GIVE THE INFORMATION.
NOT TO MENTION YOUR BOOK'S
NOT TOO BAD. SO...

- NO, NOT THAT.

- WHICH LEADS ME TO THIS,
THE BOOK.

LAST NIGHT I READ
THROUGH EVERYTHING.

I'M HAVING TO KEEP UP WITH
THE READING WITH YOUR GROUP

BECAUSE YOU HAVE THE
NEW EDITION OF THE BOOK

AND MAKING SURE EVERYTHING
I'VE DONE MATCHES AND
SO ON AND SO.

SO I READ THROUGH THE BOOK
AND I READ THROUGH ALL
THE ARTICLES AGAIN

AND I WANT TO SAY MY ARTICLES
ARE BETTER THAN THE BOOK.

SO READ THE ARTICLES IF YOU'RE
NOT GOING TO READ BOTH, OKAY?

READ THE ARTICLES,
THEY'RE VERY GOOD.

ESPECIALLY THE CHEST TUBE ONE.

THEY TALK ABOUT EVERYTHING
AND IT'S VALIDATED
IN THE BOOK,

BUT IT'S VERY QUICK
AND THEY DON'T EXPOUND ON IT.

AND THE ARTICLES GIVE IT
IN CONTEXT OF A CLIENT
AND IT'S JUST VERY READABLE

AND THEY'RE VERY, VERY GOOD.

THE SUCTION ARTICLE HAS --
LIKE, TEN STEPS.

TEN STEPS TO SAY
FOR SUCTIONING.

MANY OF THE STEPS TALK ABOUT
SUCTIONING WITH A RESPIRATOR,

AND YOU GUYS AREN'T GOING TO BE
WORRYING ABOUT RESPIRATOR,

BUT THE STEPS AND THE
TIPS ARE THE SAME.

SO READ THROUGH 'EM AND IF IT
STARTS GOING OFF INTO RESPIRATOR
JARGON, JUST LET THAT GO.

I'M NOT GOING TO HOLD YOU
ACCOUNTABLE TO A RESPIRATOR.

YOU'LL BE DOING THAT
WHEN YOU DO CRITICAL CARE,

SO I'D SAVE THAT ARTICLE
BECAUSE IT'S EXCELLENT.

BUT LEARN THE TIPS
AND LEARN THE TECHNIQUES

AND KNOW THAT WHAT I'M
TELLING YOU, I'VE VALIDATED
WITH THE LITERATURE.

SO, HOPEFULLY, THAT WILL HELP.

THE REASON THIS MODULE IS
SO BIG. IT'S ALWAYS BEEN BIG.

WE'VE ALWAYS DONE CHEST TUBE,
SUCTIONING AND TRACH CARE.

BUT I ADDED THE MODULE
FROM LAST SEMESTER

SO THAT WE COULD HAVE
A CRITICAL CARE MODULE.

SO WHAT I'VE ADDED TO YOURS
IS AN INSPIROMETER,

SPUTUM COLLECTION,
SUCTIONING A BABY,

OXYGEN AND POSTURAL DRAINAGE.

SO WHAT I'M GOING TO DO IS
THESE QUICK PASS/FAIL THINGS
FROM LAST SEMESTER.

IF WE HAVE TIME,
I'LL DO POSTURAL DRAINAGE.

IF NOT, I'LL DO IT WITH THE
CATHETER ONE NEXT SEMESTER.

IT'S VERY EASY AND IT'S ALSO
A PASS/FAIL. IT'S NOTHING
WE'RE TESTING ON.

AND THEN I'LL DO THE REGULAR
MODULE, WHICH IN AND OF ITSELF
IS RATHER HUGE.

OKAY, HERE WE GO.

OUR THEME FOR THIS WEEK
IS RESPIRATORY CARE.

SO, THE FIRST THING WE WANT TO
DO WITH ANY OF OUR CLIENTS IS
WE WANT TO PREVENT ATELECTASIS.

WE WANT TO PREVENT PNEUMONIA.
WE WANT TO PREVENT PROBLEMS.

SO YOUR POST-OP CLIENTS, PEOPLE
THAT ARE HAVING DIFFICULTY
BREATHING,

WE GIVE THEM WHAT'S CALLED
AN INCENTIVE SPIROMETER.

AND THE IDEA IS THAT
IT'S KIND OF A TOY

AND IT WILL GIVE THEM
INCENTIVE TO WANT TO TAKE
GOOD, DEEP BREATHS.

SO MOST OF 'EM LOOK
SIMILAR TO THIS.

ALTHOUGH THEY DO HAVE SOME
ELECTRONIC ONES AND I THINK
THEY'RE PRETTY FUN.

THEY LOOK KIND OF LIKE IV PUMPS,

BUT THERE'S A LITTLE
CLOWN FACE ON 'EM.

AND WHEN YOU BREATHE IN,
IT STARTS BLINKING.

AND WHEN IF YOU GET TO
THE CLOWN, THE VOLUME --

THE CLOWN BLINKS AT YOU
AND THAT'S JUST GREAT FUN.

THESE ARE NOT SO HIGH-TECH,
BUT THEY WORK LIKE THIS.

YOU TELL YOUR CLIENT,
THAT THEY'RE GOING TO BE
TAKING GOOD, DEEP BREATHS

AND IT'S THE INSPIRING
THAT YOU WANT THEM TO DO,
NOT BLOWING.

ANYBODY CAN DO THAT,
BUT THAT'S CHESTY.

WHAT YOU WANT THEM TO DO IS TAKE
GOOD, DEEP BREATHS THAT GO TO
THE BASE OF THEIR LUNGS.

SO, IF YOU CAN, IT'S BEST
IF YOU CAN TEACH THEM
BEFORE THEY HAVE SURGERY

AND WHILE THEY'LL LISTEN TO
YOU BEFORE THEY'RE HURTING.

SO YOU WANT TO TEACH
THEM THAT THE IDEA

IS TO PUT THEIR
INSPIROMETER TOGETHER.

THIS LITTLE TUBE COMES ON AND
OFF AND THEY GET A MOUTHPIECE.

AND WHAT THEY NEED TO DO
IS TAKE A GOOD, DEEP BREATH.

OUT.

PUT THEIR MOUTH ON HERE.

HOLD IT AND THEN BREATHE OUT.

WHEREVER THE BASE
OF THIS IS, VENT,

THEN THAT'S WHERE YOU WANT
TO MARK IT ON HERE,

SO THAT THEIR
INCENTIVE AFTER SURGERY

IS TO GO TO THEIR
MAXIMUM INSPIRATION.

SO, TELL 'EM TO DO ONE
OR TWO AT A TIME.

IF THEY KEPT TAKING THOSE DEEP
BREATHS ONE AFTER THE OTHER,

YOU KIND OF PASS OUT.

AND THE IDEA IS THAT
YOU'RE NOT JUST GOING...

INSTEAD, YOU'RE TAKING THAT
GOOD, DEEP BREATH IN
AND HOLDING IT,

AND IT'S A SLOW BREATH IN.

SO, ONE MORE TIME.

YOUR LITTLE HEAD
KIND OF GOES...WHOO!

AND THE IDEA IS
THAT AFTER THAT,

THEN AFTER YOU TAKE
A GOOD, DEEP BREATH AND OUT,

THAT YOU COUGH.
[COUGHING]

NOW, NOT A CHESTY COUGH.

AND THEY'LL DO THAT
BECAUSE IT HURTS TO COUGH,

BUT A GOOD ABDOMINAL
DIAPHRAGM-TYPE COUGH.

IF THEY'VE HAD ABDOMINAL
SURGERY, THEY MAY NOT
WANT TO COUGH

SO YOU MAY HAVE TO TEACH THEM
TO SPLINT THEIR STOMACH.

AND COUGH.

AND THEN TRY TO GET SPUTUM UP
WHEN THEY'RE COUGHING.

YOU WANT THEM TO DO THIS
ABOUT TEN TIMES AN HOUR.

SO A GOOD THING TO DO IS
IF THEY'RE A TV WATCHER,

LIKE, DO A COUPLE BREATHS
EVERY COMMERCIAL.

IF THEY'RE NOT,
THEN JUST WITH THE CLOCK

OR EVERY TIME THEY
TURN OR SOMETHING.

BUT YOU NEED TO GIVE 'EM
SOME KIND OF A CUEING SYSTEM
SO THAT THEY'LL GET IT.

ENCOURAGE THEM, "HEY! HEY!
THAT'S SO GOOD." YOU KNOW?

AND BE THEIR
CHEERLEADER ABOUT IT

AND THEN CHECK
ON THEM FREQUENTLY.

THEY NEED TO DO IT
WHILE AWAKE.

I MEAN, YOU DON'T WAKE PEOPLE
USUALLY DURING THE NIGHT JUST
TO TAKE A FEW DEEP BREATHS,

BUT WHEN THEY'RE AWAKE
YOU WANT TO GO AHEAD
AND ENCOURAGE 'EM WHILE,

YOU KNOW, WE'RE TAKING VITALS
OR GIVING MEDS OR SOMETHING.

TAKE SOME DEEP BREATHS.

ALRIGHT. SPUTUM.

WE COLLECT SPUTUM.

AND IT'S EASIER IF THEY'RE
TAKING GOOD, DEEP BREATHS

TO COUGH IT UP BECAUSE
WHAT YOU WANT IS SPUTUM.

YOU WANT FROM THE LUNGS.
YOU DON'T WANT SPIT AND SALIVA.

YOU NEED TO GET A CONTAINER.
IT CAN BE SOMETHING LIKE THIS.

THIS IS USUALLY FOR TB

BECAUSE THAT ONE YOU DON'T WANT
TO EXPOSE TO LIGHT

BECAUSE OF THE ACID-FAST
BACILLI,

SO IT USUALLY COMES IN
A CONTAINER LIKE THIS.

AND IT'S NICE BECAUSE IT HAS
A FUNNEL, AND SO THEY CAN...

SPIT IT UP.

SPIT IS NOT MY BEST THING
AND SPUTUM IS BY FAR NOT.

URGH. I CAN'T EVEN HARDLY
WATCH BASEBALL,

FOR THOSE GUYS OUT THERE ARE
JUST COUGHING ALL THE TIME.

ALRIGHT. SO WHAT YOU WANT 'EM
TO DO IS THE SAME THING.
GOOD, DEEP BREATHS.

AND THEN...

AND THEN THEY COUGH UP.

AND THEN YOU WANT ONE TEASPOON
TO TWO TEASPOONS FULL,

DEPENDING AGAIN...ABOUT
WHATEVER --

WHOSE SPECIMEN
YOU'RE COLLECTING.

ONCE YOU'VE COLLECTED IT,
THIS THING COMES APART.

AND THEN YOU PUT THE LID ON,
LABEL IT AND IT GOES TO
THE LAB LIKE THIS.

YOU DON'T HAVE TO SEND THIS
WHOLE CONTRAPTION DOWN.

YOU CAN, BUT YOU WANT TO
MAKE SURE IT'S SEALED WELL
OR YOU'LL LOSE YOUR SPUTUM.

SO THAT'S THE POINT OF IT.

YOU CAN DO SPUTUMS IN JUST
A REGULAR SPECIMEN CONTAINER.

JUST MAKE SURE THAT IT'S OKAY
WITH THE LIGHT ISSUE.

OKAY.

SO LET'S START WITH -- LEAN 'EM
OVER HERE. SO THAT WAS SPUTUM.

WE'RE GOING TO GET SPUTUM
WITH A SUCTION AND THAT'S
A LITTLE BIT DIFFERENT.

SOMETIMES PEOPLE CAN'T
COUGH THEIR SPUTUM UP
OR THEY CAN'T GET IT OUT

SO YOU MAY HAVE TO CALL
RESPIRATORY THERAPY
TO INDUCE THE SPUTUM.

AND SO THEY WILL PUT
THEIR SUCTION CATHETER
AND GET THEM COUGHING A LITTLE

OR PUT A LITTLE SOMETHING
INTO THEIR MOUTH AND THAT
WILL GET THEM COUGHING

AND THEN THEY'LL BE ABLE
TO SUCTION THAT SPUTUM UP.

AND WE CAN GET THOSE AS WELL,
WE CAN SUCTION SPUTUMS

AND I'LL SHOW YOU
HOW TO DO THAT.

ALRIGHT.
BABIES.

BABIES NEED SUCTIONING.

WHICH IS WHAT WE WERE
SUPPOSED TO DO LAST WEEK.

THIS WAS THE BULB THAT
THEY WERE TALKING ABOUT

TO SUCTION OUT BABIES' NOSES
AND BABIES' MOUTHS.

AND SO WHAT YOU WANT TO DO
IF A BABY IS CONGESTED
IN THEIR MOUTH

OR THEY'RE CHOKING ON FLUIDS,
YOU WANT TO BE ABLE
TO GET THAT OUT.

YOU CAN DO IT SIMPLY
WITH A BULB.

HERE -- EVERY NEWBORN SHOULD
HAVE THIS IN THEIR CRIB

AND THEN PEOPLE THAT ARE
ADMITTED, DEPENDING ON THE
SIZE OF THE BABY.

USUALLY, UNDER A YEAR HAVE SOME
KIND OF A BULB THERE FOR THEM.

THERE'S TWO THINGS WE NEED TO
REMEMBER ABOUT BULBING A BABY.

ONE IS, THERE'S ON THE PERINEUM
AND THERE'S ALREADY BORN.

AND SO I JUST WANT TO
DISTINGUISH BETWEEN THE TWO

AND THAT WAS THE MAIN
PURPOSE OF DOING THIS.

WHEN A CHILD IS BEING BORN,
YOU'RE WATCHING THE BIRTH,
YOU'RE IN OBSTETRICS.

AND THE BABY IS COMING OUT,
AND THE HEAD COMES OUT,

AND THEY USUALLY STOP 'EM
AT THAT POINT AND THEN
THEY BULB THE BABY.

WHICH DO YOU SUPPOSE THEY DO
FIRST? MOUTH OR NOSE?

- MOUTH FIRST.
- MOUTH.

AND THE REASON IS
BECAUSE IF YOU DO NOSE,

THEY HAVE AMNIOTIC FLUID IN
THEIR MOUTH AND THEY MAY GO...

AND ASPIRATE AMNIOTIC FLUID.

AND SO THEY DO MOUTH FIRST
ON THE PERINEUM AND THEN NOSE.

ONCE THEY'RE BORN,
WE DO NOSE FIRST AND THEN MOUTH.

AND SO THAT'S THE DIFFERENCE
BETWEEN THE TWO.

SO IF THEY HAD A LITTLE
CONGESTED NOSE,

YOU WANT TO GET A LITTLE
DIAPER OR SOMETHING TO
WIPE THIS OFF ON.

YOU WANT TO SQUEEZE THIS FIRST,
THEN PUT IT IN THE NOSTRIL.

GET YOUR STUFF AND THEN JUST
SQUEEZE IT OUT ON THE LITTLE
DIAPER OR ON A CLOTH.

SAME THING ON THIS SIDE.
SQUEEZE IT OUT.

AND THEN YOU WANT TO GO OVER
HERE AND THEN GO BETWEEN
THE GUM -- GUMS AND CHEEK.

SQUEEZE FIRST, PUT IT IN...
AND THEN SUCK IT UP.

OKAY?

THEY HAVE A NEW LITTLE THING,
THIS IS ACTUALLY AN ADULT SIZE.

BUT THEY HAVE A NASO ASPIRATOR
THAT YOU CAN HOOK TO SUCTION.

AND YOU CAN PUT THOSE
TO THEIR LITTLE NOSES
AND JUST GET NOSE SUCTION.

SAME IS IF SOMEONE HAS
A TRACH OR SOMETHING,
YOU COULD DO A NOSE.

AND I'LL TALK A LITTLE BIT MORE
ABOUT HOW TO WORK THESE.

BUT THERE ARE LITTLE
GADGETS FOR...

SEPARATE THINGS.

ALRIGHT.

I WANTED TO MENTION OXYGEN.

AND IN YOUR BOOK --

YOU'RE AVOIDING BOOK.
I DON'T KNOW.

BUT THERE'S A WONDERFUL
GRAPH OVER HERE

ON PAGE 749, I THINK.

YES. THAT TALKS ABOUT
THE DIFFERENT DELIVERY
SYSTEMS FOR OXYGEN.

AND WHAT YOU WANT TO DO
IS REVIEW WHAT THESE ARE.

I'M GOING TO SHOW YOU
WHAT THEY ARE AND WHY
THE DIFFERENCE.

