:43
And remember keywords sterile,
because again,
it's the respiratory system,
we want to make sure
this is sterile saline.
07:52
Let me open this and go ahead
and add it to my sterile field.
07:58
Now you see what I've got
here for the sterile saline
that totally works, you may have
like a bottle, for example.
08:07
And you can use that as
well as long as it's sterile
whatever equipment you've got.
08:13
All right,
this is our lubricating package.
08:15
So this is really important
to lubricate the catheter
for comfort when you
insert it in our patient.
08:21
Now, you'll see
some nurses go ahead
and hold out the catheter
and put this on here.
08:27
I will tell you just from
my personal experience,
sometimes it's hard to make sure you
hit the catheter in the air like this.
08:33
Also, I want to make sure I don't touch
this package to the sterile catheter.
08:38
So me, I go ahead and put it
in the sterile tray itself,
that way I can eliminate
that possibility.
08:51
Okay, so I'm just going to
add it to my sterile field.
08:58
All right,
that should work right there for me.
09:00
So now I'm going to go ahead,
once I've got everything done,
it'd be great idea to go ahead and
perform our hand hygiene here again,
then I want to go ahead
and don my sterile gloves.
09:11
So again,
anytime you do a sterile procedure,
it's a great idea to
have another pair,
sometimes we may drop it,
it could be the wrong size,
whatever that may be, always a
great idea to bring an extra pair.
09:28
So think of this as a
separate sterile field.
09:32
When you open up the package,
this parts going on the table,
and you want to open this up
where you can see the wings.
09:42
So just as a refresher here,
when you're putting on sterile gloves,
there's always these
great little flaps that's
how you know it should
be facing the top
and that's what you want.
09:52
So let me get a hold of my
wings here and open this up.
09:56
So notice how these
want to flap in.
09:59
I really like to turn
that on the corners
to make sure it doesn't inhibit
my sterile field or contaminated.
10:11
Okay, now if you guys remember,
there's actually a 1 inch
border around a sterile field
so that way we can move
this or manipulate that.
10:21
So now I want to go ahead
and start with my gloves.
10:23
Again, this is gonna vary and
practice is key with these things.
10:27
Now, some people like to start with their
dominant or their non-dominant hands,
it's totally up to you when
whatever you're comfortable with.
10:35
Here's an example,
I actually am right-handed,
but I like to
start with my left.
10:38
So, now let's take a
look at the gloves.
10:41
Just as a recap here.
10:43
You see how there's
that cuff folded.
10:45
Now think about like a cuff on
a shirt when you pull it back,
that's the part inside
that's touching your skin.
10:52
That's why we can
touch this cuff here.
10:54
So now I'm going to go
ahead and pinch this,
because again,
this part is going to touch my skin.
11:01
I'm going to try to open this up
and slide my hand in like a pizza.
11:05
And I'm just going to take my time
here, don't get in a rush.
11:09
So I'm going to try to
wiggle my fingers in there.
11:12
Notice as well, when I donned
sterile gloves or put those on,
I like to keep this up,
I don't want to accidentally drag
this and contaminate my gloves.
11:24
So just try to manipulate,
wiggle that on and pull those on.
11:30
And sometimes guys,
sometimes you may tear it, that's okay.
11:34
That's why it's a great
idea to do backup.
11:36
Now really mines here
at the end of the cuff.
11:38
But just in case,
I'm going to go ahead and get rid of these
because I actually already
have another pair here.
11:43
Alright,
so now that I've got these on
because I want to kind of
move this out of the way guys,
I'm not above using an
elbow and moving this
or just pinch the middle
and get rid of this.
11:53
So we can touch that later,
we can get rid of all that stuff later.
11:57
So now that I've got
my sterile gloves on.
12:00
Now, here's an important
piece of the skill because
obviously, I'm going to
have to touch equipment.
12:05
And also I've got sterile
stuff here as well.
12:08
So you need to decide which
hands going to stay sterile
and which one's going
to be non-sterile.
12:13
So I'm right-handed,
so I like to keep this a sterile.
12:17
So now I'm going to take this
and with my sterile hand,
I'm going to pick up the catheter
because remember,
inside here a sterile.
