Research Request – Suction machines types and cleaning | FOI document library

DOCUMENT 17 FOI 24/25-0889

Research Request – Suction machines types and cleaning

What are the different types of suction machines? What is the best practice Brief cleaning associated with portable suction machine use?

Date 12/09/19

s47F - perso Requester Kate

Researcher Aanika

Contents

Tracheostomy ……………………………………………………………………………………………………………………….. 2

Typical equipment and associated consumables required for Tracheostomy …………………………….. 2

Suction Machine ……………………………………………………………………………………………………………………. 2

Typical equipment and consumables required for suctioning ………………………………………………….. 3

Clinical guidelines for indication and use ……………………………………………………………………………….. 4

Liners ……………………………………………………………………………………………………………………………………. 5

Cleaning of portable suction machines ……………………………………………………………………………………. 5

Key sections of this previous research have been included and additional information re: suction machine types and cleaning have been included.

P a g e | 1 Page 221 of 258

FOI 24/25-0889

Tracheostomy When a participant requires the use of a ventilator, it is common to also require a portable suction machine, air humidifier and for some participants, also a cough assist machine.

Typical equipment and associated consumables required for Tracheostomy

People with tracheostomies may require several pieces of equipment and associated consumables which are explained in the table below.

Machine / R & N consumables per annum equipment

Ventilator This mechanical home ventilation guidelines website has a lot of information about the consumables associated with ventilators.1

The equipment required for invasive Tracheostomy ventilation will include at a minimum

Tracheostomy tube and replacements, including inner cannulas
Dressings for Tracheostomy site
Volume‐cycled ventilator with appropriate alarms and humidifier
Backup ventilator for primary ventilator failure
Handheld resuscitation bag with Tracheostomy adapter
Suction device with catheters for secretion removal
Backup power supply for ventilator (battery or generator)2

The equipment required for Non‐ Invasive ventilation at a minimum includes the following:

Pressure‐ or volume‐type ventilator
Appropriate interface mask or mouthpiece
Secretion management program or device
Backup power supply for ventilator (battery or generator)

Suction Machine Endotracheal suctioning (ETS) is one of the most common procedures performed in patients with artificial airways. It is a component of bronchial hygiene therapy and mechanical ventilation that involves the mechanical aspiration of pulmonary secretions from a patient’s artificial airway to prevent its obstruction. The procedure includes patient preparation, the suctioning event, and follow‐up care.

There are two (2) methods of endotracheal suctioning based on the selection of catheter: open and closed. The open suctioning technique requires disconnecting the patient from the ventilator, while the closed suctioning technique involves attachment of a sterile, closed, in‐line suction catheter to

1 https://intensivecareathome.com/mechanical‐home‐ventilation‐guidelines/

2 https://intensivecareathome.com/mechanical‐home‐ventilation‐guidelines/

P a g e | 2 Page 222 of 258

FOI 24/25-0889

the ventilator circuit, which allows passage of a suction catheter through the artificial airway without disconnecting the patient from the ventilator.

There are also two (2) methods of suctioning based on the catheter suction depth selected during the procedure: deep and shallow. Deep suctioning is defined as the insertion of a suction catheter until resistance is met, followed by withdrawal of the catheter by 1 cm before application of negative pressure, and shallow suctioning as the insertion of a suction catheter to a predetermined depth, usually the length of the artificial airway plus the adapter3.

Typical equipment and consumables required for suctioning

The tracheostomy table above says that ‘section device with catheters for secretion removal’ and a secretion management program’ are required.

The journal article ‘AARC Clinical Practice Guidelines: Endotracheal Suctioning of Mechanically Ventilated Patients with Artificial Airways 2010’ also states that the following necessary and optional equipment is required:

12.1 Necessary Equipment

12.1.1 Vacuum source

12.1.2 Calibrated, adjustable regulator

12.1.3 Collection bottle and connecting tubing

12.1.4 Disposable gloves

12.1.4.1 Sterile (open suction)

12.1.4.2 Clean (closed suction)

12.1.5 Sterile suction catheter

12.1.5.1 For selective main‐bronchus suctioning, a curved‐tip catheter may be helpful. The information related to the effectiveness of head turning for selective suctioning is inconclusive.