BUT THIS IS WHERE YOUR
INFORMATION WILL BE.

THERE'S A LITTLE BIT OF
INFORMATION ABOUT O2

AND SOME OF THE PERIMETERS.
I'LL TALK ABOUT THAT
IN A SECOND.

AND THEN THEY GIVE YOU SOME
GOOD PICTURES ABOUT WHAT
EACH OF THESE ARE.

BUT THEY'RE A LITTLE
DIFFICULT TO DISTINGUISH

AS FAR AS THE PICTURES,
SO I WANTED TO SHOW YOU.

OXYGEN THERAPY
IS GIVEN TO PEOPLE

WHO USUALLY HAVE A O2
SATURATION BELOW 94%.

WE WANT PEOPLE TO BE ABOVE 94,

SO IF THEY ARE, THEN THERE'S
USUALLY NOT MUCH NEED
FOR THE OXYGEN.

BUT IF THEY AREN'T,
THEN THAT'S WHAT WE'RE
TRYING TO SUPPLEMENT.

AND SO WE'RE GOING
TO DETERMINE --
ACTUALLY, WE AREN'T.

BUT THE DOCTORS ARE GOING
TO DETERMINE HOW MUCH O2
THE CLIENT GETS,

BASED ON THEIR ARTERIAL BLOOD
GASES, BASED ON THEIR CONDITION,
DIAGNOSIS AND SO FORTH.

SO, HOW TO DO WE DELIVER
ALL THESE DIFFERENT
KINDS OF OXYGEN?

WELL, THE ONE YOU'RE PROBABLY
THE MOST FAMILIAR WITH
IS NASAL PRONGS.

NASAL PRONGS CAN DELIVER
UP TO SIX LITERS OF OXYGEN

THROUGH THE PRONGS.
ONE TO SIX.

ANYTHING OVER FOUR LITERS OF
OXYGEN NEEDS TO BE HUMIDIFIED.

SO WE CAN GIVE DRY OXYGEN,
BUT MOST OF THE TIME WE DON'T.

SO IF YOU JUST COULDN'T GET
TO SOME DISTILLED WATER

TO PUT INTO YOUR O2 DISTRIBUTOR,

THEN IT'S OKAY FOR A LITTLE
WHILE, BUT YOU DO WANT
TO HUMIDIFY IT.

BECAUSE AIR JUST BLOWING UP THE
NOSTRILS GETS REALLY DRYING.

TO WORK THE NASAL PRONGS,
YOU WANT TO GET YOUR PRONGS

AND THEY KIND OF CURVE
AND FORK THIS WAY.

SO THE FORK GOES
TOWARDS THE CLIENT.

IT DOESN'T SHOOT OUT THIS WAY
OR YOU'LL BE SHOOTING
THE AIR OUT THEIR NOSTRIL.

OKAY? SO IT GOES UP LIKE THIS.

AND THEN THESE WRAP
AROUND THE EARS.

AND KIND OF LIKE THOSE
OLD-FASHIONED COWBOY HATS,
IS WHAT IT REMINDS ME OF.

YOU HAVE THIS LITTLE PENDANT
AND THAT TIGHTENS IT
SO THAT IT'S SNUG.

YOU DON'T WANT IT TOO TIGHT,

BECAUSE IT CAN CAUSE PRESSURE
SORES BEHIND THE EARS

AND LEAVE MARKS ON THEIR FACE.

SO JUST SNUG ENOUGH THAT
IT'S NOT FALLING OFF
OF 'EM ALL THE TIME.

I'VE SEEN SOME CLIENTS --
IN FACT, I VISITED A FRIEND THE
OTHER DAY IN THE HOSPITAL.

SHE HAD HERS LIKE THIS BECAUSE
IT WAS DRIVING HER CRAZY.

AND THEY ACTUALLY JUST
TAPED IT TO HER CHEEKS

BECAUSE IT WAS JUST GETTING TO
WEAR OUT THE BACK OF HER EARS.

AND SO ANYTHING, AS LONG AS
THESE LITTLE PRONGS ARE HERE.

WHEN YOU'RE DOING YOUR O2,
THESE COME IN A PACKAGE.

YOU GET 'EM FROM
RESPIRATORY THERAPY.

AND THEY GET CONNECTED
TO YOUR O2...

HERE.

THIS LITTLE PIECE AT THE
BOTTOM IS THE HUMIDIFIER

AND YOU NEED TO PUT
DISTILLED WATER IN THERE.

AND YOU CAN GET THAT ALSO
FROM RESPIRATORY THERAPY.

SO YOU FILL THAT UP
WITH DISTILLED WATER.

AND THEN YOU DO YOUR LITER FLOW
BY TURNING THIS DIAL.

AND IF THAT WERE TO --
IT WOULD JUST RUN THROUGH THERE,
THEY GET A LITTLE HUMIDITY.

WHEN YOU GET UP INTO
THE HIGHER LITER FLOW,

SOMETIMES THE MOISTURE FROM THE
HUMIDIFIER GETS INTO THE TUBING

AND YOU HAVE TO
KIND OF DUMP IT OUT.

SO YOU WANT TO DISCONNECT,
DUMP OUT THE FLUID

AND THEN RECONNECT LIKE THIS.

- BUT LEAVE IT FULL?
- BUT LEAVE IT FULL. YEAH.

- FULL TO THE TOP?

- NO, TO THE TOP FULL LINE.

AND THERE'S A LINE
THAT TELLS YOU ON HERE,
HOW FAR TO FILL IT UP TO.

ONE OF THE REASONS
WE HAD THESE INSTALLED

WAS BECAUSE I WANTED YOU TO
PRACTICE TAKING THEM IN
AND OUT OF THE WALL

BECAUSE YOU CAN
HOOK UP OXYGEN

AND THAT'S KIND OF FUN TO DO.

I'M GOING TO GO AHEAD
AND TURN THIS OFF.

BUT I DO WANT TO MENTION
THAT THIS IS NOT REAL OXYGEN

AND IT'S NOT EVEN
REAL COMPRESSED AIR,

IT'S A COMPRESSOR DOWN
IN THE BASEMENT THAT'S
AN OIL COMPRESSOR,

AND SO THIS IS NOT OXYGEN
YOU WOULD WANT TO BREATHE.

URGH. SO THAT'S WHY WE
HAVE OUR BIG RED SIGN.

IT'S JUST A GAS MACHINE
DOWNSTAIRS THAT...

HAS AIR FOR US.

ALRIGHT.
TO GET THIS OFF,

ALL YOU HAVE TO DO IS TWIST
AND IT SHOOTS ITSELF OFF.

IT'S A LITTLE TWISTING DIAL
RIGHT HERE.

AND THEN TO PUT IT IN, YOU WANT
TO HOLD IT NICE AND FIRM,

GET IT IN THE RIGHT DIRECTION
AND THEN JUST POP IT
INTO THE WALL.

SO PRACTICE TAKING THOSE IN
AND OUT OF THE WALL AND JUST
TO GET THE FEEL OF IT.

ALRIGHT. NOW, I'LL JUST LOOK
DOWN HERE.

NASAL PRONGS DELIVERS
24-44% CONCENTRATED O2.

WHICH IS DECENT ENOUGH,
BUT SOMETIMES YOU NEED MORE.

SO YOU MAY NEED TO
GO TO A MASK.

ESPECIALLY IF YOUR
CLIENT'S NOT A MOUTH --

I MEAN, NOT A NOSE BREATHER.
WHAT IF THEY'RE ARE A
MOUTH BREATHER?

YOU KNOW? YOU NEED
TO GET OXYGEN TO 'EM.

SO A MASK MAY BE WHAT YOU WANT.

THIS PARTICULAR MASK
IS CALLED THE OXYMIZER.

IT JUST GETS 24-80%.
A LITTLE BIT HIGHER THAN
THE NASAL PRONGS,

BUT IT GETS IT TO THEIR MOUTH.

THERE'S SOME DISADVANTAGES
TO THE MASK.

MOST OBVIOUS?
CAN'T EAT.

THAT WOULD BE MY PRIORITY.

SO THESE ARE A LITTLE
INCONVENIENT SO WHAT YOU DO --

YOU TRY TO GET THEM OVER
YOUR EARS SO IT WON'T
STAY ON AS WELL.

NOT FUN. MAYBE UP HERE.

BUT THEY HAVE TO BE SNUG
OR THEY DON'T WORK.

AND PLUS, ISN'T IT KIND
OF HARD TO HEAR ME?

IT'S HARD TO TALK
TO YOUR PATIENTS TOO

AND THEN THEY'RE
SHORT OF BREATH AS WELL.

SO THESE ARE A PROBLEM.

VERY HOT, VERY STUFFY
AND VERY IRRITATING.

BECAUSE FOR THEM TO WORK,
THEY HAVE TO BE SNUG, RIGHT?

SO, YOU DO GET A LITTLE MORE
LITER FLOW, BUT THEY'RE
A LITTLE IRRITATING.

THE NON-REBREATHER MASKS OR THE
PARTIAL NON-REBREATHER MASK

GIVES US THE HIGHEST
CONCENTRATION OF O2.

THEY NEED TO BE SET AT
6 TO 15...LITER FLOW.

AND WHEN THEY ARE --
SET IT AT 10.

AND WHEN THEY ARE,
THE LITTLE BAG --

IT'S HARD TO TELL, CAN YOU TELL
IT'S FULL A LITTLE BIT?

AIR'S GOING THROUGH HERE

AND IT'S CAUSING THEM NOT
TO RE-BREATHE SO MUCH
CARBON DIOXIDE.

A NON-REBREATHER
CARBON DIOXIDE.

THERE'S LITTLE HOLES THERE
SO THAT IT COMES OUT,

BUT IT TRAPS THE AIR AND
IT ALLOWS THEM TO GET A
HIGHER CONCENTRATION.

THIS IS A PARTIAL NON-REBREATHER
AND I DON'T HAVE A TOTAL
NON-REBREATHER.

BUT THE POINT IS THAT I WANT YOU
TO APPRECIATE IS THIS BAG.

IT'S KIND OF LIKE WHEN
YOU GO ON THE AIRPLANE

AND THE THING FALLS DOWN
AND THEY SAY PUT IT
ACROSS YOUR FACE.

AND THE BAG WON'T FILL UP,
THIS WON'T EITHER.

IT'S JUST EVER SO SLIGHT, YOU
CAN SENSE THE AIRS IN THERE.

BUT IT TRAPS THE CARBON DIOXIDE
AND IT ALLOWS THEM

TO NOT RE-BREATHE THEIR
OWN AIR AND GET OXYGEN.

SO YOU GET THE HIGHEST
CONCENTRATION OF THAT.

THE OTHER ONE, THE VENTURA MASK,
IS THE MOST ACCURATE.

THIS GIVES THE MOST,
BUT THE VENTURI MASK
IS THE MOST ACCURATE.

I DON'T HAVE A VENTURI MASK, BUT
THERE'S A GOOD PICTURE OF IT

HERE ON PAGE 752.

AND WHAT IT DOES HERE,
IS AT THIS POINT RIGHT HERE,

THERE'S A LITTLE DIAL
THAT ACTUALLY DIALS THE
LITER FLOW FROM THE MASK.

AND SO THAT'S WHAT ALLOWS IT
TO BE A LITTLE MORE ACCURATE.

I'VE USED THEM IN THE PEDIATRIC
ENVIRONMENT THE MOST,

WHEN WE NEEDED TO HAVE
GOOD CONTROL OF OUR O2.

BUT THAT'S KIND OF THE
DEAL ON HOW THOSE WORK.

ALL THE MASKS ARE A PROBLEM WHEN
IT COMES TO EATING, TALKING AND
FOR LONG-TERM WEAR,

BECAUSE THEY CAN CAUSE
BREAKDOWN ON THE SKIN
AND PEOPLE DO NEED TO EAT.

SO, USUALLY, WE HAVE PRONGS
THAT WE SET ASIDE

AND WE PUT PRONGS ON FOR MEALS
IF THEY CAN TOLERATE IT.

THEN THEY'RE JUST OFF
FOR A LITTLE BIT OF TIME
IF THEY CAN TOLERATE IT.

SO, YOU JUST HAVE TO FIND OUT
WHAT'S GOING ON WITH
YOUR CLIENT.

OKAY.

WENT THROUGH THAT PRETTY FAST.

I THINK WHAT I WANT TO DO IS...

I THINK I'M GOING TO DO SUCTION
AND TRACH CARE FIRST,

AND THE THEN WE'LL DO
THE TEST TUBE LAST.

YOU HAVE IN YOUR KITS,
A SUCTION CATHETER KIT AND
YOU HAVE A TRACH CARE KIT.

AND YOU CAN JUST APPRECIATE
THAT YOUR CLIENT HAS
A TRACH, TRACHEOSTOMY.

WHAT I WANT TO DO
IS EXPLAIN A LITTLE ABOUT
WHAT A TRACH IS, HOW IT WORKS

AND THEN SHOW YOU
A LITTLE VIDEO CLIP

AND THEN WE'LL DO OUR CARE, SO
THAT YOU KNOW WHAT'S GOING ON.

A TRACHEOTSOMY IS CREATED
BY THE PHYSICIAN.

A LITTLE STOMA.
AN INCISION IS MADE ON HERE
AND A TRACH IS PUT IN

SO THAT THE CLIENT CAN PASS AIR
THROUGH THIS TRACHEAL SPACE.

FOR SOME REASON, WE RELATE IT TO
TRAUMA, WE RELATE IT TO DISEASE,

THAT THEY CAN'T PASS AIR
OR GET A GOOD ENOUGH
OXYGEN CONCENTRATION

THROUGH THEIR NOSE
OR THROUGH THEIR MOUTH.

THESE MAYBE SHORT-TERM.
THEY MAYBE LONG-TERM.

IT JUST DEPENDS AGAIN
ON THE SITUATION.

YOU'LL SEE CANCER CLIENTS,
FOR EXAMPLE, THAT HAVE --

THAT'S HOW THEY'RE GOING TO OUT
OF THIS WORLD, IS WITH A TRACH.

AND SO YOU JUST NEED TO KNOW,
IS THIS CHRONIC, IS THIS ACUTE,
WHAT'S GOING ON?

TRACHS COME IN TWO
DIFFERENT SIZES.

WE HAVE THE SHORT TRACH HERE
THAT'S USUALLY FOR
SHORT-TERM USE,

BUT IT JUST COMES DOWN
PARTIALLY INTO THE TRACHEA.

AND THEN WE HAVE THE LONGER,
AND THESE DON'T FIT.

BUT THESE ARE LONGER
ENDOTRACH TUBES

THAT ARE EITHER ORAL
OR CAN GO THROUGH THE TRACH.

BUT THEY CAN GO DEEPER INTO
THE TRACH WHEN THEY'RE
PUT ON TO A RESPIRATOR.

OUR'S IS JUST GOING
TO BE A SHORT TRACH

AND WE'RE NOT GOING TO BE
CONNECTED TO A RESPIRATOR.

A TRACH LOOKS --

WELL, LET ME TALK ABOUT THIS
ONE, I THINK IS THE EASIEST.
YOU CAN SEE IT BETTER.

A TRACH HAS AN INNER CANNULA,
WHICH IS THIS PIECE RIGHT HERE,

THAT KEEPS THE SPUTUM
FROM BUILDING UP.

WE'LL TALK ABOUT
THAT IN A MINUTE.

AND IT HAS THE OUTER CANNULA
WHICH IS WHAT MAINTAINS
THE PATENT AIRWAYS,

WHAT GOES DOWN INTO
THIS THROAT AREA.

THEY COME IN DIFFERENT SIZES
BECAUSE WE CAN PUT A TRACH
IN ANYONE FROM INFANT TO ADULT.

SO AN ADULT SIZE CUFF,
TYPICALLY SIZE SIX OR ABOVE

WHICH IS WHAT THIS IS.

THE OUTER CANNULA INTO THE
TRACHEA, CAN HAVE A CUFF
OR CANNOT HAVE A CUFF.

IT JUST DEPENDS ON WHAT THE
CLIENT'S STATUS OR DIAGNOSIS IS.

YOU'RE GOING TO GET MORE INTO
THAT THEORY NEXT SEMESTER
AND IN CRITICAL CARE,

BUT I NEED YOU TO APPRECIATE
WHAT YOU'RE LOOKING AT
WHEN WE'RE SUCTIONING.

THE CUFF ON HERE...

WHEN IT GOES INTO THE CLIENT --
I HAVE TO USE THIS ONE
ON THE CLIENT.