12:26
So again, I'm touching inside, I'm going
to move this a little closer to me.
12:32
I'm going to make
sure when I grab this
that I get a good grip of this and this
catheter doesn't go all over the place,
so I'm going to
get a hold of it.
12:42
So my right hand is going to be
my sterile one, like you see.
12:45
And now I've got a hold of
my suction control here.
12:48
Now I'm going to take my,
what we call our non-dominant non-sterile
or you may hear my dirty hand
is what I'm gonna refer it to.
12:56
Now I can touch equipment
that's not sterile.
12:59
So here's this and now
we're going to connect.
13:03
Okay, so this is important
here because you see this hand
holding the catheter
will maintain sterility.
13:11
Notice I'm being really
careful about this catheter.
13:14
Now this one's important
because this is my dirty hand
and this is what's going
to control suction here.
13:20
So that's why we've got assigned
one hand versus the other.
13:24
So now if you remember
your suctions on,
I want to take my catheter and
I want to dip it into the saline
and suck that up just to make sure
suctions working and clearing the catheter.
13:36
Also, I want to take this and
also lubricate the tip as well.
13:41
Now this is a great time if your
patient is conscious and awake,
you want them to instruct
to cough and deep breathe
that may help to get some secretions
a little bit higher up in the throat
and that will be
easier for suctioning.
13:55
Also,
if your patient can help you,
you want them to
tilt their head back
and that will expose the
nostrils a little bit better
because today we're going to
do nasal pharyngeal suctioning.
14:06
Alright, so now I'm going to go ahead
and make sure I lubricate my catheter.
14:16
And now that we've
got this lubricated,
I can go ahead and
get ready to insert.
14:21
Now again, notice the
positioning on our patient.
14:23
This is really important here.
14:26
So with the patient,
if they begin to cough, that's okay.
14:31
Sometimes you've got to really
just assess your patient here.
14:34
Now you can imagine this thing
going to the back of your mouth,
you're probably gonna cough, it's gonna
take a little bit, that's pretty normal.
14:42
So if that happens,
make sure you assess your patient.
14:46
Also, this is a little bit of
a higher level skill, right?
This can be a little bit scary
for honestly if it's new to you
as the nurse also
for the patient.
14:54
So bring another experienced nurse
in to help monitor the patient.
14:58
Now we can go ahead
insert and apply suction.
15:01
So when we do this, we want to go
ahead insert into the nasal cavity.
15:07
Now notice before I start,
notice here with my thumb,
I am not applying suction yet
that's really important, okay?
So when we advance the catheter,
you do not apply suction.
15:21
So I'm going to
advance my catheter.
15:25
And again, the length is going
to kind of depend on the patient.
15:29
So once I'm about to,
once I'm applying suction,
now I can go ahead
and put my thumb down.
15:34
Now once it's inserted,
when I remove it,
I've got to do this
intermittently.
15:38
So again, once we withdraw,
I'm going to intermittently
apply suction with my thumb
while I'm withdrawing it.
15:47
So you notice to maintain
sterility of the catheter,
I can go ahead and make sure that
I keep this in my sterile hand.
15:55
Now, this is really important
that sometimes you may
have to do this a couple of
times, and that's all right.
16:00
But you want to make sure you
give your patient adequate rest,
you can imagine that again,
we're going down the respiratory tract
and the patient may have
a hard time breathing.
16:10
If they do,
let the patient relax,
let them just kind of
calm down a little bit,
reapply oxygenation if needed.
16:19
So just know that.
16:21
So again, many times you're going
to have to do this, 2 or 3 times.
16:26
So once I withdraw it,
I want to reapply suction to
clean out my catheter here.
16:31
So to apply suction,
don't forget,
I'm going to put
my thumb on there,
suck up my sterile
saline to clean out cath,
clean out the catheter
and do another pass.
16:40
So let me show you that again.
16:42
So again,
without suction my fingers off.
16:46
I'm going to insert down
the patient's nasal cavity.
16:54
Again, see my thumb,
no suction here.
16:57
And then when we're
ready to suck,
we're going to go
intermittent suction.
17:03
Withdraw and wrap it around in
my hand into a continuous motion
and then withdraw it.