12.1.6 Sterile water and cup (open suction)

12.1.7 Goggles, mask, and other appropriate equipment for standard precautions

12.1.8 Oxygen source with a calibrated metering device

12.1.9 Pulse oximeter

12.1.10 Manual resuscitation bag equipped with an oxygen‐enrichment device for emergency backup use

12.1.11 Stethoscope

12.2 Optional Equipment

12.2.1 Electrocardiograph

3 https://www.aarc.org/wp‐content/uploads/2014/08/06.10.0758.pdf Page 758

P a g e | 3 Page 223 of 258

FOI 24/25-0889

12.2.2 Sterile sputum trap for culture specimen

12.3 Personnel. Licensed or credentialed respiratory therapists or individuals with similar credentials (eg, MD, RN) who have the necessary training and demonstrated skills to correctly assess need for suctioning, perform the procedure, and adequately evaluate the patient after the procedure.4

This journal article makes no reference to ‘liners’ as requested by providers. Liners are single use Suction receptacle liners for suction canister in a medical suction unit5.

Clinical guidelines for indication and use A journal article from 2010 by the American Association for Respiratory Care ‘AARC Clinical Practice Guidelines: Endotracheal Suctioning of Mechanically Ventilated Patients with Artificial Airways 2010’, examining endotracheal suctioning of mechanically ventilated patients with artificial airways concludes that:

(1) It is recommended that endotracheal suctioning should be performed only when secretions are present, and not routinely;

(2) It is suggested that pre‐oxygenation be considered if the patient has a clinically important reduction in oxygen saturation with suctioning;

(3) Performing suctioning without disconnecting the patient from the ventilator is suggested;

(4) Use of shallow suction is suggested instead of deep suction, based on evidence from infant and pediatric studies;

(5) It is suggested that routine use of normal saline instillation prior to endotracheal suction should not be performed;

(6) The use of closed suction is suggested for adults with high FIO2, or PEEP, or at risk for lung derecruitment, and for neonates;

(7)Endotracheal suctioning without disconnection (closed system) is suggested in neonates;

(8) Avoidance of disconnection and use of lung recruitment maneuvers are suggested if suctioning‐induced lung derecruitment occurs in patients with acute lung injury;

(9) It is suggested that a suction catheter is used that occludes less than 50% the lumen of the endotracheal tube in children and adults, and less than 70% in infants;

(10) It is suggested that the duration of the suctioning event be limited to less than 15 seconds 6.

A clinical guideline has been developed by Intensive Care NSW, to provide clinicians with recommendations to guide the development of local policy/procedures in related to suction through an artificial airway in critically ill adult patients in NSW acute care facilities. 7

4 https://www.aarc.org/wp‐content/uploads/2014/08/06.10.0758.pdf 760‐761 5 https://www.megamedical.com.au/suction‐receptal‐liner‐1500ml 6 Page 758 https://www.aarc.org/wp‐content/uploads/2014/08/06.10.0758.pdf 7 https://www.aci.health.nsw.gov.au/networks/icnsw/intensive‐care‐manual/statewide‐guidelines/suctioning‐ an‐adult‐icu‐patient

P a g e | 4 Page 224 of 258

FOI 24/25-0889

This NSW Intensive care NSW document also makes no reference to ‘liners’.

Liners

One portable suction machine provider lists liners in the associated consumables though8. It may be that some suction machines require or recommend the liners, while others do not.

For example, this portable suction machine has a built in bottle cavity that can be cleaned9. The product information sheet says: NOTE: The canister and lid supplied with the unit are not autoclavable. They must be washed in sterilisation solution.

Medshop Australia lists pumps that have both reusable (washable) canisters and disposable canisters10.

It appears that the liners are for the canisters that are cleanable and using the liners is about efficiency rather than necessity.

Cleaning of portable suction machines

The following information has been found on cleaning of suction machines and infection control matters.

In terms of the procedure for actually cleaning the canister and tubing, this is entirely dependent of the machine and is apparently stipulated in the machine models guidance material.