WHEN THE CUFF IS DEFLATED,
THEN THE CLIENT CAN PASS AIR

THROUGH THE MOUTH AND THE NOSE
INTO THE TRACHEA.

BUT WHEN THE CUFF IS INFLATED,

THEN JUST SIMPLY INFLATE IT
WITH THIS SYRINGE HERE.

THEN THE BALLOON GETS FILLED UP

AND THEN IT BLOCKS THE TRACHEA

SO THAT THE ONLY WAY YOU CAN
PASS AIR IS THROUGH THE TRACHEA.

NO AIR EXCHANGE NOW HAPPENS
FROM THESE UPPER ORIFICES.

THIS IS IMPORTANT FOR WHEN
THEY'RE ON A RESPIRATOR

BECAUSE WHEN YOU'RE PUSHING
AIR IN, YOU DON'T WANT
THE AIR LEAKING OUT.

SO THAT WE CLOSE IT OFF,
SO THAT THEY GET ALL OF
THEIR AIR IN AND OUT.

WE ALSO CAN USE
THIS BULB FOR PEOPLE

THAT MIGHT HAVE DIFFICULTY
WITH CHOKING, FOR EXAMPLE.

LIKE WITH BRUSHING
THEIR TEETH OR EATING,

YOU MIGHT CLOSE THIS OFF TO
PREVENT ASPIRATION BECAUSE
THAT'S A PROBLEM FOR THEM.

THEN THEY EXCHANGE AIR THROUGH
HERE, BUT THEN THEY CAN EAT.

OR THAT YOU CAN BRUSH THEIR
TEETH AND A LITTLE CAN GO DOWN

AND IT'LL GO DOWN THE RIGHT SLOT
AND SO THAT'S THE PURPOSE.

THERE'S A LOT OF INFORMATION
ABOUT CUFFS THAT I DON'T
WANT TO GET INTO.

SUFFICE IT TO SAY YOU DON'T
LEAVE THEM FULL ALL THE TIME

OR YOU CAN CAUSE EROSIONS
ONTO THE ESOPHAGUS.

YOU HAVE TO RELEASE THEM
SO THAT YOU DON'T BREAK DOWN --

NOT THE ESOPHAGUS,
I'M SORRY, THE TRACHEA.

IT CAN CAUSE SCARRING,
IT CAN CAUSE TRAUMA,

IT CAN CAUSE TISSUE DAMAGE,
IT CAN CAUSE STENOSIS.

THERE'S A LOT OF THINGS THAT
CAN HAPPEN RELATED TO POOR
INFLATION OF THE CUFF.

BUT I WANT YOU TO APPRECIATE
WHAT IT MEANS.

WHEN THE CUFF IS FULL,
THE LITTLE BALLOON HERE
IS FULL AND PUFFED UP.

WHEN THE BALLOON IS FLAT,
THAT MEANS THE CUFF IS DEFLATED

AND SO YOU KNOW THAT
THEY'RE ABLE TO PASS AIR FROM
NOSE AND MOUTH DOWN TRACHEA.

AND PRIMARILY WE'RE
ABLE THEN TO WORK

THROUGH THIS TRACHEA SPACE
TO GIVE THEM OXYGEN.

ALRIGHT. NOW, WHEN THE CUFF --

THE INNER CANN--
OR THE OUTER CANNULA

STAYS IN ALL THE TIME TO
MAINTAIN THE PATENT AIRWAY.

BUT IT'S BEEN MY EXPERIENCE
BECAUSE I'VE WORKED
HOSPITAL CARE,

NOT AS MUCH HOMECARE,
ALTHOUGH SOME,

THAT PEOPLE THAT HAVE THESE
THAT I'M HAVING TO TAKE CARE OF

ARE PRODUCING
QUITE A BIT OF SPUTUM.
THAT'S THE WHOLE POINT OF IT.

THEY WEREN'T ABLE
TO CLEAR THEIR AIRWAYS.
THEY'VE GOT THIS TRACHEA.

THEY'RE SPUTUM, SPUTUM, SPUTUM.

HOCKING IT, HOCKING IT OUT.

IF WE JUST LEFT THIS
OUTER CANNULA IN THERE

WITHOUT A MECHANISM TO CLEAN
THAT SPUTUM BUILD-UP,

THIS WOULD BLOCK OFF AND WE'D
HAVE TO PUT ANOTHER ONE IN.

SO WE'D BE REPLACING THIS TUBE
WHICH IS A LITTLE TRAUMATIC.

IT CAN BE DONE, I'M GOING TO
SHOW YOU A VIDEOTAPE,

SO THAT YOU DON'T FREAK OUT
ABOUT THE WHOLE THING.

BUT IT'S EASIER IF WE TAKE OUT

THE INNER CANNULA,
CLEAN IT,

PUT IT BACK IN TO MAINTAIN
THIS AIRWAY AS PATENT.

AND IT'S NOT AS TRAUMATIC
FOR THE CLIENT.

THERE'S TWO KINDS
OF INNER CANNULAS.

THERE'S A PERMANENT
AND THEN THERE'S A DISPOSABLE.

TOO BAD FOR YOU,
YOU HAVE THE PERMANENT.

AND SO WE'RE GOING
TO HAVE TO CLEAN IT.

BUT IF THEY HAVE A
DISPOSABLE INNER CANNULA.

LIKE THIS ONE.
IT'S JUST A LITTLE FLIPPY.

IT COMES OUT,
YOU THROW IT AWAY,

YOU OPEN UP YOUR NEW ONE IN THE
LITTLE CASE AND YOU PUT IT IN

AND YOU DON'T HAVE TO
PLAY IN THE SPUTUM AT ALL.

THAT'S GOOD. AND THEY'RE
USING THEM A LOT MORE
THAN THEY USED TO.

BUT BECAUSE OF THE COST
OF IT, PEOPLE THAT HAVE
DIFFERENT INSURANCES,

AND PEOPLE THAT ARE GOING TO BE
HOME WITH THEM FOR A LONG TIME

VERY OFTEN HAVE THE PERMANENT
INNER CANNULA BECAUSE IT'S
CHEAPER TO MAINTAIN IT

THAN IT IS TO KEEP
BUYING THESE DISPOSABLES

THAT ARE "SINGLE USE ONLY"
AND MAY NEED TO BE DISPOSED OFF
TWO OR THREE TIMES A DAY

DEPENDING ON HOW MUCH SPUTUM
YOU'RE PRODUCING.

SO, YOU'LL SEE BOTH AND YOU WANT
TO KNOW WHICH ONE DO I HAVE.

DISPOSABLE OR THE PERMANENT
THAT LOCKS INTO PLACE.

AND THE DISPOSABLES --
DID I SWITCH?

THIS DOESN'T FIT VERY GOOD.

OH, THAT'S BECAUSE IT'S
THIS ONE.

THE DISPOSABLES SAY ON THEM
"ONE TIME USE ONLY"

OR "SINGLE USE".
SO THAT GIVES YOU A CLUE.

AND YOUR PERMANENT
ONES LOCK IN PLACE.

YOU PUT 'EM IN,
YOU POINT 'EM DOWN.

PUT 'EM IN AND THERE'S
A DOT HERE THAT YOU NEED
TO SCREW IT IN PLACE

AND THEN IT'LL LOCK
AND YOU'LL SEE BY HAVING
BOTH YOUR DOTS MATCHING UP.

BUT IT SHOULDN'T BE ABLE
TO PULL OUT EITHER.

THE OTHER THING THAT'S IMPORTANT
ABOUT THE TRACH

WHEN IT'S IN PLACE
IS THAT YOU HAVE A PLATE.

AND THE PLATE ROTATES SO WHEN
IT GOES INTO DIFFERENT ANATOMIES

THAT IT CAN LAY FLAT SO THAT THE
TRACH IS IN THE RIGHT POSITION.

AND THEN WE SECURE IT WITH TIES

WHICH IS WHAT WE'RE GOING
TO DO ON OUR CLIENT.

OKAY.

LET'S JUST GO DO
SOME CARE HERE.

I THOUGHT IT WAS ABOUT TIME YOU
EXPERIENCED A MAN

SINCE WE'RE DOING BREATHING
THINGS AND HE CAN BREATHE.

HE'S HAVING TROUBLE.

FIRST THING YOU'RE GOING TO DO,
YOUR ASSIGNMENT.

AND I WISH WE HAD SAME MANS
FOR ALL THE BEDS.

BUT WHAT WE ARE GOING TO DO IS
HOOK UP ALL OF THE MANNEQUINS

SO THAT YOU WILL
HAVE BREATH SOUNDS.

AND I WANT YOU TO START
LISTENING TO BREATH SOUNDS

BECAUSE YOU NEED TO DETERMINE
IF THEY NEED TO BE SUCTIONED.

WE AREN'T WRITING ANY
MORE ORDERS. IF WE GO BACK
TO OUR HIGH-FIVE,

CHECK YOUR DOCTOR'S ORDERS
AND NURSING CARE PLAN.

THE DOCTOR WILL SAY SUCTION.

BUT THE DOCTOR SHOULDN'T SAY
SUCTION EVERY TWO HOURS

OR SUCTION EVERY FOUR HOURS.
WE DON'T DO THAT ANY MORE.

FOR ONE, IT'S TOO TRAUMATIC
FOR THE CLIENT

AND IT'S JUST NOT
GOOD ENOUGH CARE.

YOU NEED TO SUCTION WHEN
THEY NEED TO BE SUCTIONED

AND NOT JUST ON A
ROUTINE SCHEDULE.

SO HOW DO YOU KNOW YOUR CLIENT
NEEDS TO BE SUCTIONED?

THEY'RE COUGHING.

OH, I CLEARED THIS I HAD IT
PRE-SET A MINUTE AGO.

THAT'S INTERESTING.
BREATH SOUNDS.

O2 SAT HAS DROPPED...

BELOW 94.
ANYTHING REALLY.

IF THEY'VE BEEN HOLDING AT A
NORM THAT'S ACCEPTABLE FOR THEM
AND IT THEM DROPS LOWER.

GURGLING RHONCHI, SO YOU'RE
GOING TO OSCULTATE THEIR LUNGS.

DYSPNEA, THEIR RESPIRATORY
RATE GOES UP.

AND THEN OF COURSE
PRODUCTIVE SPUTUM.

YOU'RE SEEING THE SPUTUM
AND THEY'RE STRUGGLING.

NOW, IF THEY'RE ABLE
TO COUGH IT OUT

AND THEY CAN HANDLE IT,
THAT'S ONE THING,

BUT IF THEY'RE JUST STRUGGLING
AND HAVING DIFFICULTY, THEN
THEY NEED TO BE SUCTIONED.

AND SO THAT'S WHEN WE'RE
GOING TO SUCTION OUR CLIENT.

TO SUCTION YOUR CLIENT,
YOU'RE GOING TO GATHER
THE APPROPRIATE EQUIPMENT.

THERE'S A COUPLE OF THINGS
THAT YOU'RE GOING TO GATHER.

YOURS -- I TRIED TO GET
INTO SOMEONE'S BAG TODAY.

YOUR SUCTION...KIT
LOOKS LIKE THIS.

IT'S A 12 FRENCH
SUCTION CATHETER.

ONCE AGAIN, THESE ARE DIAMETERS
MEASURED IN FRENCH,

SIMILAR TO THE NG TUBES.

SO IT'S GOING TO FEEL
A LOT SIMILAR DOING THAT

BECAUSE WE'RE GOING TO
PUT IT DOWN THEIR NOSE,
MOUTH AND OR TRACH.

SO WE'RE GOING TO GET A SUCTION
KIT DETERMINED BY THE FRENCH.

I HAPPEN TO HAVE A
14 FRENCH WHICH IS FINE.

BUT THESE TWO KITS ARE
A LITTLE BIT DIFFERENT

AND THIS IS WHAT YOU'RE GOING
TO SEE OUT IN THE FIELD.

I DON'T KNOW WHICH ONE
BECAUSE THEY'RE DOING
TWO DIFFERENT KINDS.

THE KIT THAT YOU HAVE
IS PRE-PACKAGED WITH GLOVES,

A LITTLE CONTAINER FOR WATER
AND YOUR SUCTION CATHETER.

AND THEN WE ARE GOING TO PUT
THE SUCTION CATHETER IN
WITH OUR STERILE GLOVES.

THEY'VE ALSO CREATED
A NEW SUCTION CATHETER
THAT HAS A SLEEVE ON IT.

AND I'LL SHOW YOU AFTER
WE'VE DONE WHAT WE'VE DONE

SO YOU CAN APPRECIATE
WHAT WE'RE DOING.

BUT THERE'S NO GLOVES
IN THIS ONE

BECAUSE THE SLEEVE IS
GOING TO MAINTAIN THE
CATHETER AS STERILE.

ALRIGHT. SO I HAVE MY
CATHETER KIT,

I HAVE SOME STERILE WATER
OR STERILE SALINE,

IT DOESN'T REALLY MATTER.

THIS IS FOR IF I NEED TO GET...

A SPUTUM SPECIMEN.
THIS IS A LUKENS-TRAP.

IT'S REALLY GOOD IF YOU
HAVE AN 02 SAT MONITOR

AND IT'S REALLY EVEN BETTER
IF YOU HAVE 'EM

ON A MONITOR ALL TOGETHER
SO THAT YOU CAN SEE
WHAT THEIR O2 IS.

SO RIGHT NOW THEY'RE AT 98,

BUT WHAT HAPPENS IF YOU LOOK
OVER AND ALL OF A SUDDEN...

THEY DROP TO 88?

SOMETHING'S GOING ON. SO WE'RE
GOING TO WANT TO SUCTION 'EM.

NOT TO MENTION THEY
SOUND GURGLING WITH THEIR
RHONCHI OVER HERE.

SO YOU'RE GOING TO
PUT A SAT MONITOR ON.

YOU'VE PROBABLY WORKED
WITH SOME OF THESE.

THIS ONE'S A PORTABLE ONE.

I'M GOING TO PASS IT AROUND
SO THAT YOU CAN

CHECK OUT YOUR O2 SATS,
SEE HOW YOU ARE DOING.

IF YOU'RE AWAKE,
TAKING GOOD, DEEP BREATHS.

YOU WANT TO CLIP IT.
IT TELLS YOU WHERE THE
FINGERNAIL PART GOES.

PUT IT ON YOUR FINGERNAIL.

THIS WILL BE INTERESTING.
I HAVE PLASTIC NAILS RIGHT NOW.

YOU'RE SUPPOSED TO TAKE OFF
FINGERNAIL POLISH

AND YOU'RE SUPPOSED TO TAKE OFF
ACRYLICS TO GET A GOOD READING.

AND INTERESTINGLY,
THERE'S A TYPO IN YOUR BOOK.

IF YOU WANT TO CHECK CAPILLARY
REFILL TO SEE HOW THEY'RE
EXCHANGING THEIR BLOOD.

IF THEY'RE CAPILLARY REFILL
IS MORE THAN THREE SECONDS,

THEN YOU'RE GOING TO WANT
TO FIND ANOTHER METHOD
OF CHECKING O2 SATS,

BECAUSE THEY'RE NOT
CIRCULATING THEIR BLOOD.

AND YOUR TEXTBOOK ACTUALLY
SAYS LESS THAN THREE,

WHICH WOULD BE A GOOD
CAPILLARY REFILL.

I WAS READING THAT
LAST NIGHT AND I WENT,
"WELL, THAT'S BACKWARDS."

SOMEONE GOT THEIR GREATER THANS
AND LESS THANS BACKWARDS
OR SOMETHING IN THEIR MINDS.

SO THAT WOULDN'T MAKE ANY SENSE.
OKAY. SO THIS IS NICE.

- WHAT DO YOU DO IF THE PATIENT
HAS FINGERNAIL POLISH ON?

- THAT'S A TRICKY ONE
BECAUSE THERE'S OTHER PLACES
YOU CAN TAKE THEIR O2 SATS.

IF THEY'LL LET YOU TAKE IT OFF,
THEN YOU CAN.

YOU JUST TAKE IT OFF
WITH ACETONE AND THAT WILL
ALSO REMOVE ACRYLICS.

BUT YOU CAN ALSO CHECK
IT ON EAR LOBES.

AND SO EAR LOBES WILL
GIVE YOU A NICE READING.

AND WHEN YOU DO EAR LOBES --

THIS DOESN'T WORK OBVIOUSLY,
THE FINGER ADAPTOR.

I HAVE MY OTHER ONE,
IT'S OVER ON THE CART.

