Intersurgical TrachSeal™ Closed suction system
Every time a breathing system is opened this action causes a number of problems for both the patient and nursing staff.
There is an immediate loss of PEEP to the patient.
Oxygen desaturation may have an impact on the patient’s overall condition.
Bacteria and other pathogens may find their way into the lungs with the introduction of an open catheter.
A coughing reflex by the patient may put the healthcare provider at risk from cross-infection.
Since the introduction of closed suction systems in 1987, care providers have been offered a solution that keeps the breathing system and PEEP intact.
The benefit to the patient is the least possible disruption of ventilation and blood oxygenation and ultimately a chance for faster recovery.
How to use TrachSeal™
Check the internal diameter of the endotracheal tube.
Select a TrachSeal™ with the correct suction tube diameter for the endotracheal tube in accordance with current guidelines.
AARC guidelines Mechanical Suctioning of Ventilated Patients, 2010 ET Tube Size - Catheter 2.1 Diameter of the suction catheter should not exceed one half the inner diameter of the artificial airway in adults, providing an internal to external diameter ratio of 0.5 in adults.
Carefully review the instructions for use.
Remove the disconnection wedge. An included clip allows convenient attachment to your clothes or patients bedding.
Remove the breathing system and attach the TrachSeal™ using a push/twist action. Hold the ET tube connector to avoid placing strain on the cuff.
Attach the breathing system using a push/twist action.
You may also use the included catheter mount between the breathing system and the TrachSeal™.
Suctioning
A requirement for suctioning the patients airways should not be based on routine time intervals, but on published indicators. These are listed by the AARC guidelines for Mechanical Suctioning of Ventilated Patients, 2010:
6.2.1 sawtooth pattern on the flow/volume loop on the monitor screen of the ventilator and/ or the presence of coarse crackles over the trachea are strong indicators of retained pulmonary secretions.
6.2.2 increased peak inspiratory pressure during volume-controlled mechanical ventilation or de-creased tidal volume during pressure-controlled ventilation.
6.2.3 deterioration of oxygen saturation and / or arterial blood gas values.
6.2.4 visible secretions in the airway.
6.2.5 patient's inability to generate an effective spontaneous cough.
6.2.6 acute respiratory distress.
6.2.7 suspected aspiration of gastric or upper airway secretions.
When a suction intervention is indicated, initiate the suction unit and regulate the vacuum.
AARC guidelines for Mechanical Suctioning of Ventilated Patients, 2010: 2.3 Negative pressure of 80-100mmHg in neonates and less than 150 mm Hg in adults have been recommended.
Attach the suction tubing to the vacuum source.
AARC guidelines for Mechanical Suctioning of Ventilated Patients, 2010: 2.3 The negative pressure of the unit must be checked by occluding the end of the suction tubing before attaching it to the suction catheter, and prior to each suctioning event.
Attach suction tubing to the TrachSeal™ closed suction catheter.
Ensure that the suction valve lock is in place.
AARC guidelines for Mechanical Suctioning of Ventilated Patients, 2010: 2.2 In preparation for the suctioning event, delivery of 100% oxygen in pediatric and adult patients […] for 30-60 seconds prior to the suctioning event is suggested, […]
If using the 72 hour version, open the isolation valve.
Unlock the suction valve.
Advance catheter gently down the ET tube.
When the numbers on the ET tube and catheter are aligned, the tip of the suction catheter is located at the distal end of the endotracheal tube.
Tips aligned
Extend the suction catheter a maximum of two centimetres beyond the end of the ET tube to clear the Murphy eyes ready for suctioning.
Push down on suction valve and gently withdraw catheter.
AARC guidelines for Mechanical Suctioning of Ventilated Patients, 2010: 3.3 The duration of each suctioning event should be no more than 15 seconds.
Black marker appears
If using the 72 hour version close the isolation valve.
Cleaning TrachSeal™
Open the irrigation port cap.
Attach a designated saline ampoule to the irrigation port.
Suction until ampoule is empty. Depressing the suction valve intermittently may be beneficial in the cleaning process.
Follow the same process when using a syringe
Close the irrigation port cap.
Lock the suction valve.
To remove the TrachSeal™
Slide the disconection wedge between the TrachSeal™ and the ET tube.
Reconnect the breathing system or replace with a new TrachSeal™ product.
Intersurgical TrachSeal™ Closed suction system
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