Removing excess fluid in the surgical cavity during a procedure is key to improve visibility, but managing the level of suction is equally as important to protect tissues and organs. To hear the latest on how suction can be managed, Surgical Products connected with Catherine Engstrom, clinical resource manager of perioperative consulting services at Medline, and Candace Samudio, MBA, BSN, RN, CNOR, associate director of clinical excellence at Zimmer Biomet.
How does choosing the right level of suction effect a case?
Engstrom: Choosing the right level of suction depends on what is being suctioned. Generally speaking, the negative pressure needed for the suctioning process is 80-100 mmHg. Too much negative pressure can cause tissue damage and with too little negative pressure the goal of the suctioning process may not be reached. There are many options when it comes to choosing the right suction device or tip. Each tip has a specific function and use.
Yankauer with and without bulbous tip: Used most commonly for pharyngeal suction tasks such as a tonsillectomy procedure or after the patient is extubated after a general anesthetic.
- Flange tip: Can be used in abdominal surgeries or orthopedic procedures.
- Suction catheter: Can be used for tracheostomy tube suctioning or chest tube suctioning to clear mucous membranes or blood or body fluids.
- Poole suction tip: A two piece device developed to suction the abdominal cavity without capturing the intestines or other tissues.
- Frazier tip: Comes in various sizes and is mainly used for neurological procedures or EENT procedures.
- Orthopedic specialty tip: Designed to be used in orthopedic procedures where there is bone fragments being suctioned.
The length and diameter of the suction tubing itself will play a vital role in the suctioning task. When a length of tubing is added to a suction apparatus, the resistance will increase and flow rates will decrease. The single most important factor affecting the resistance of the suction apparatus is the inner diameter of tubing, catheter, and catheter connectors
Samudio: Suction is used in various ways during a surgical procedure. Different types of fluid, different sized suction tubing, type of suction tip, surgeon’s technique and preference and multiple other things will need to be considered when deciding the level of suction. One of the most important aspects of suction is maintaining a clear visual field for the surgeon regardless if it is an open abdominal surgical procedure or an arthroscopic procedure. The level of suction needs to be at a level that provides adequate suction to meet the surgeon’s needs and not put the patient at risk for injury.
Too much suction could cause injury to delicate tissue or could remove fluid from a joint capsule during an arthroscopic procedure too quickly. Too little suction could result in poor visualization of the surgical field for the surgeon.
What are common errors when it comes to choosing suction devices?
Samudio: Most error happen when staff are:
- Not aware of different options on the market
- Not being aware of specifications needed to install equipment (water, drain, and electrical requirements).
- Not fully understanding cost of ownership
How can surgical teams make sure they’re using the equipment correctly, since some seems self-explanatory?
Engstrom: Choosing the proper type of equipment in a surgical setting is accomplished by the facility and many times by a committee; ideally with clinical input. To help ensure staff is operating equipment safely, the facility is generally responsible for providing proper training. The healthcare vendor is usually the person who will arrange training as new equipment is introduced to the clinical setting. Medline often helps with installation and in-service training.
Additionally, it is important that surgeons and their staff take advantage of education opportunities to help them perform at the top of their licenses.
Samudio: Surgical teams should be fully trained and in-serviced with opportunity for return demonstration prior to implementation. They should also keep Instructions for Use readily available and contact representatives and/or clinical support when necessary.