BUT THERE'S A LITTLE TAPE ONE
THAT YOU CAN PUT ONTO EAR LOBES,

A LITTLE DISPOSABLE ADAPTOR
AND IT'LL READ THEIR O2 SATS
FROM THEIR EARS.

AND THAT'S WHAT THEY TEND
TO USE NOW IN ANESTHESIA

BECAUSE WOMEN JUST DON'T LIKE
PARTING WITH THEIR NAILS.

THEY SPEND A LOT OF MONEY
ON 'EM AND SO FORTH.

SO THESE ALSO GET OUR HEART
RATES AND, BOY, I'M FLIPPING.

SO HERE YOU GO,
CIRCULATING THAT BLOOD.

SO YOU CAN GIVE THAT A CHECK.

O2 SAT ISN'T ENOUGH WHEN
YOU'RE DOING SUCTIONING.

YOU WANT TO BE CHECKING THEIR
PULSE AND SEE HOW THEY'RE DOING

WHILE YOU'RE SUCTIONING AS WELL.

SO THAT'S WHEN IT'S REALLY NICE
TO HAVE A MONITOR OR HAVE
A MONITOR LIKE THAT

THAT'S GIVING YOU MORE THAN
JUST THE O2 SAT READING.

BECAUSE A LOT OF THINGS CAN
BE AFFECTED WHEN YOU SUCTION.

THE THING ABOUT SUCTIONING
A CLIENT IS

THAT WHEN YOU SUCTION SPUTUM,
YOU ALSO SUCTION O2.

AND IT IS A GIVEN THAT IF YOU'RE
GOING TO SUCTION THEIR SPUTUM,

YOU'RE GOING TO LOWER
THEIR O2 SATS.

SO WE HAVE TO BE PREPARED
TO GIVE THEM MORE OXYGEN,

SO THAT WHEN WE SUCTION,
WE DON'T DEPLETE THEM.

SO I'M GOING TO NEED
HELP OVER HERE AS WELL.

BUT I HAVE HOOKED UP
OVER HERE...

A BAG SO THAT I CAN GIVE THEM O2

WHICH IS CONNECTED,
JUST LIKE MY OXYGEN WAS TO --

OR TO MY OXYGEN TUBING
TO THIS O2.

AND I'M GOING TO TURN
MY LITER FLOW UP TO
BETWEEN 10 AND 15

WHENEVER YOU BAG
TO GIVE 100% O2.

NOW, WHEN I'M SUCTIONING,

MY GOAL IS THAT I'M GOING
TO GIVE 'EM SOME AIR

OR HAVE MY CLIENT TAKE
THREE GOOD, DEEP BREATHS.

THEN I'M GOING TO SUCTION.

WHEN I'M DONE, I'M GOING
TO GIVE 'EM MORE AIR

OR HAVE 'EM TAKE
GOOD, DEEP BREATHS.

SO YOU'RE SANDWICHING
THE SUCTION WITH AIR.

SO THAT YOU'RE HYPERVENTILATING
'EM A LITTLE BIT,
SUCKING OUT SOME AIR

AND THEN RE-VENTILATING 'EM
SO THAT YOU CAN GIVE THEM AIR.

ALRIGHT. WHEN YOU DO
THE BAGGING TECHNIQUE...

AND I'M JUST SHOWING YOU NOW
AND WE'LL DO IT RIGHT
HERE IN A MINUTE.

BUT THE IDEA IS YOU ARE
GOING TO PUT THE VALVE

THAT SHOOTS THE AIR
TO THE CLIENT.

THEY SWITCH 'EM
ON DIFFERENT BAGS.

THIS BAG, IT COMES OUT HERE,

BUT SOMETIMES THE AIR
COMES OUT AT THE END.

AND THEN YOU HAVE TO
HAVE AN EXHALE VALVE.

RIGHT? SO IF YOU HOOK
THIS TO THE CLIENT,

WHICH I'M GOING TO DO HERE,
STABILIZE THE PLATE,

HOOK IT TO THE CLIENT.

AND -- OH, I GOT TO MATCH
HIS BREATHING HERE.

AND THEN SQUEEZE AND OUT.

YOU'VE GOT TO HAVE
SOME PLACE TO EXHALE

BECAUSE I'M STAYING CONNECTED
DURING THE BREATHING PART.

AND THAT'S WHAT THIS
OTHER VALVE IS FOR, EXHALE.

SO YOU WANT TO COORDINATE YOUR
BREATHS WITH HIS BREATHING

AND IT'S A FULL SQUEEZE...

OF...

THE BAG,
COORDINATED WITH THEM.

OKAY? SO WHEN I --

ONE OF YOU GIRLS WHO LOOK
OFFICIAL IN UNIFORM
WANT TO BE MY BAGGER.

SHE'S LOOKING LIKE,
"OKAY, I'LL DO IT."

ALRIGHT. YOU'RE GOING
TO COME OVER HERE.

YOU'RE GOING TO PUT ON
GLOVES, MASK AND A GOGGLE
IN THEORY, OKAY?

BECAUSE THIS IS
THE OTHER THING.

I HOPE YOU'LL TAKE SOME TIME TO
WATCH THE MANUFACTURER'S VIDEOS,

BECAUSE IT'S REALLY IMPORTANT
SOMETIMES TO SEE 'EM REALLY

DO SOMETHING ON SOMEONE AND
THEY'RE VERY EXCELLENT VIDEOS.

THE ONLY PROBLEM WITH THE
VIDEOS IS, LIKE I TOLD YOU,

THE CLIENTS THAT I'VE SUCTIONED

ALWAYS ARE PRODUCING
COPIOUS AMOUNTS OF SPUTUM.

I MEAN, IT'S COMING OUT OF THEM.

IT'S SHOOTING OUT OF THEM.

AND THESE VIDEOS ARE PEOPLE
THAT HAVE HAD TRACHS
FOR A LONG TIME

AND THEY'RE VERY STABLE
AND THEY DON'T HAVE SPUTUM.
IT'S A FAKE OUT.

THEY'RE CLEANING
AND SHOWING YOU HOW,

BUT THERE'S NO SPUTUM
COMING OUT OF 'EM.

AND I'M LIKE, "TOO CLEAN."

SO YOU'RE NOT GETTING
THAT PIECE OF THE REALISM,

BUT YOU'RE GETTING HOW IT WORKS
TO REALLY DO IT ON SOMEONE.

AND THEY'RE REALLY
VERY EXCELLENT VIDEOS.

SO WE WILL BE IN THE
GATHERING UP OF EQUIPMENT.

GATHERING GOGGLES,
MASK AND GLOVES

BECAUSE YOU HAVE TO GET SO CLOSE
TO THE WORKING ENVIRONMENT.

ALRIGHT.

WELL, I THINK I'VE GATHERED
MY EQUIPMENT FOR SUCTIONING.

AND WHAT I'M GOING TO BE
DOING IS TRACHEAL SUCTION.

THERE ARE THREE KINDS OF
SUCTIONING AND THIS
IS SO IMPORTANT.

FOR SOME REASON,
PEOPLE DON'T CAPTURE ON THIS

AND I NEED YOU TO CAPTURE ON
THIS PIECE OF INFORMATION.

THERE'S NASOPHARYNGEAL
SUCTIONING.

SO WHAT DOES THAT MEAN?

THAT THE TUBE GOES IN THE NOSE
TO THE BACK OF THE THROAT.

NASOPHARYNGEAL.
YOU'RE GETTING THE CONGESTION
OUT OF NOSE BACK OF THROAT.

THERE'S ORAL PHARYNGEAL.

MOUTH TO BACK OF THROAT.

AND THEN THERE'S TRACHEAL,
NASOTRACHEAL OR TRACHEAL.

WHICH MEANS YOU'RE GOING
DOWN INTO THE TRACHEA AREA
TO GET SPUTUM.

THE DOCTOR WILL WRITE
THE KIND OF SUCTIONING
HE WANTS YOU TO DO.

TRACHEAL SUCTIONING
IS DEEP SUCTIONING

WHERE SOMETIMES THE CLIENT
JUST HAS HEAVY CONGESTION
AND HAS DIFFICULTY BREATHING.

YOU NEED TO KNOW
WHICH ONE YOU DO.

WHEN YOU PUT A CATHETER DOWN
FOR NASOPHARYNGEAL SUCTIONING,

HOW MUCH DO YOU PUT DOWN?

WELL, REMEMBER WHEN WE
MEASURED FOR THE NG TUBE
FROM EAR LOBE TO NOSE,

THAT'S ABOUT AS FAR
AS YOU WOULD PUT IT DOWN
TO DO NASOTRACHEALS.

SO YOU CAN JUST GET AN ESTIMATE
OF ABOUT WHERE THAT IS
AND THEN PUT IT DOWN.

ABOUT WHERE THEY GAG
AND BACK UP.

NASOPHARYNGEAL.
DID I SAY TRACHEAL? SORRY.

NASOPHARYNGEAL,
BECAUSE THAT'S THE BACK HERE,
THE PHARYNX AREA.

NASOTRACHEAL WILL GO DOWN
UNTIL...IT STOPS, BASICALLY.

AND SOMETIMES THAT'S A LITTLE
TRICKY TO HIT WHEN YOU GO NASO.

YOU REALLY HAVE YOUR BETTER LUCK
GOING TRACHEAL TO TRACHEAL.

SO MOST OF THE TIME
WE DO NASOPHARYNGEAL,

ORAL PHARYNGEAL
AND THEN JUST TRACHEAL.

ALRIGHT? VERY IMPORTANT.

WHEN YOU DO ORAL PHARYNGEAL,
THAT WAS WITH THE YANKER.

REMEMBER THE YANKER BACK FROM
O2 -- I MEAN, FROM ORAL CARE.

WAY BACK WITH BED BATHS.

THIS IS CALLED THE YANKER.

WHAT IT DOES IS IT CONNECTS
ONTO OUR SUCTION APPARATUS.

THIS IS OUR SUCTION APPARATUS.

TO TURN ON SUCTION
WHICH IS NEGATIVE PRESSURE.

SUCKING, NEGATIVE PRESSURE.

YOU'RE GOING TO TURN YOUR
MACHINE ON TO REGULATE.

TURN IT UP TO 80MM OF MERCURY.

WALL UNITS COME IN
MILLIMETERS OF MERCURY,

WHEREAS PORTABLE UNITS
COME IN CENTIMETERS OF MERCURY.

AND YOU GOT TO KNOW
THE DIFFERENCE.

WHICH IS BIGGER?
A MILLIMETER OR CENTIMETER?

- CENTIMETER.
- CENTIMETER.

SO IF YOU HAVE CENTIMETERS, THEY
ARE ON THE LITTLE PORTABLE UNITS

AND IT WILL BE
10 TO 15CM OF PRESSURE

VERSUS A WALL UNIT
WHICH IS 80 TO 120.

SO WHEN WE'RE WORKING
OFF A WALL UNIT,

YOU'RE GOING TO PUT THE SAME
AMOUNT OF PRESSURE THAT THE
DENTIST PUTS ON, BASICALLY.

RIGHT? TO GET THOSE
POCKETS OF SALIVA.

AND IT WOULD JUST
GO DOWN IN HERE

INTO THAT BACK POSTERIOR
LINGUAL POCKET IN HERE.

AND THAT'S ORAL SUCTIONING.

ALRIGHT.

THAT'S NOT WHAT I'M GOING TO DO.

COS I'M STILL AT
GATHERING MY EQUIPMENT.

SO I'M GOING TO COME
INTO THE ROOM.

I'M GOING TO IDENTIFY --
I'VE WASHED MY HANDS,

I'M GOING TO IDENTIFY
MY CLIENT WHICH IS...

SAM. GOOD MORNING, SAM.
HOW ARE YOU DOING?

OH, I'M SORRY.
I KNOW YOU CAN'T TALK.

RIGHT? THEY CAN'T TALK
WHEN THEY HAVE A TRACH IN

BECAUSE IT'S RIGHT BELOW
THEIR VOICE BOX.

AND THE AIR CAN'T PASS THROUGH
SO THEY'RE ABLE TO VOCALIZE.

SO THEY STILL MAYBE
VERY ALERT AND ORIENTED,

BUT THEY MAY BE UNABLE
TO GIVE YOU VERBAL COMMENTS.

SO YOU MAY NEED TO GET
A TABLET OF PAPER FOR THEM,

AN ETCH A SKETCH OR SOMETHING
SO THAT THEY'RE ABLE --

ETCH A SKETCH,
NO, THAT WOULDN'T WORK.
WHAT'S THAT GOOGLE THING?

THOSE LITTLE BOARDS.
MAGNETIC BOARDS THAT THEY
WRITE ON, YOU KNOW?

KIDS HAVE 'EM NOW.
I CAN'T REMEMBER THE NAME,
BUT YOU KNOW WHAT I MEAN.

SOMETHING.

THEY GO, "YEAH."

WE ALL KNOW, HMM-HMM, CHARADES.

SOUNDS LIKE. I DON'T KNOW,
I CAN'T REMEMBER.

BUT, ANYWAYS, SOMETHING
THAT THEY CAN COMMUNICATE
AND FLASH CARDS FOR SOME HELPS.

BUT YES-NO ANSWERS
WILL WORK JUST AS WELL.

AND I'M GOING TO PROVIDE SOME
PRIVACY HERE WHEN WE SUCTION.

IT LOOKS LIKE TO ME THAT
YOU ARE PRODUCING A LOT OF
SPUTUM OUT OF YOUR TRACH

AND I'M GOING TO GO AHEAD
AND SUCTION YOU

AND SEE IF IT WILL MAKE IT
A LITTLE EASIER FOR YOU
TO BREATHE.

IN FACT, I'M ACTUALLY
HEARING SOME GURGLING.

YOUR HEADS NICE AND HIGH,
SO THAT'S GOOD.

ARE YOU COMFORTABLE LIKE THAT OR
WOULD YOU LIKE IT TO BE HIGHER?

COMFORTABLE? GOOD.

CAN'T ASK TOO MANY
QUESTIONS OR WHOO!

OKAY. THE FIRST THING I WANT
TO DO PRIOR TO SUCTIONING

IS I WANT TO LISTEN TO THEM
AND SEE AND HEAR...

AND I JUST KNOW
THAT I WOULD DO THIS

BECAUSE I WOULD MASK --
FULL THING.

GOOD, DEEP BREATHS,
IN AND OUT.

ARE YOU HAVING APNEA?
AM I GOING TO HAVE TO DO A CODE?
YES, YOU ARE. SORRY.

I DON'T KNOW WHY YOU PUKED IN
THE APNEA HERE SOMETIMES

THERE.
CURED.

LISTEN TO ALL THE LUNG FIELDS.

OH, HE'S KIND OF
REALLY GURGLING.

WELL, I KNOW I DON'T HAVE
MY STETHOSCOPE IN MY EARS,

BUT --
AND YOU CAN'T DO THAT.

OKAY. SO I'M GOING TO
LISTEN TO THE FRONT,

I'M GOING TO LISTEN
TO THE SIDES

AND I AM ALSO GOING TO
HAVE HIM SIT UP IF HE CAN
AND LISTEN TO THE BACK,

SO THAT I CAN LISTEN
TO ALL OF HIS LUNG FIELDS

AND HAVE A GOOD IDEA
OF WHAT'S GOING ON.

I ALSO, WHEN I'M LOOKING
AND ASSESSING,

I'M LOOKING AT HIS COLOR.
I'M LOOKING AT HIS
RESPIRATORY RATE.

I'M LOOKING TO SEE WAS HIS
BALLOON FILLED OR NOT.

AM I HEARING ANY LEAKING
OR HISSING RELATED TO
THE BALLOON.

IF THE BALLOON IS FILLED AND
I'M HEARING A HISSING, THEN THE
BALLOON'S NOT WORKING TOO GOOD.

SO I WANT TO BE
LISTENING FOR THAT.

I'M LOOKING TO SEE IF
THERE ARE DRIED SECRETIONS.

ARE WE DOING ENOUGH CARE
FOR THIS CLIENT?

IT'S ONE THING TO DO
ROUTINE CARE WHICH IS OKAY,

WE'LL CHANGE THE INNER
CANNULA EVERY SHIFT,

BUT WHAT IF THINGS ARE
GETTING ALL DRIED UP?
WE NEED TO DO IT MORE.

SO I'M LOOKING TO SEE WHAT KIND
OF SPUTUM, HOW MUCH SPUTUM,

COLOR OF SPUTUM AND IS THE CARE
THAT I'M GIVING ADEQUATE.

