Ireton Joanna
Respiratory Unit, Great Ormond Street Hospital for Children, NHS Trust, London.
Paediatr Nurs. 2007 Dec;19(10):14-8.
The risks of suction are well documented. Nurses caring for children with tracheostomies must use their clinical judgement as well as a safe suction procedure based on evidence. Preperation, correct equipment and suction pressures, a safe suction procedure and post-procedure assessment are included in a proposed protocol for a self-ventilating child with a tracheostomy. Suction presures are recommented at the lower limits suggested by research, i. e. presures of 80-120 mmHg (10-16 Kpa) for adolescents, 80-100 mmHg (10-13 Kpa) for children and 60-80 mmHg (8-10 Kpa) for neonates. Three holed catheters are advocated of a size no larger than half the internal diameter of the patient's tracheostomy. It is recommended that the suction catheter not be inserted further than the end of the tracheostomy tube. Routine instillation of saline is not recommended. A combination of education, staff involvement and mechanisms for adult, evaluation and modification of the protocol are required to support implementation of the protocol and improvements in practice.
吸痰的风险已有充分记录。护理气管切开患儿的护士必须运用临床判断力，并依据证据采用安全的吸痰程序。对于自主通气的气管切开患儿，拟定的方案包括准备工作、正确的设备和吸痰压力、安全的吸痰程序以及术后评估。建议吸痰压力采用研究提出的下限值，即青少年为80 - 120 mmHg（10 - 16 Kpa），儿童为80 - 100 mmHg（10 - 13 Kpa），新生儿为60 - 80 mmHg（8 - 10 Kpa）。提倡使用三孔导管，其尺寸不超过患者气管切开内径的一半。建议吸痰导管插入深度不超过气管切开管的末端。不建议常规滴注生理盐水。需要通过教育、员工参与以及对方案进行成人、评估和修改的机制，来支持方案的实施并改进实践。
