Apprenticeship Learning Log

Date of Learning: 10/01/2025

Time: 09:30-1630

Title of learning activity: Acute Sim Responding to adverse event.

Diary of Learning activity

Today we reflect on

Airway suctioning is a medical procedure used to remove secretions, mucus, or foreign material from a patient’s airway to maintain or improve ventilation and oxygenation. It’s often performed in critical care, emergency settings, or for patients who cannot clear their airways effectively on their own (e.g., due to a coma, respiratory illness, or post-surgical recovery). Here’s a breakdown of its indications and contraindications:

Indications for Airway Suctioning

1. Inability to Clear Airway Secretions:

When a patient cannot effectively clear their own airway (e.g., due to weakness, neurological impairment, or unconsciousness), suctioning is indicated to help clear mucus, blood, or other secretions that could obstruct airflow.

1. Excessive Secretions:

Conditions like chronic obstructive pulmonary disease (COPD), cystic fibrosis, or pneumonia can lead to excessive mucus production. Suctioning may be necessary when the secretions are too thick or abundant for the patient to clear on their own.

1. Airway Obstruction:

Suctioning is indicated when there is an obstruction in the airway due to vomit, blood, or other foreign material that could impede breathing. This is particularly important in situations like aspiration or trauma.

1. Respiratory Distress or Hypoxia:

If a patient is exhibiting signs of respiratory distress (e.g., labored breathing, decreased oxygen saturation) due to airway blockage, suctioning may be necessary to remove the obstruction and restore normal airflow.

1. Pre- or post-procedure:

Airway suctioning may be performed before or after certain medical procedures (e.g., endotracheal intubation, bronchoscopy) to clear the airway or to prevent complications.

1. Ventilator Patients:

Patients who are on mechanical ventilation may require regular suctioning to remove accumulated secretions that could interfere with the ventilator’s function or cause infections like ventilator-associated pneumonia (VAP).

Contraindications for Airway Suctioning

1. Presence of a Secure Airway:

If the patient has a secured and patent airway (e.g., endotracheal tube, tracheostomy tube), suctioning should only be performed if there is clear evidence of obstruction or excessive secretions. Routine suctioning without a clinical need could cause harm.

1. Increased Risk of Bleeding:

Suctioning should be avoided in patients who are at high risk for bleeding (e.g., after recent surgery, patients with bleeding disorders, or those on anticoagulants) unless absolutely necessary. Suctioning may cause trauma to the airway lining, leading to bleeding.

1. Severe Hypoxia or Bradycardia:

Suctioning may cause temporary hypoxia (low oxygen levels) or bradycardia (slow heart rate), especially if done improperly or for too long. In patients with severe hypoxia or bradycardia, suctioning should be approached cautiously, and oxygen support should be used as needed.

1. Recent Facial or Neck Surgery:

In patients who have undergone recent surgery to the face, neck, or airway (e.g., laryngeal surgery, tracheostomy placement), suctioning should be avoided or performed with extreme caution to prevent trauma or infection.

1. Acute Bronchospasm:

If a patient is experiencing bronchospasm (e.g., in asthma or anaphylaxis), suctioning may provoke further airway constriction and worsen the situation. Treatment for bronchospasm should be prioritized first (e.g., bronchodilators), and suctioning should be delayed unless necessary.

1. Excessive Suctioning:

Repeated suctioning or suctioning for too long can damage the mucosal lining of the airway, leading to irritation, inflammation, or even trauma. It should be performed only when clinically indicated, and care should be taken to limit the duration and frequency of suctioning.

minimizes risks and improve outcomes, suctioning should always be performed according to best practices:

• Sterile technique: Maintain aseptic technique to avoid introducing infection.
• Pre-oxygenation: Administer supplemental oxygen prior to suctioning, especially for patients who are already hypoxic.
• Limit duration: Suctioning should generally be limited to no more than 10-15 seconds to minimize the risk of hypoxia and other complications.
• Monitor closely: Continuously monitor the patient’s vital signs (oxygen saturation, heart rate, respiratory rate) during and after the procedure to assess for any adverse effects.

 

KSBs addressed:

K1. Understand the code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates (NMC 2018), and how to fulfil all registration requirements

K4. Understand the principles of research and how research findings are used to inform evidence-based practice

K6. Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice

K16. Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care

K19. Know how and when to escalate to the appropriate professional for expert help and advice

K22. Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health

K23. Know how to meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity

K41. Know the roles, responsibilities and scope of practice of different members of the nursing and interdisciplinary team, and own role within it

S1. Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates (NMC, 2018), and fulfil all registration requirements

S2. Keep complete, clear, accurate and timely recordsS3. Recognise and report any factors that may adversely impact safe and effective care provision

S30. Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed

S38. Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members

B1. Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy and preferences

B2. Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice

B3. Be adaptable, reliable and consistent, show discretion, resilience and self-awareness