SO SOME OF IT'S JUST PRACTICAL.

LOOKING AT THAT CLIENT,
HOW DOES HE LOOK,

HOW DOES HE SOUND,
DOES HE NEED TO BE SUCTIONED?

IT JUST SO HAPPENS THAT I'M
ALSO GOING TO WORK ON YOUR
TRACH A LITTLE TOO,

BUT WHAT I'D LIKE TO DO
IS SUCTION YOU A FIRST

AND SEE IF WE CAN GET YOU
BREATHING A LITTLE EASIER

AND THEN I'LL GO AHEAD
AND CHANGE YOUR TRACH DRESSING.

SO I AM GOING TO
GET MYSELF SET UP.

IN THE MEANTIME,
COULD YOU BAG MY CLIENT?

AND THIS IS WHAT WE WANT TO DO.

YOU DON'T HAVE
TO BAG YOUR CLIENTS.

ALL I WANT YOU TO DO
IS TAKE A DEEP BREATH,
HAVE 'EM TAKE DEEP BREATHS.

BUT I WANT YOU TO SEE
WHAT THAT WOULD LOOK LIKE.

SHE HAS GOGGLES,
MASKS AND GLOVES ON.

AND WHAT'S SHE'S GOING TO DO,
SHE'S JUST GOING TO GIVE YOU
A LITTLE EXTRA OXYGEN HERE

FOR A COUPLE OF MINUTES,
WHILE I GET THE SUPPLIES READY.

BECAUSE WHEN I SUCTION YOU,
I SUCTION OUT OXYGEN
AS WELL AS SPUTUM

AND WE DON'T WANT YOU TO GET
HYPOXIC OR GET HYPOXEMIA, RIGHT?

LOW OXYGEN LEVELS
IN THE BLOOD, LOW O2 SATS.

SO THOSE ARE THE RISKS INVOLVED.

SO SHE'S GOING TO DO THIS.

NOW WHEN YOU DO THIS,
THIS IS THE DEAL.

I WANT YOU TO DO THIS. TAKE ONE
HAND AND SUPPORT THE PLATE.

DON'T PUSH THE PLATE OR IT
MAKES THEM START COUGHING.

BECAUSE YOU STIMULATE
THAT COUGH REFLEX.

BUT IF YOU'LL SUPPORT THE PLATE
AND THEN PUT THIS ON

AND THEN COORDINATE THE
SQUEEZE WITH HIS IN AND OUT.

AND IT'S A FULL SQUEEZE,
WE'RE SET AT TEN,
WE'RE GIVING 100% O2.

AND SO SHE'LL BE DIZZY OVER
THERE IN A COUPLE OF MINUTES.

WHAT I'M GOING TO DO OVER HERE
IS SET UP MY FIELD.

SO YOU WANT TO OPEN UP YOUR KIT.

AND ON THE TOP SHOULD
BE STERILE GLOVES.

THEY GET VERY, VERY STICKY.

AND YOU'RE GOING TO PUT ON
YOUR STERILE GLOVES FIRST.

OH, BUT BEFORE I DO THAT,
I'M GOING TO OPEN THIS UP.

THEN I'M GOING TO PUT ON
MY SECOND STERILE GLOVE.

YOU WANT TO HAVE YOUR WATER OPEN
BECAUSE THEN YOU'RE
GOING TO END UP

CONTAMINATING ONE OF YOUR
HANDS TO OPEN YOUR BAG.

INSIDE...THIS KIT

IS MY SUCTION CATHETER.

I PICKED --
MINE IS A 14 FRENCH, I THINK.

12 OR 14. BECAUSE I KNOW
IT'S ABOUT HALF THE SIZE
OF THE DIAMETER OF MY TRACH.

AND REMEMBER, I TOLD YOU,
WE HAD SIXES AND --
SIXES AND FOURS.

YOU GUYS ARE GOING TO
HAVE MOSTLY FOURS ON
THE MANNEQUINS IN THERE.

THAT'S THE SIZE OF THE TRACH.

AND YOU HAVE 12 CATHETERS
WHICH WILL BE ABOUT
HALF OF THE DIAMETER.

BECAUSE WE DON'T WANT TO
CUT OFF ALL OF THEIR BREATHING
WHEN WE GO DOWN.

INSIDE IS MY SUCTION CATHETER

WHICH I'M GOING TO LEAVE
RIGHT HERE ON ITS
LITTLE STERILE FIELD.

AND THEN THERE'S A CUP THAT I'M
GOING TO PUT STERILE WATER IN,

SO THAT WHEN I SUCTION,
I'M GOING TO BE ABLE

TO RINSE THE SPUTUM OUT
OF THE CATHETER.

I'M GOING TO SET THIS HERE
AND IT'S APPARENT AT THIS POINT

THAT I'M GOING TO HAVE TO
SACRIFICE ONE OF THESE HANDS,

SO THAT I CAN HOLD
EQUIPMENT AND POUR WATER.

SO I'M GOING TO LIFT MY WATER.

I'VE ALREADY CHECKED IT.
I'VE CHECKED MY EXPIRATION
DATES, EVERYTHING'S GOOD.

AND I'M GOING TO FILL UP THE
LITTLE CUP AS MUCH AS POSSIBLE.

SOMETIMES IF YOU KIND OF TAP 'EM
A LITTLE BIT, THE LITTLE BAG
WILL SHIFT IN THE BOTTOM.

YOU CAN'T SEE,
BUT...IT'S TRUE.

OKAY. NOW, WHAT I NEED TO DO
IS GET TO THE SUCTION CATHETER.

SO YOU NEED TO SET
YOURSELF UP CORRECTLY WHEN
YOU RE-PACKAGE YOUR KITS.

I WANT YOU PRACTICING
WITH YOUR KITS.

YOU'RE REALLY GOING TO
POUR WATER FOR SUCTIONING

AND YOU'RE REALLY
GOING TO SUCTION.

THIS HAND IS STERILE,
THIS HAND IS NOT.

THIS HAND NEEDS TO TOUCH
MY SUCTION EQUIPMENT

SO THAT I CAN HOOK 'EM TOGETHER.

YOU HAVE AN EXTENSION TUBING

THAT'S CONNECTED TO
A WALL UNIT OVER HERE,

A BUCKET.

THAT'S WHAT'S GOING
TO COLLECT THE SPUTUM.

CAN YOU KIND OF SEE THAT
OTHER GREEN ONE OVER THERE?

THE BUCKET.

AND THEN THERE'S ANOTHER
CONNECTION THAT GOES
TO THE SPUTUM.

COULD YOU WIPE THAT
WITH AN ALCOHOL SWAB?
DO YOU HAVE A FREE HAND?

OH, I DO. ALL GOOD NURSES
CARRY THEM IN THEIR POCKETS.

HERE. OKAY.

SO I'M GOING TO TURN
MY SUCTION ON

AND I WANT IT TO
BETWEEN 80 AND 120.

SO I'M GOING TO PICK A HAPPY
MEDIUM OF 100 FOR NOW.

AND SHE'S CLEANED ME ALL UP

AND I AM GOING TO CONNECT
THIS FINGER DEVICE

WHICH IS WHAT I'M GOING TO PUT
MY SUCTION TOGETHER WITH.

WITH STERILE,
NON-STERILE.

AND I CAN'T TOUCH MY
STERILE HAND TO THIS PIECE.

OH, I'M OUT.

DID YOU SEE WHAT HAPPENED?
IT SWUNG.

THIS SWUNG AND IT HIT HERE.

SO I'M CONTAMINATED, DONE DEAL.

BUT ALL GOOD NURSES
BRING TWO.

DID I BRING TWO?
OH, NO. I DID.

WHOO! OKAY.
ALWAYS BRING TWO.

BECAUSE THINGS HAPPEN,
LIFE HAPPENS.

AND THIS IS A DIFFERENT KIT.
THIS IS WHAT YOURS LOOKS LIKE.

I NEED TO GET RID OF THAT.

SO THIS IS WHAT YOUR KIT LOOKS
LIKE. YOUR GLOVES ARE HERE.

I OBVIOUSLY DON'T
NEED MY WATER AGAIN,

BUT AT THE RATE I'M GOING,
WHO KNOWS?

THIS IS TOTALLY SIDEWAYS.

SO PACK YOUR GLOVES UP GOOD
AND YOU THEN CAN JUST PUT SOME
NON-STERILE GLOVES IN THERE.

ALRIGHT.

OKAY. I'M GOING TO HAVE
A LITTLE BETTER CONTROL HERE.

I'M GOING TO PUT THIS IN MY
HAND SO IT'S NOT GOING
TO GO FLYING EVERYWHERE.

CONTAMINATED.
STERILE.

CONNECT.

OKAY. NOW I CAN HOLD LIKE THIS,
I'M STILL STERILE

AND THAT LEAVES THIS HAND
TO ADJUST OR TURN THINGS ON

OR MOVE THINGS THAT I FORGOT
OR I CAN GRAB ON.

BUT SEE, I'M ALWAYS
ABOVE MY WAIST AND ALWAYS OUT.

THIS IS WHAT GETS YOU
YOUR SUCTION, IS WHEN
YOUR THUMB IS ON --

I DON'T KNOW WHAT YOU CALL THIS.
APPLICATOR.

AND THEN YOU'RE GOING TO
STICK IT INTO THE WATER
TO LUBRICATE IT.

BUT WHEN I STICK IT INTO
THE WATER, I'M ALSO GOING
TO PUT MY THUMB ON

AND SEE HOW HIGH THE PRESSURE
GOES UP WHEN I PUT SUCTION ON.

AND IT ACTUALLY IS UP TO 130.

SO I'M GOING TO TURN IT
DOWN JUST A LITTLE BIT.

TRY IT ONE MORE TIME.

AND I'M MUCH HAPPIER. 110.

SO CHECK TO SEE WHAT
YOUR REAL SUCTION IS

BEFORE YOU GO SUCTIONING
ONTO YOUR CLIENT.

ALRIGHT.
THANK YOU SO MUCH.

ALRIGHT,
HE'S NICE AND VENTILATED.

I AM GOING TO TAKE THIS
AND I'M GOING TO PASS THIS DOWN.

I'VE NOTICED THAT
YOUR O2 SAT IS 88,

SO HOPEFULLY, IT'S NOT
GOING TO BE WORSE.

IT SHOULD'VE GONE UP
AND IT SHOULD'VE --
WITH HER BAGGING IT.

I'M GOING TO PASS
THIS DOWN INTO HIS TRACH

WITHOUT PUTTING MY THUMB
ONTO THE CONNECTOR

OR ONTO THE ADAPTOR THERE.

I'M GOING TO PUT
IT DOWN TILL IT STOPS

AND THEN I'M GOING
TO PULL BACK A LITTLE BIT.

AND THEN I'M GOING
TO PUT MY FINGER ON HERE

AND I'M GOING TO
SUCTION FOR TEN SECONDS.

USUALLY THEY START COUGHING...
[COUGHING]

WHILE YOU'RE SUCTIONING.
OKAY? YOU ONLY HAVE
TEN SECONDS TO DO IT.

GO AHEAD AND BAG HIM
BECAUSE YOU BAG AFTERWARDS.

AND THEN I NEED TO RINSE
THAT SPUTUM OUT.

OKAY? I NEED TO GIVE HIM
ONE MINUTE BETWEEN SUCTIONS,

SO THAT HE CAN RECOMPOSE
AND RE-OXYGENATE.

LET'S JUST GIVE
HIM A LITTLE MORE.

WHOO! I CAN'T DO THIS
STUFF ANYMORE.

- AND WHILE YOU'RE AT IT,
COULD YOU TILT THAT MONITOR A
LITTLE BIT SO IT'S NOT BLURRING.

- NO.

I CAN'T WITH ONE HAND.

- JUST TURN IT THE OTHER WAY.

YEAH, THAT'S BETTER.

- ALRIGHT. HOW ARE YOU DOING?

IT'S BEEN A MINUTE, I'M GOING TO
SUCTION YOU ONE MORE TIME.

AND I WANT YOU TO DO TWO PASSES.

I'M GOING TO LUBRICATE.

SHE'S HOLDING THAT SO NICELY,
DID YOU SEE HOW IT
KIND OF STUCK?

AND IF SHE JERKED
WITHOUT HOLDING THAT,

THEN YOU CAN ALSO
TRAUMATIZE THAT TRACHEA.

THAT'S WHY YOU WANT
TO STABILIZE THIS PLATE.

I'M GOING TO PUT
THIS DOWN AGAIN.

[COUGHING]

START COUGHING,
COUGHING, COUGHING.

I'VE HIT BOTTOM.
I PULLED BACK A LITTLE AND...

AND THAT'S WHAT IT SOUNDS LIKE.

THEIR EYES LOOK PANICKY AT YOU.

YES, THANK YOU.
BAG. RINSE.

I THINK THAT WAS THE
MOST FRIGHTENING THING

WHEN I FIRST STARTED
SUCTIONING PEOPLE,

WAS THEIR EYES WERE PANICKY.

AND I DON'T KNOW,
MAYBE I TRAUMATIZED THEM
MORE THAN I SHOULD.

WE DIDN'T HAVE AS MANY RULES
AS WE HAVE TO GIVE YOU
WHEN WE SUCTION.

BECAUSE THEY CAN'T TALK
AND THEY'RE KIND OF
CHOKING IN SPUTUM

AND IT'S A PANICKY SITUATION.

THINK IF YOU COULDN'T BREATHE.

YOU KNOW? IT JUST --
IT FEELS PANICKY.

SO TRY TO HELP 'EM RELAX,

TRY TO JUST HELP THEM
CATCH THEIR BREATH,

GIVE THEM THAT GOOD
FULL MINUTE IN BETWEEN

AND NOT GETTING YOUR SUCTION
UP TOO HIGH WILL HELP THEM
NOT FEEL SO TRAUMATIZED.

ALRIGHT.
WONDERFUL.

THE NEXT SUCTION, I WANT
YOU TO DO TWO TRACH SUCTIONS

AND THEN I WANT YOUR THIRD
PASS TO BE NASOPHARYNGEAL.

ALRIGHT? NOW NASOPHARYNGEAL
DOESN'T HAVE TO BE STERILE,

BUT TRACH HAS TO BE STERILE.

SO YOU CAN DO THE TRACH FIRST
AND THEN YOU CAN STOP.

YOU CAN DO NASO,

WHICH IS GOING TO BE ABOUT TO
THE END OF MY HAND, RIGHT?

IF WE MEASURE FROM EAR LOBE
TO NOSE AND PASS IT.

SO I'M JUST GOING TO PASS IT
DOWN INTO HIS NOSE AND THEN...

WHEREVER YOU'RE GETTING THE
SPUTUM OR IT'S CONNECTING,

THAT'S WHERE YOU WANT TO STAY
AND GET THE SPUTUM AND
THEN BE DONE.

AND THEN THE SAME THING.
EITHER HAVE 'EM -- BAG THEM
OR YOU CAN TAKE DEEP BREATHS.

AT LEAST THREE GOOD,
DEEP BREATHS.

- TEN SECONDS OR LESS?
- TEN. EVERYTHING IS TEN.

HOWEVER, I HAVE READ ONE TEXT
WHERE IT WAS 15 SECONDS,

BUT IT'S STILL LIMITED.
YOU JUST CAN'T STAY
DOWN THERE FOREVER.

- DO YOU NEED TWO
PEOPLE TO DO THIS?

- IF YOU'RE GOING
TO BE BAGGING, YES.

I CAN'T DO IT BY MYSELF,
IT'S IMPOSSIBLE.

BECAUSE YOU GOT TO HOLD THE
PLATE, YOU GOT TO STAY STERILE.

SO IF YOU'RE IN A BAGGING
SCENARIO, YOU'VE GOT
TO HAVE HELP.

WHEN YOU'RE IN A JUST A DEEP
BREATHE SCENARIO, YOU CAN
DO IT ALL BY YOURSELF

AND THAT'S WHAT YOU'RE
GOING TO HAVE TO DO TO TEST

BECAUSE WE DON'T HAVE ENOUGH
TIME TO PAIR UP WITH EVERYONE.

THE FINAL PASS THAT
YOU WOULD MAKE IS ORAL.

AND SO IF YOU WANTED TO
GET ANYTHING OUT OF THE
BACK OF THE THROAT,

ORAL PHARYNGEAL MOUTH,
THEN YOU CAN DO YOUR
FOURTH PASS THAT WAY.

