Hello fellow colleagues,
I am currently working on my placement in the surgical and medical wards. This past week I have had a few interesting patients in which we were required to suction.
One of these patients was a post laparotomy and the other had come in due to a bad fever.
These patients were in need of suctioning as they had ineffective coughs and you could hear their secretions being transmitted audibly and UATS were heard on auscultation. These patients were not intubated- they were however drowsy. Due to them having ineffective cough my supervisor and I decided to use an oropharyngeal airway (Guedel) and then suction via this. We treated both these patients in the morning and returned in the afternoon for a second treatment session due to the copious amounts of secretions in the lungs. On the 1st visit both patients did not like the experience and found it very uncomfortable as well as tiresome but we still managed to suction a large amount of secretions. On the 2nd visit both these patients refused the Guedel airway. As you can’t force a Guedel in on a conscious patient without their consent we decided to try the nasopharyngeal route instead but the patients nostrils were too small and we were unable to gain entry.
The situation that then arose was that we had two patients who clearly needed suctioning however were both refusing and were unable to clear independently and effectively. I was concerned as to what you would do in this situation because you can not force someone to give their consent however there would be a large likelihood these patients would deteriorate over time due to the large amounts of secretions still present. In the end my supervisor told me that all we could do was leave these patients and try at a later time as the extra stress placed on them via forcing suctioning could be detrimental to their status. I was however concerned that by not treating them that would also be detrimental to their status.
I thought I would just share this incident with you as I found it an interesting situation as I would have thought that it would be a priority to treat someone presenting like these two patients did. Has anyone else had any interesting suctioning issues on their placements??
Debs
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4 comments:
Hey Deb,
Good on you for having a go with the suctioning. It must be one of the harder tasks to do on placement.
I guess you have to put yourself in the patients shoes sometimes and imagine what it is like when someone is trying to stick something down your throat/nose. I mean we all know what it felt like in class, imagine all the extra fears you have as a helpless and sick patient.
Your concerns about not suctioning are also well justified. Did you try explaining them to the patient? Perhaps you could talk to their Doctors or nurses and get them to explain the risks to the patients of not suctioning.
In the end you can only do your best and must always respect the patients wishes, which you did Debs.
Take it easy
Nico.
hey deb, i totally understand how you feel. we've a cardio patient with dementia who has a really dodgy chest who also keeps refusing suctioning? and that puts us in a pretty tight spot as well.
well, i've but one suggestion on top trying to persuade the patient and convincing him that it's necessary. how about trying to facilitate a cough (eg with a tracheal rub) and if they really can't spit it out, they can swallow the sputum? or after the patient coughs, you can use the other suctioning equipment, i can't remember what it's called but it's harder and shorter (so you don't have to stick in a guerdel's) and only goes to the back of the mouth so it should be alot more comfortable as well? good luck :)
Hey Deb,
Your post actually addresses a scenario that can be applied to a more global level. That is the question and dilemma about what responsibility we as therapists have to patients who refuse any type of physiotherapy intervention. I remember running into this difficulty last year where a patient refused any type of physiotherapy for an orthopaedic problem. This is a tough situation as the reason we are studying this profession is to offer help to people and we find it hard to understand why some patients do not want to be helped. But on the other hand we have to respect the wishes of the patient as we need consent to perform any intervention. I think if we as therapists have attempted to educate the patient on the detriments of not receiving treatment, as you’ve done in this situation, then you’ve fulfilled your responsibility even if you feel that more needs to be done. Just as an addition and one which may not apply to your scenario because of the patient’s level of consciousness, an option to consider entails being able to offer a different form of intervention. For example, an alternate way to mobilise secretions would be to offer Flutter PEP which may be more comfortable for the patient.
Gareth
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