The Australian Guidelines for the Prevention and Control of Infection in Health Care and the NSW Infection Control Policy state that:

All procedures that generate or have the potential to generate secretions or excretions require that either a face shield or a mask worn with protective goggles be worn.

Therefore, the use of PPE to prevent mucosal or conjunctival splash injury is mandatory while suctioning the patient (both open and closed suction). This must include mask and goggles or face shield; gloves and gown/apron.

Suctioning of the artificial airway is to be completed using a clean technique for closed system suction and aseptic non‐touch technique for (1) for open suction to minimise the potential for introduction of exogenous organisms into the respiratory tract of the critically ill patient11.

An American manufacturer of medical devices states the following:

There are many portable suction units to choose from these days, and each model has its own specific guidelines for maintenance, which can be found in their user’s manual or online. But there are some general procedures that should be followed, no matter the model. So let’s take a look at some of the routine maintenance you should be performing on your suction equipment.

Preventive Care

8 https://www.laerdal.com/au/doc/135/Laerdal‐Suction‐Unit‐LSU#/Webshop/CONSUMABLES 9 https://dearjane.com.au/wp‐content/uploads/7E‐A‐PORTABLE‐SUCTION‐PUMP.pdf 10 https://www.medshop.com.au/diagnostic‐equipment/suction‐units/ 11 https://www.aci.health.nsw.gov.au/networks/icnsw/intensive‐care‐manual/statewide‐ guidelines/suctioning‐an‐adult‐icu‐patient/infection‐prevention

P a g e | 5 Page 225 of 258

FOI 24/25-0889

 As a healthcare professional, you know the importance of preventive care. The same holds for true for EMS equipment, so to keep your portable suction unit running smoothly, here are a few important reminders:  Always ensure your batteries are charged – a dead suction unit will be useless to you AND your patient.  Test your unit at regular intervals – this should be part of your morning/evening checkout.  Make sure your unit is always clean – for the sake of your patient’s as well as your own safety against pathogens.  Insure any fluids are contained within the canister and have not worked their way up into the vacuum line – if so, disinfect the unit!

Sanitizing Your Suction Unit

Contaminated equipment has no place in EMS and suction units, by their very nature, can serve as prime reservoirs for biohazardous materials. Blood, saliva, mucous, and tissue are likely sources of infectious pathogens, so sanitizing your unit is just as important as keeping it running. Here are a few guidelines:  Sanitize after each use – don’t put it off until the end of the shift!  Discard ALL disposable parts – this includes the canister, patient tubing, and catheters.  Follow appropriate guidelines for disposal of biohazardous materials.  Clean your suction unit using a mild detergent and if necessary, use a mixture of bleach and water (1 part bleach/10 parts water). Be sure to rinse thoroughly!  Follow the instruction manual when it comes to disinfecting the mechanics of the unit.  NEVER reuse any disposable parts – they are disposable for a reason!  Do not submerge your suction unit.

Disinfecting Your Suction Unit

Here are a few reminders for disinfecting your portable suction unit:  Always wear personal protective equipment when handling contaminated equipment:  Gloves  Face and Eye Protection  Protective Clothing  Disconnect the unit from any power source prior to cleaning.  Disconnect the battery from the PC Board when cleaning the interior chassis.  Remember to use disinfectant wipes to clean all outer surfaces of the unit, such as control nobs, screens and handles12.

Keep It Clean

Portable suction units are inherently at risk for transmitting dangerous pathogens. It is your job to ensure your unit is kept free of harmful contagions. Here are a few reminders:

 Sanitize the unit after each use  Never reuse disposable parts, including the canister, patient tubing, and catheters.  Always dispose of biohazardous materials properly  Use a mild detergent to clean the unit, preferably a mixture of bleach and water (1 part bleach/10 parts water)  To disinfect the mechanics of the unit, refer to manufacturer guidelines  Never submerge your suction unit – it will damage the electronics13

12 https://blog.sscor.com/the‐routine‐maintenance‐you‐should‐be‐performing‐on‐your‐suction‐equipment 13 https://blog.sscor.com/three‐best‐practices‐for‐portable‐suction‐machine‐maintenance

P a g e | 6 Page 226 of 258