ONCE YOU'RE DONE, RINSE,
TAKE A FEW DEEP BREATHS
AND NO MATTER WHAT --

WHENEVER YOU SUCTION, THEY HAVE
TO BREATHE AFTER YOU'RE DONE.

ALRIGHT. WE CAN GO AHEAD
AND TURN THE O2 OFF.

BECAUSE WE'RE NOT
USING THAT ANY MORE.

AND I AM DONE WITH YOU.
THANK YOU VERY MUCH.

THIS CAN GET BAGGED...

IN THE TRASH AND THIS THING CAN
GET DISPOSED OFF.

AND THEN MY GLOVES REALLY
ARE JUST THERE FOR ME,

AND I CAN CLEAN UP MY AREA.

I WANT TO SHOW YOU ONE OTHER
THING THAT YOU CAN DO STERILE,

IF YOU NEED TO GET
A SPUTUM SPECIMEN.

OKAY. LET'S SAY I JUST OPENED
THIS UP AND I'M STERILE.

I NEED TO GET
A SPUTUM SPECIMEN

AND ACTUALLY, I'M GOING
TO DO IT THIS WAY.

THIS IS CALLED A LUKENS-TRAP

I'M GOING TO CONTAMINATE
BOTH HANDS AND I'LL PUT THE
STERILE GLOVES ON AGAIN.

I WANT TO CONNECT THIS PIECE
TO THE SUCTION EQUIPMENT.

AND...STERILE GLOVES.

OKAY.

NOW WHAT I WANT TO DO IS PICK UP
MY STERILE CATHETER AGAIN

AND I WANT TO CONNECT IT...

TO THIS LUKENS-TRAP.

NOW I CAN DO THIS
WITHOUT SHOOTING IT OFF.

NOW I CAN LUBRICATE
A LITTLE WITH WATER,

BUT I CAN'T SUCTION
WITH WATER TO TEST IT.

BECAUSE IF I DO,
THEN IT'S ALL GOING TO GO...

INTO THE TRAP.

SO WHAT YOU WOULD DO IS SAY,
"OKAY. I'M GOING TO COME
GET A SPECIMEN."

HAVE 'EM TAKE THEIR DEEP
BREATHS, PUT IT IN...

THEN...

IT FALLS AND PLOPS INTO HERE.

YOU MAY NEED TO DO
ONE OR TWO PASSES.

AND THEN WHEN YOU'RE
DONE WITH THIS...

THIS GETS DISCONNECTED.

AND THEN IT'S COVERED LIKE THIS,
LABELED AND SENT TO THE LAB

AS A SUCTION SPUTUM SPECIMEN.

OKAY? AND THAT'S WHAT
A LUKENS-TRAP IS FOR
GETTING A SPECIMEN.

ALRIGHT.

NOW, THAT'S WHAT
YOU'RE GOING TO DO.

LET ME JUST SHOW YOU
ONE OTHER THING.

OKAY, REMEMBER I TOLD YOU THEY
CREATED THESE NEW SLEEVES.

THEY LOOK LIKE THIS,

IF YOU WOULD OPEN UP A KIT.

GET YOUR LITTLE BOX. YOU WANT
TO HAVE THE INSIDE BE STERILE.

SO I'LL JUST TRADE THAT NOW
SO I DON'T WRECK IT.

THEN I THINK I WOULD
PUT REGULAR GLOVES ON.

WHERE ARE MY GLOVES?

OVER THERE.

WHEN YOU'RE WORKING
WITH YOUR SLEEVE...

YOUR GLOVES DON'T HAVE
TO BE STERILE ANY MORE

BECAUSE THE SLEEVE
LOOKS LIKE THIS.

IT COMES IN A FRENCH
JUST LIKE THE OTHERS DID,

AS FAR AS THE PACKAGE GOES.

BUT THIS IS HOW IT COMES NOW.

YOU'RE GOING TO CONNECT IT
TO YOUR SUCTION.

STILL AT 81.10.

AND THEN I'M GOING TO...

PULL THE END OFF
AND NOW THIS IS STERILE.

I SLIDE IT OUT.

SUCTION JUST THE SAME.

AND THEN I'M GOING
TO PUT IT DOWN.

BUT FOR ME, IT TAKES TWO HANDS
SO I'M GOING TO HOLD

AND THEN SLIDE IT DOWN
INSIDE THAT SLEEVE.

AND THEN WHEN I SUCTION...

THIS COMES DOWN AND THAT'S WHAT
MAINTAINS IT AS STERILE.

SO IT'S THE INSIDE
THAT'S STERILE.

DEEP BREATHE AND SO FORTH
AND THEN SLIDE IT BACK DOWN.

RINSE.

THEN THE SAME THING.

PUT IT IN. GET IT GOING.
PRETTY COOL, HUH?

SO YOU DON'T HAVE TO WORRY
SO MUCH ABOUT STERILE
AND TOUCHING

BECAUSE THE CATHETER ITSELF
IS GOING TO STAY STERILE.

YOU'RE -- YOU DON'T
HAVE TO BE.

AND THEN THIS WHOLE THING
GETS DISPOSED OFF.

ALRIGHT.

I WOULD NOTICE THE AMOUNT,
COLOR, QUANTITY OF SPUTUM

AND THEN THIS BUCKET
NEEDS TO BE EMPTIED AT
THE END OF EVERY SHIFT.

AND ACTUALLY EMPTIED
IS THE WRONG WORD.

IT JUST GETS DISPOSED OFF. YOU
JUST TAKE IT AND THROW IT AWAY.

AND THEN PUT ANOTHER
ONE IN ALL TOGETHER.

THERE'S A COUPLE OF THESE,
YOU CAN PASS 'EM AROUND
AND SEE HOW THEY FEEL.

I DON'T NEED THEM BACK.

ALRIGHT. WELL, MY CLIENT'S
BEEN SUCTIONED.

BUT THE NEXT THING I NEED
TO DO IS I NEED TO TAKE
CARE OF THIS TRACH.

I NEED TO CLEAN THAT
INNER CANNULA AND I NEED
TO CHANGE THE TRACH TIES.

NO, I DID HAVE ONE OTHER
PROP FOR SUCTIONING.

THIS IS THE COOLEST THING
FOR ORAL CARE FOR SOME OF
YOUR CLIENTS THAT ARE --

MAYBE COMATOSE OR MAYBE ON
RESPIRATORS OR SOMETHING
AND NEED TO BE SUCTIONED.

YOU CAN...HOOK THESE
UP TO THE SUCTION.

AND THEN THESE CAN BE
DIPPED IN MOUTHWASH
OR DIPPED IN WATER.

AND THEN YOU USE THE LITTLE
BRUSH TO SCRUB THEIR MOUTH
AND SUCTION AT THE SAME TIME,

SO THAT THEY DON'T GET
THE POOLING OF FLUID
IN THEIR MOUTH.

AND YOU CAN REALLY
GIVE NICE ORAL CARE,
SO SCRUB, SCRUB, SCRUB.

AND THEN SUCTION BACK IN THOSE
POCKETS. SCRUB, SCRUB, SCRUB.

AND THEN SUCTION BACK
IN THE POCKETS.

AND WHAT'S IT GOING
TO BE SET AT?

- 80.
- 80?

- MILLIMETERS.
- MILLIMETERS OF MERCURY

IF IT'S A WALL UNIT.
WHAT IF IT'S PORTABLE?

- 10-15.
- 10-15?

- CENTIMETERS.
- CENTIMETERS.

- DO THEY HAVE TO BE
ORDERED?

- USUALLY YOU CAN JUST GET THEM
ON YOUR CENTRAL SUPPLY CART.
THERE'S A CHARGE ITEM.

BUT YOU DON'T HAVE TO HAVE
AN ORDER TO DO ORAL CARE.

- THEN YOU CAN DO SUCTIONS.

- YES, WHEN THEY'RE COMATOSE.

YOU HAVE TO HAVE
SUCTION STANDBY.

IF YOU DIDN'T HAVE SUCTION
AND SOMEONE ASPIRATED,

THEN YOU WOULDN'T BE DOING
GOOD NURSING PRACTICE
BECAUSE THAT'S --

WE ALWAYS HAVE SUCTION
STANDBY FOR OUR CLIENT.

I CAN'T IMAGINE NOT EVEN
ORDERING IT, BUT YOU WOULD
ALWAYS HAVE IT.

OKAY. SO NOW WE'RE GOING
TO MOVE ALONG AND WE'RE
GOING TO DO OUR TRACH.

YOU'RE GOING TO HAVE
GATHERED UP YOUR EQUIPMENT,

WHICH NOW IS GOING TO INCLUDE,
YOUR TRACH KIT...

- WAS THERE A CHUX ON HERE?

- IT WAS OUTSIDE.

- OKAY. COMPLICATIONS OF
SUCTIONING, THAT'S WHAT
I WANTED TO TALK ABOUT.

I ALREADY TALKED ABOUT
IT CAN LOWER

THE OXYGEN IN THE BLOOD
AND OXYGEN SAT LEVELS,

BUT A TOO LONG, TOO HIGH
A PRESSURE OR TOO
LARGE A CATHETER

CAN ACTUALLY CAUSE ATELECTASIS.

- WHAT'S THAT?
- COLLAPSED LUNG.

- COLLAPSED LUNG, OKAY?

IT CAN CAUSE BRONCHOSPASMS
IF THE PRESSURE'S TOO HIGH,

YOU CAN CAUSE
HEMODYNAMIC ALTERATIONS

AND THAT'S ESPECIALLY RELATED TO
SOMEONE THAT'S ON A RESPIRATOR.

YOU CAN INCREASE INTRACRANIAL
PRESSURE AND YOU CAN CAUSE
AIRWAY TRAUMA.

SO THE BEST POSSIBLE CONSISTENT
USE AND CONSISTENT SUCTIONING

IS THE BEST WAY TO PREVENT
THOSE THINGS.

IS PEOPLE DOING IT RIGHT AND
DOING IT RIGHT ALL THE TIME.

SO SOME OF THE RULES AND
THESE ARE IN YOUR ARTICLE,

BUT I JUST WANT TO HIGHLIGHT
WHAT I DIDN'T MISS.

SUCTION -- OR WHAT I MISSED.
SUCTION ONLY WHEN NECESSARY.

I TALKED ABOUT O2.

OKAY.

EVERYTHING ELSE I DID.

THE OTHER THING I WANTED
TO MENTION IS IT USED
TO BE PRACTICED

AND I AM STILL HEARING
'EM DO IT SOMETIMES,

IS TO PUT SALINE INTO THE
TRACHEA. OH, JUST A CC OR TWO.

SQUIRT IT IN BECAUSE
THAT WILL HELP LOOSEN UP

THICK TENACIOUS SECRETIONS.

WELL, THEY FOUND OUT
THAT IT'S NOT TRUE

AND IN FACT IT CAN
ACTUALLY CAUSE INFECTION.

SO WE SHOULD NOT
BE ADDING SALINE.

IT DOESN'T REALLY THIN
THE MUCOSA AND IT'S --

JUST HARDLY, YOU'RE ABLE
TO FIND SUPPORT FOR IT
IN THE LITERATURE.

NOW THAT'S TRUE, BUT THEN
THE LITERATURE SAYS

THERE'S DEBATE ABOUT IT
AND IT SAYS SPARE IT.

SO YOU'RE GOING
TO SEE IT OUT THERE,

BUT MOST OF THE RESEARCH
RECENTLY HAS SAID

THAT IT'S NOT NECESSARY
AND DON'T DO IT.

SO, DON'T WASTE
YOUR TIME WITH IT.

- WHAT ABOUT THE BABIES,
DON'T THEY --

- SAME THING. WE DON'T USUALLY
PUT ANYTHING IN.

WE JUST PULL THEM. SPARE THE
SALINE, DON'T USE IT.

ALRIGHT, I HAVE MY TRACH CARE
KIT AND IT'S A STERILE KIT.

I HAVE SALINE AND
I HAVE PEROXIDE.

AND WE'RE GOING TO GO AHEAD
AND DO SOME CLEANING OF
THAT INNER CANNULA.

I'M GOING TO OPEN UP MY KIT.

AND INSIDE THE KIT IS ALL
YOUR SUPPLIES ONCE AGAIN.

I HAVE A LITTLE DRAPE IN HERE.

AND I AM GOING TO
TAKE THIS DRAPE...

WHICH IS STERILE.

SO I AM GOING TO SET MY SELF UP
A LITTLE STERILE FIELD.

I'M NOTICING I'VE GOT THAT ONE
INCH BORDER AND I AM USING
ALL OF IT.

I CAN'T SEEM TO
GET MY HAND IN HERE.

ALRIGHT, AND THEN
I'M GOING TO LAY THAT DOWN

ON THE CLIENT BELOW HIS TRACH.

NOT CROSSING OVER MY FIELD.

ALRIGHT, I WANT
IT TOWARDS MYSELF.

OKAY, INSIDE MY TRACH
KIT IS MY GLOVES.

AND BOY, ARE THEY STUFFED IN
THERE PRETTY PITIFULLY.

I'M -- I NEED TO SET
SOME SUPPLIES DOWN.

AND I THINK THE ONLY WAY I AM
GOING TO BE ABLE TO DO IT

IS TO PEEL MY LID OFF
AND USE IT AS A STERILE FIELD.

AND, BOY, IS THIS A TINY ONE.
THIS IS A NEW KIT I'VE
NEVER SEEN BEFORE.

THIS IS YOUR KIT,
IT'S A LITTLE BIT BIGGER.

AND YOU HAVE THREE
CONTAINERS IN YOUR KIT.

I HAVE THREE CONTAINERS,
BUT MY CONTAINER IS IN --

MY THIRD CONTAINER IS INSIDE
A CONTAINER IN HERE.

YOU WILL SEE WHAT I MEAN,
BUT EVERYTHING ELSE
WILL BE THE SAME.

WHAT I NEED TO DO
IS DIG INTO THIS KIT

AND FIND THE CUP OF MY GLOVE

WITHOUT CONTAMINATING
THIS CONTAINER.

BOY, OH BOY! OH BOY!

HMM!

HMM!

HMM!

[LAUGHTER]

FORGET IT. ALWAYS
BRING EXTRA GLOVES.

THESE WERE TOO MANGLED
TO DEAL WITH.

AND I JUST DON'T WANT
TO DEAL WITH THAT.

SO I'M GOING TO GET RID OF 'EM
AND JUST USE MY OWN GLOVES.

AND THAT'S WHY I WANTED YOU
TO SAVE ONE MORE PAIR

FOR BACKUP FOR YOUR KITS.

SO PROBABLY AFTER YOU'VE RESET
IT UP AND UNSTUCK YOUR GLOVES,

IT MIGHT NOT BE A PROBLEM.
BUT YOU CAN SEE,

IT CAN BE A PROBLEM COS
EVERYTHING IN THERE IS STERILE.

SOME OF IT I NEED TO BE STERILE
AND SOME OF IT I DON'T.

AND SINCE I AM USING THIS I'M
GOING TO GO AHEAD AN OPEN THIS
UP AND HAVE MORE STERILE FIELD.

I NEED MORE STERILE FIELD.

AND MORE STERILE FIELD.

THESE ARE GOOD STERILE FIELDS.

OH, MUCH BETTER GLOVES.

THOSE ONE SIZE FIT ALL.
PUT IT ON.

OKAY, WELL THAT'S NOT GOING TO
WORK BECAUSE I AM CROSSING OVER.

OKAY, WHAT I WANT TO DO IS GET
MY SUPPLIES TOGETHER HERE.

AND I HAVE A BRUSH,
TWO PIPE CLEANERS.

AN APPLICATOR,
TWO APPLICATORS.

TIES TO CHANGE MY TRACH TIES
WHICH DON'T NEED TO BE STERILE.

I'M JUST GOING TO SET
THEM OVER THERE FOR NOW.

MY -- I CALL IT THE BIB.

BUT MY TRACH DRAPE HERE AND I AM
GOING TO SET THAT ASIDE NOW.

IT DOESN'T NEED TO BE STERILE.

MY FOUR BY FOURS
ACTUALLY SHOULD BE,

AND I'M GOING TO ALSO SET
THEM ON THIS FIELD

OR YOU COULD SET THEM
ON YOUR LITTLE PAPER TOP.

REMEMBER WHEN I PEELED
THAT OFF, THE TOP WILL WORK.

AND I CAN'T USE THEM
COS I THREW MY GLOVES DOWN.

THAT WAS LAZY OF ME.

OKAY, I HAVE THREE CONTAINERS.

AND THE INSIDES OF THE
CONTAINERS ARE WHAT
I AM CONCERNED WITH.

I AM ACTUALLY GOING TO SET
THESE OVER HERE FOR NOW TOO.

MY BRUSH IS WHAT'S GOING
TO DO MOST OF THE WORK.

I MAY NEED MY PIPE CLEANERS.

AND I AM ACTUALLY GOING TO
USE THE EDGE OF MY BRUSH

WITH A NON-STERILE HAND.

SO I WANT IT TO STICK
OUT SO I CAN GET TO IT.

I'M GOING TO
SACRIFICE ONE HAND

TO POUR SOLUTION
INTO MY BOTTLES.

THE IDEA IS THAT I'M GOING TO
CLEAN THE SPUTUM...

OFF OF THE SUCTION CATHETER...

WITH HALF STRENGTH PEROXIDE,
HALF STRENGTH SALINE SOLUTION.

SO I'M GOING TO POUR THAT IN
TILL IT'S GOT HALF AND HALF.

IT DOESN'T HAVE TO BE PERFECT.

MY LIDS HAVE BEEN DOWN,
AND I'LL JUST GO.

THIS HAND IS STILL STERILE.

ALRIGHT, THIS IS WHAT
I NEED TO DO.

THIS ISN'T STERILE IN
ITS PUREST FORM BECAUSE
THIS TRACH ISN'T STERILE.

IT'S JUST INTO THE TRACHEA AND
WE WANT IT TO BE AS STERILE
AS POSSIBLE, THE OTHER END.

I'M GOING TO STABILIZE THE
PLATE. I'M GOING TO
COME OVER HERE

AND I'M GOING TO TWIST
THE INNER CANNULA OFF

AND THEN JUST OPEN
IT OUT LIKE THIS.

AND THROW IT INTO...

THE HALF STRENGTH PEROXIDE
AND SALINE SOLUTION.

THEY'RE USUALLY SO FULL
OF SPUTUM RIGHT NOW

THAT IT'S JUST FROTHING
AND BUBBLING ALL UP
IN THERE, FROTHING.

AND RIGHT NOW HE
STARTS COUGHING.

AND SPUTUM STARTS SPITTING
OUT OF THIS THING AND
I'M THINKING,

"GREAT. NOW THAT'S ALL DIRTY,
BUT I CAN'T CLEAN THAT ONE."

BUT THAT'S WHAT HAPPENS
AND WE'RE GOING TO SLIDE

THE OTHER INNER CANNULA IN
AND THAT WILL KEEP IT PATENT.

WHAT I WANT TO DO WITH
MY LITTLE STERILE HAND

WHICH ISN'T THAT
STERILE ANY MORE

COS I TOUCHED
THAT OUTER CATHETER,

YOU CAN SEE
THIS ISN'T PERFECT.

I'M JUST GOING TO DIP
IT INTO THE WATER

AND I'M JUST GOING TO WIPE
ALONG THE OUTSIDE EDGE HERE

AND CLEAN ANY CRUSTY
SPUTUM RIGHT HERE

THAT'S GOING TO BE WHERE
MY INNER CANNULA IS GOING
TO GO BACK IN.

THE REST ISN'T STERILE

AND SO I'M GOING TO DO
IT WITH CLEAN HANDS
WHEN I AM DONE.

BUT I JUST WANT TO WORK
AROUND THAT PIECE FOR NOW.

I'M JUST GOING TO LAY
THAT RIGHT THERE.

NOW, I WANT TO HAVE
MY MOST STERILE HAND

WHICH IS THIS ONE THAT
ONLY TOUCHED THIS

TO COME HERE AND I'M GOING TO
GRAB BY THE INNER CANNULA TOP.

AND I'M GOING TO GRAB MY BRUSH
AND THEN I'M GOING TO SCRUB
THE SPUTUM OFF OF HERE.

MAY I JUST SAY THIS IS VERY
CLEAN WHAT YOU'RE LOOKING AT,

BUT WHEN IT'S ALL FULL
OF SPUTUM, IT STARTS
STICKING ONTO YOUR BRUSH

AND IT STICKS AND PLOPS AND --

AND I AM SO HAPPY THAT
I AM BEHIND A MASK

BECAUSE I'M GOING, "URGH.
THIS IS NOT MY BEST THING."

EVERYONE CAN HAVE THINGS
AND THIS IS NOT MINE.

I DIDN'T KNOW NURSES
COULD HAVE A THING.

I THOUGHT EVERYONE HAD
TO LIKE EVERYTHING.

ALRIGHT, CLEAN, CLEAN, CLEAN.

CLEAN IT ALL OFF HERE.
SCRUB, SCRUB.

IT MAY BE SO FROTHY, YOU CAN'T
EVEN SEE WHAT YOU GOT OFF YET.

SO YOU MAY NEED TO DIP IT
INTO YOUR PLAIN SALINE WATER

TO SEE IF YOU GOT
ALL THE SPUTUM OFF.

WHAT IS THE POINT OF CLEANING
IT IF YOU DON'T GET IT
ALL OFF OF THERE?

DON'T THROW OUT YOUR BRUSH YET

BECAUSE YOU'RE GOING
TO NEED THE BRUSH POSSIBLY

OR THIS IS WHEN YOU MIGHT NEED A
PIPE CLEANER TO REALLY SCRAPE.

I DON'T WANT TO USE
THAT END TO SCRAPE.

AND TRY TO GET
THAT SPUTUM OFF THERE.

GET IT CLEAN
AND THEN RINSE IT.

AND THEN ONCE IT'S CLEAN,

YOU WANT TO DRY IT OVER
HERE ON YOUR 4 BY 4.

THEN I'M GOING TO
STABILIZE THIS PLATE.

PUT THIS IN AND THAT'S WHEN
THEY START COUGHING.

COS ANY KIND OF PRESSURE
THAT GETS RIGHT THERE
WHERE YOU COUGH.

I MEAN, YOU CAN PUSH YOUR
OWN CRICOID A LITTLE BIT,
IT JUST KIND OF...

OKAY, MAKE SURE
IT'S LOCKED IN PLACE.

NOW, NOTHING IS
STERILE ANY MORE.

I'M GOING TO REMOVE THIS
LITTLE BIB OFF OF HERE

BECAUSE WHAT'S HAPPENING
IS THEY'RE HOCKING UP
SPUTUM HERE, RIGHT?

AND THIS IS CATCHING
IT DOWN HERE

SO THAT ALL THAT WETNESS
ISN'T MACERATING THEIR
SKIN ON THEIR CHEST.

YOU'RE TRYING TO KEEP
IT CLEAN AND DRY.

SO YOU CAN TAKE THIS OUT.

AND THEN I WANT TO GET THIS
OTHER APPLICATOR THAT
I HAVEN'T USED YET.

AND I WANT TO CLEAN
ALONG THIS PLATE

AND I WANT TO CLEAN UNDER HERE
AROUND THE STOMA, THE SKIN
OPENING OF THE TRACH.

AND GET THAT NICE AND CLEAN.

YOU MAY NEED TO BRING ANOTHER
PACKAGE OF APPLICATORS.

IF YOU SEE THAT IT'S
LOOKING CRUSTED,

THEN YOU NEED
TO GET MORE STUFF.

AND THEN I'M GOING TO LOOK
UNDERNEATH THE PLATE.

I JUST WANTED TO DO THAT ONE
DAY ON THE PLATE. AND IT
WAS SO CRUSTY THERE.

NO ONE, I DON'T THINK HAD EVER
CLEANED UNDER THE PLATE.

SO GET THAT NICE AND CLEAN.

AND I NEED TO REPLACE
THAT LITTLE BIB.

BUT FOR NOW, I'M GOING TO
WAIT BECAUSE I NEED TO
CHANGE THE TRACH TIES.

THE TIES THAT HOLD THE TRACH
IN PLACE STAY ON AT ALL TIMES.

AND THEY'RE ONLY CHANGED
PER POLICY OR PER SOILING.

SO USUALLY EVERY THREE DAYS,
EVERY FIVE DAYS

OR WHEN THEY'RE JUST
GROSSLY SOILED.

YOU DON'T CHANGE THEM
EVERYDAY, EVERY SHIFT,
OR ANYTHING LIKE THAT.

SO YOU JUST NEED TO KNOW
WHEN TRACH TIE DAY IS.

WHAT YOU WANT TO DO
IS GET YOUR TRACH TIE.

IT'S A LONG PIECE
OF TWILL TAPE LIKE THIS.

AND YOU'RE JUST GOING TO TAKE
IT AND STICK IT THROUGH
LEAVING THE OLD TIES ON.

STICK IT THROUGH HERE.

UP OR UNDER IT DOESN'T
REALLY MATTER AS LONG
AS YOU CAN GET TO IT.

AND OH, IT'S GOING TO MAKE HIM
START COUGHING THE MORE YOU
TRAUMATIZE THAT THING.

AND THAT'S WHEN
I MAY USE MY APPLICATORS.

I MAY GET ONE OF THESE AND
KIND OF STUFF IT A LITTLE BIT,

IF I CAN'T GET
IT THROUGH THE HOLE.

BE CAREFUL THAT YOU DON'T GIVE
'EM ROPE BURNS WHEN YOU'RE
PULLING THESE THROUGH.

PULL 'EM THROUGH SO THAT ONE
SIDE IS LONGER THAN THE OTHER.

AND THEN WHAT I WANT HIM
TO DO IS TO LIFT UP.

AND ACTUALLY, I JUST DO NOT LIKE
LEANING OVER TRACHS LIKE THAT.

MM-MM. NOT GOOD.
NOT GOOD AT ALL.

I'M GOING TO JUST WALK
MY LITTLE SELF OVER HERE.

AND I WANT TO SLIP THIS
THROUGH THE BOTTOM.

AND THEN...

LET ME LIFT YOUR HEAD
UP A LITTLE, MR. SPADE.

BRING THAT THROUGH AND THEN
YOU WANT TO TIE THIS

INTO A SQUARE KNOT
FOR OUR PURPOSES

COS WE'RE GOING TO REUSE TWILL
TAPE, JUST PUT IT IN A BUBBLE.

BUT YOU WANT IT IN A KNOT SO
THAT IT DOESN'T COME UNDONE.

AND YOU WANT TO MAKE SURE...

THAT YOU CAN GET AT LEAST
ONE FINGER...

IN HERE. THINK ABOUT
THAT A MINUTE.

IF YOU DON'T -- IF YOU GET IT
TOO TIGHT...IT'S THEIR NECK.

ALRIGHT, THEN THIS ONE
CAN BE CUT OFF.

AND I MIGHT HAVE TO.

THEN TAKE THE OLD ONE OFF.

THAT WAY THE CLIENT'S NEVER AT
RISK OF THIS THING FALLING OUT

OR SHOOTING OUT
WHEN THEY COUGH.

COS THAT WOULD NOT BE
A FUN THING TO HAVE
THEM LOSE THEIR TRACH.

SO GO AHEAD AND PULL THIS OUT
AND THEN PULL THE OLD ONE OUT

AND THEN THEY WILL HAVE THEIR
CLEAN TRACH TIES ON THERE.

ALRIGHT.

ONCE HE'S ALL SET, THEN YOU CAN
GO AHEAD AND PUT THIS NEW...

SPUTUM DRAPE HERE. AND IT
NEEDS TO GO SO THAT THE
SPLIT IS AT THE TOP.

HOPE THAT'S OBVIOUS.

BUT YOU'D BE SURPRISED HOW
MANY DRESSINGS I SEE
THE OPPOSITE WAY.

AND IT WOULDN'T SERVE
ANY PURPOSE RIGHT?

BECAUSE THE SPUTUM IS COMING
DOWN AND IT'S SUPPOSED
TO GET CAUGHT HERE.

THESE CAN BE CHANGED.
IN FACT I'D PROBABLY CHANGE --

I HAD A CLIENT THAT WAS
JUST, OH, SO PRODUCTIVE.

AND I WAS CHANGING THIS EVERY
TEN MINUTES ON HIM.

EVERY TIME I WALKED BY THE ROOM,
THERE WAS JUST SPUTUM EVERYWHERE

AND IT WAS ON HIM ALL THE TIME.
I COULDN'T KEEP UP WITH IT.
IT WAS JUST TOO MUCH.

AT LEAST HE WAS
GETTING IT OUT.

SO WHAT I DID WAS I JUST GAVE
HIM A STACK OF DRAIN SPONGES.

I SAID, "HERE. CAN YOU
CHANGE IT YOURSELF?"

AND HE DID, HE WAS
PERFECTLY CAPABLE.

AND IT WAS, LIKE,
WELL, BRAINSTORM.

I SHOULD HAVE THOUGHT OF THAT,
YOU KNOW, THREE HOURS AGO.

BUT THAT GAVE HIM SOMETHING
TO DO AND HE COULD KEEP
HIMSELF DRY THAT WAY.

COS I HAD OTHER CLIENTS
TO SEE AND SO FORTH.

SO THEY CAN TAKE CARE OF THAT.

AND THAT'S WHAT WE'RE TALKING
ABOUT THIS ROUTINE CARE.

WHAT'S ROUTINE? IT'S WHAT YOUR
CLIENT NEEDS TO KEEP 'EM DRY.

ALRIGHT, CLEAN UP YOUR MESS.

AT THIS POINT, YOU CAN
RE-ASSESS VITAL SIGNS.

YOU CAN RE-ASSESS LUNG SOUNDS
TO SEE HOW YOUR SUCTIONING
AFFECT YOUR CLIENTS.

SEE WHAT THEIR O2 STATUS IS.
MY CLIENT'S APNEAC AGAIN,

SO I'M PROBABLY GOING TO
HAVE TO RESUSCITATE HIM.

AND HE'S STILL COUGHING.

BUT AT LEAST HE'S COUGHING
AND THAT'S GOOD.

LUNGS SOUND BETTER.
[COUGHING]

AND HE'S GOOD TO GO.

WASH YOUR HANDS AND DOCUMENT.

AND YOU'RE GOING TO DOCUMENT
ALL OF THE THINGS WE
JUST TALKED ABOUT.

YOUR SPUTUM, THE TYPE,
THE AMOUNT, THE FREQUENCY,

HOW THEY TOLERATED
THE SUCTIONING,

THE CARE YOU GAVE
TO THE TRACH,

THE BIB, HIS O2 SATS,
HIS VITAL SIGNS,

EVERYTHING THAT YOU DID GETS
DOCUMENTED ON HERE.

PUT THIS UP.

AND YOU'RE LOOKING PRETTY
GOOD THERE, MR. SPADE.

AND I'LL CLEAN THIS UP LATER.

ALRIGHT, I DID WANT -- OH!

THEY NEED GOOD ORAL
HYGIENE AS WELL.

I WANT MY POINT BEFORE I LEAVE
IF THEY HAVEN'T GRADED ME YET.

MAKE SURE THEY HAVE GOOD ORAL
HYGIENE. DON'T FORGET THAT.

YOU KNOW, YOU CAN GET SO TRACH
FOCUSED AND OVERWHELMED WITH
ALL THAT SPUTUM AND STUFF,

THAT THE SAME THING,
NASAL CARE AND ORAL HYGIENE.

I TALKED TO YOU BRIEFLY
ABOUT WHAT HAPPENS

IF THEY HOCK THAT CATHETER
OR THAT TRACH OUT?

OR WHAT -- DO YOU
EVER CHANGE TRACHS?

I HAVE JUST A SHORT LITTLE
THREE-FOUR MINUTE CLIP HERE

OF A MAN CHANGING HIS OWN TRACH.

AND I THOUGHT YOU MIGHT
JUST LIKE TO SEE THIS.

SO MOST OF THE TIME
THEY'RE OKAY,

BUT YOU WANT TO FILL IT
PRETTY SOON BECAUSE
THE STOMA WILL CLOSE.

AND SO THAT'S THE IDEA.
BUT YEAH, YOU SHOULD
HAVE PLENTY.

AND NOT ALL OF THEM
HAVE A CUFF.

MANY ARE NON-CUFFED
WHICH IS WHAT YOU USE --

I WORKED MOSTLY FLOOR NURSING
AND SO MOST OF MINE

WERE UNCUFFED WHEN WE
WORKED AROUND TRACHS.

- SO IF THIS THING FELL OUT AND
THAT'S THE ONLY ONE YOU HAD,

YOU WOULD END UP CLEANING IT?

- THAT'S A GOOD QUESTION,
I DON'T REALLY KNOW
THE ANSWER TO.

BECAUSE THAT WOULD
BE MY NIGHTMARE.

OH, I HAVE TO PICK
ME UP OFF THE FLOOR?

I WOULDN'T PUT A DIRTY
ONE IN, THAT'S FOR SURE.

I THINK IT WOULD JUST
DEPEND ON THE CLIENT.

AND BOY, OH, BOY.
YEAH, PROBABLY. 911.

BECAUSE YOU NEED A SPARE TRACH.
THAT'S --

GOOD NURSES MAKE SURE
THERE ARE SPARES.

I MEAN, THAT'S
WHAT WE'RE ABOUT.

KIND OF LIKE A DIABETIC WITH
ONLY ONE BOTTLE OF INSULIN.
WHAT'S WITH THAT?

OKAY.

LAST BUT NOT LEAST.
WE STILL GOT TIME.

SO THAT'S ONE DRILL
AND THIS IS YOUR FINAL DRILL.

AND THIS ONE IS GOING
TO BE A GROUP ACTIVITY.

AND I WANT TO PREP AS A
GROUP ACTIVITY BY SAYING
I HATE GROUP ACTIVITIES.

I'VE BEEN IN GROUPS BEFORE.
AND WHAT HAPPENS IN GROUPS

IS ONE OR TWO PEOPLE DO ALL THE
WORK AND ALL THE TALKING

WHILE TWO OR THREE
TAKE A RIDE.

WELL, SINCE I KNOW THAT. DON'T
YOU KNOW, I'LL BE WATCHING
FOR WHO'S RIDING,

BECAUSE YOU'RE THE ONES I AM
GOING TO ASK THE QUESTIONS TO.

AND YOU'RE GOING TO HAVE
INDIVIDUAL GRADES FOR
EACH OF IT.

SO IF EVERYTHING IS GOING ALONG
RIGHT AND YOU'RE IN AGREEMENT,
EVERYONE GETS THE POINTS.

BUT IF SOMETHING IS AMISS,
THEN I'LL GO AROUND THE GROUP
AND TRY TO FIGURE OUT

WHO KNOWS WHAT'S RIGHT AND
WHAT'S WRONG. AND I'LL GET
IT ALL FIGURED OUT.

AND YOU CAN TRUST ME ON THAT.

AND I'M GOING TO GIVE EACH
OF YOU YOUR OWN SCENARIO,
A PROBLEM TO SOLVE.

AND YOU WILL SEE WHAT
I MEAN WITH JUST YOU.

ALRIGHT, WE NEED TO TALK
ABOUT CHEST TUBES.

WHO NEEDS A CHEST TUBE? WHAT
KIND OF DIAGNOSES GO WITH
CHEST TUBES AND SO FORTH.

THE CHEST TUBE
IS JUST EXACTLY THAT.

A TUBE THAT GOES INTO THE CHEST,
INTO THE THORAX, CALLED
THE THORACOTOMY.

AND WHAT WE'RE TRYING
TO DO IS RELIEVE PRESSURE

THAT'S HAPPENED IN THE
PLEURAL SPACE THAT'S
CAUSED LUNGS TO COLLAPSE.

TYPICALLY, IT'S CALLED A
PNEUMOTHORAX WHICH IS AIR
IN THE PLEURAL SPACE.

FOR A PNEUMOTHORAX
TO HAVE A CHEST TUBE,

YOU HAVE TO HAVE MORE THAN
15% OF THE LUNG COLLAPSED.

THAT'S NOT FOR YOU TO DIAGNOSE,
IT'S FOR THE PHYSICIANS TO
DIAGNOSE.

BUT THEY WILL HAVE DONE THAT
RELATED TO CHEST TRAUMA,

PROBABLY AND/OR CHEST X-RAY.

THERE ARE THREE
KINDS OF DEFINITIONS.

THERE ARE THREE THINGS THAT
CAN LEAD TO PNEUMOTHORAX
AND THAT'S --

OR CAUSES AND THAT'S TRAUMATIC.

USUALLY, THAT HAS TO DO WITH
SOMETHING BLUNT HITTING IT,
A SUCKING CHEST WOUND.

IT'S USUALLY OPEN, BUT IT
COULD BE CLOSED WOUND.

SOME KIND OF TRAUMA THAT'S
CAUSED THE LUNG TO COLLAPSE

SO A TRAUMATIC PNEUMOTHORAX.

THERE COULD BE AN
IATROGENIC PNEUMOTHORAX

WHICH IS SOMETHING THE IATRO,
IS US CAUSING IT.

SO FOR EXAMPLE A PHYSICIAN PUTS
IN A SUBCLAVIAN LINE

AND NICKS THE LUNG,
WE CAUSED THE PNEUMOTHORAX.

AND FINALLY A SPONTANEOUS
PNEUMOTHORAX.

AND IT COULD BE PRIMARY
FOR REASONS WE DON'T KNOW,

IDIOPATHIC OR IT COULD BE
SECONDARY TO A DISEASE PROCESS.

A FRIEND OF MINE LAST WEEK
HAD PNEUMONIA

AND HAD A PNEUMOTHORAX,
BUT LESS THAN 15%.

SO BECAUSE IT WAS DISEASE
CAUSED AND NOT THE WHOLE LUNG,

SHE DIDN'T HAVE TO HAVE A CHEST
TUBE AND THEY TREATED IT

WITH MEDICATION AND RESPIRATORY
THERAPY AND SO FORTH.

SO IT VARIES, BUT THE KEY IS
THAT GREATER THAN 15%,
COLLAPSE OF LUNG.

THE FINAL KIND OF
PNEUMOTHORAX YOU CAN HAVE

IS A TENSION PNEUMOTHORAX

WHICH IS REALLY THE
VERY MOST SERIOUS KIND.

ALL THESE WORDS ARE DEFINED
QUITE WELL IN ALL THE ARTICLES
AND ALL THE BOOKS.

BUT A TENSION PNEUMOTHORAX
IS INCREASED PRESSURE IN
THAT PLEURAL SPACE

THAT CAUSES THE HEART TO SHIFT
OVER AND CAUSES DIFFICULTY

IN BREATHING, POOR AIR EXCHANGE
AND CAN BE FATAL.

AND SO THAT'S WHAT
WE'RE TRYING TO PREVENT.

WE DON'T WANT IT TO GET
WORSE THAN IT ALREADY
IS IN THAT SPACE.

SO A CHEST TUBE IS PUT
INTO THE THORACIC AREA

AND DEPENDING UPON WHAT KIND
OF CHEST PROBLEM THERE IS

IS WHERE THE TUBE
WILL BE PLACED.

IF IT'S A PNEUMOTHORAX,
IT'S TYPICALLY PLACED HIGH

AROUND THE SECOND INTERCOSTAL
SPACE, MID CLAVICULAR LINE.

BECAUSE AIR RISES,

AND SO THEY'RE TRYING TO GET THE
AIR OUT OF THE SPACE.

BUT IF IT'S
A HEMOTHORAX, OR...

WHAT ELSE? EMPYEMA,
PUS IN THE LUNG.

FLUIDS GO TO THE BOTTOM
OF THE LUNG,

SO WHAT THEY TEND TO DO IS PUT
THAT IN THE FIFTH OR SIXTH
INTERCOSTAL SPACE

ON THE POSTERIOR PART OF THE
LUNG SO THAT THE TUBES WILL
COME OUT FROM HERE.

SO PNEUMO IS USUALLY
ANTERIOR HIGH,

AND FLUIDS ARE USUALLY
POSTERIOR AND LOW.

THE ONLY EXCEPTION TO THAT
IS WHEN THEY DO HEART SURGERY

AND TRYING TO PREVENT
MEDIASTINAL SHIFT,

THEN THEY WILL PUT A CHEST TUBE,
MAYBE EVEN IN TWO PLACES,

HIGH AND LOW WHEN YOU'VE GOT
BLOOD AND AIR POST-OP.

OR AND EVEN WITH TRAUMA, YOU MAY
HAVE TWO TUBES DRAINING 'EM
BOTH OUT OF THAT SPACE.

SO IF YOU HAVE A CLIENT THAT'S
GOING TO HAVE A CHEST TUBE,

THEY WILL HAVE DONE AN X-RAY,
THEY WILL HAVE DONE AN ABG,

THEY WILL HAVE...

TAKEN VITAL SIGNS AND ASSESS

THAT THIS CLIENT IS
HAVING DIFFICULTY BREATHING
AND SO FORTH.

SO THAT IT'S INDICATIVE THAT
THIS CHEST TUBE IS NEEDED.

SO IF A CLIENT COMES TO YOU

AND YOU HAVE TO GET EVERYTHING
READY, THAT'S ONE SCENARIO.

OR THEY MAY ALREADY HAVE
THE CHEST TUBE AND YOU
HAVE TO MAINTAIN IT

BUT NEVERTHELESS YOU NEED
TO KNOW THE WHOLE OF IT.

WHEN YOU COME WITH
YOUR GROUP TO MY STATION,

I WILL GIVE YOU ONE
OF FOUR SCENARIOS.

IT WILL EITHER BE A
PNEUMOTHORAX OR A HEMOTHORAX.

ONE OR THE OTHER, SO YOU
CAN THINK AIR OR FLUID.

AND IT WILL EITHER, THE
CHEST TUBE WILL EITHER BE IN

OR YOU WILL HAVE TO HELP THE
DOCTOR GET READY TO PUT IT IN.

I'M GOING TO START FROM
THE BEGINNING OF HOW TO
SET IT ALL UP

BECAUSE YOU NEED TO KNOW
THAT INFORMATION.

BUT I MAY JUST SAY, "THE TUBE
IS IN, WHAT ARE YOU GOING
TO DO AS A NURSE

FOR THE SHIFT TO TAKE CARE
OF YOUR CLIENT WITH
THE CHEST TUBE?"

BECAUSE THAT'S WHAT LIFE
IS LIKE FOR US WHEN
WE'RE WORKING.

ALRIGHT, I WILL CHECK
MY DOCTOR'S ORDERS.

I WILL GATHER MY EQUIPMENT
AND THAT'S A HUGE JOB

IF THE DOCTOR'S GOING
TO PUT A CHEST TUBE IN,

YOU HAVE TO GET
A CHEST DRAINAGE UNIT.

AND IT COMES IN A PACK
WITH THE CHEST TUBE ITSELF.

THERE'S THREE COMPARTMENTS.

AND IN THESE
COMPARTMENTS ARE...

DIFFERENT FUNCTIONS
THAT WILL BE TAKING PLACE.

THIS COMPARTMENT RIGHT HERE
IS THE DRAINAGE COMPARTMENT.

SO IF THEY'RE GETTING --
IF THEY HAVE A HEMOTHORAX,

AND THERE'S BLOOD
IN THEIR SPACE.

AND WE'RE DRAINING THE BLOOD OFF
SO THAT THE LUNG CAN REINFLATE,

THEN WE NEED TO
CAPTURE THAT BLOOD.

AND IT WILL COME INTO THE
DRAINAGE PART OF THE UNIT.

BECAUSE THIS IS REALLY
ALL OPEN, RIGHT?

IT'S AN OPEN --
THIS IS AN OPEN TUBE.

OPEN, OPEN, OPEN INTO
THIS SPACE OPEN, RIGHT?

AT SOME POINT WHERE
IS THE END OF THE TUBE?

ISN'T THAT A CURIOUS THING?

THAT'S THE WATER SEAL WHICH
IS THE SECOND CONTAINER.

SO HERE'S THE DRAINAGE
COMING OUT,

BUT WE'RE GOING TO SEAL
THIS UP WITH A WATER SEAL.

IT'S THE END OF THE LINE,
KIND OF, A THING.

I CAN'T TELL YOU EXACTLY
HOW IT WORKS PHYSIOLOGICALLY,

BUT KNOW IT TO BE
TRUTH LIKE THIS.

IF THIS WERE THE END
OF THE TUBE

AND I PUT MY THUMB ON IT,
THAT WOULD SEAL IT UP HARD.

NOTHING COULD ESCAPE AIR --

IF THERE GOT TOO MUCH
AIR IN THE SPACE,

THE AIR COULDN'T ESCAPE OUT,
IT'D BE TRAPPED.

BUT IF I CREATE A SOFT SEAL
WITH WATER, YOU KNOW HOW
YOU BLOW IN A STRAW

WHEN YOU'RE DRINKING OUT
OF A CUP AND THE WATER
BLURPS UP THE TOP?

THIS IS WHAT WE'RE TRYING
TO CREATE, A SOFT SEAL.

SO THAT IF A PRESSURE BUILDS
UP INTO THIS PLEURAL SPACE,

IT CAN BLURP OUT.

AND THE WATER HERE WILL
MAINTAIN ENOUGH OF A SEAL

SO THAT WE KEEP THE RIGHT
PRESSURE GOING INTO THE LUNG.

HOW DO WE KNOW WHAT THAT IS?
WELL, THEY FIGURED IT ALL OUT.

AND WE NEED 2CM, SONAMETERS,
WHATEVER I SAY AT THE TIME,

OF PRESSURE HERE
IN THIS WATER SEAL.

OKAY? HOW DO YOU GET
IT IN THERE?

WELL, ALL THE UNITS HAVE
DIRECTIONS SO THAT'S
ALWAYS HELPFUL.

BUT THIS PARTICULAR UNIT IS
DESCRIBED IN YOUR BOOK

AND IT'S WHAT'S USED IN
MANY OF THE FACILITIES
IN THE VALLEY.

IT HAS THE
WATER SEAL VALVE HERE,

AND YOU HAVE TO GET A SYRINGE
AND CONNECT IT LIKE THIS.

AND THEN YOU HAVE A VALVE
THAT TURNS IT OFF OR ON.

YOU NEED IT OPEN AND THEN
YOU POUR YOUR WATER.

AND REALLY YOU NEED JUST STERILE
WATER. SODIUM CHLORIDE
ISN'T RECOMMENDED

BECAUSE SODIUM CHLORIDE,
THE SALTS BUILD UP IF THEY
HAVE IT FOR A WHILE.

SO JUST PLAIN OLD STERILE
WATER, AND YOU JUST POUR
A LITTLE IN HERE.

AND YOU WATCH THE LINE

UNTIL THE FLUID IS RIGHT
AT THE 2CM LINE.

OKAY?

SO I HAVE MY...

UNITS SET AND I HAVE
MY WATER SEAL SET.

BUT I MENTIONED THERE
WERE THREE COMPARTMENTS.

THE THIRD COMPARTMENT IS THE
SUCTION PRESSURE COMPARTMENT.

AND THEY FOUND THAT IF
THEY HOOKED UP SUCTION

DIRECTLY TO THIS UNIT,
IT WAS TOO STRONG.

BUT IF THEY PUT WATER IN
AS A MEDIATOR

SO THAT IT DIDN'T PULL TOO HARD
THAT THE RIGHT AMOUNT OF SUCTION

WOULD BE TO THAT PLEURAL SPACE
AND WOULDN'T CAUSE DAMAGE.

SO WHAT THEY FOUND WAS THAT 27CM
OF WATER IN THIS SPACE

WHEN WE HOOK IT
TO SUCTION WOULD CREATE

THE RIGHT AMOUNT OF SUCTION
INTO THIS PLEURAL SPACE

SO THAT IT WOULDN'T DAMAGE
THE TISSUES AND THE LUNGS

AND YET IT WOULD DRAW OFF
THE AIR AND THE FLUID

SO THAT THE CLIENT'S
LUNG WOULD REFILL.

- DID YOU SAY 20?

- 20CM IS IN THE SUCTION.

SO THE SUCTION LINE
IS HERE AT 20.

THE WATER SEAL LINE IS TWO,

AND THE DRAINAGE COMPARTMENT IS
WHATEVER DRAINAGE NEEDS TO BE.

TO FILL IN THE
SUCTION COMPARTMENT,

YOU JUST POUR IT INTO
THIS TOP HOLE RIGHT HERE,

AND IT FILLS UP.

AND THEN YOU PLUG IT WITH THIS
PLUG THAT'S GOT TWO HOLES IN IT.

YOU NEVER SEAL ANYTHING
WITH A SOLID HARD SEAL.

NOT WITH TAPE, NOT WITH ANYTHING
BECAUSE THEN IT CAN'T BURP OUT.

AND WE NEED IT TO BE ABLE TO
FLUCTUATE A LITTLE BIT.

ALRIGHT, ONCE YOUR TUBE IS --

YOUR COMPARTMENT IS SET HERE,
YOUR CHEST TUBE DRAINAGE UNIT.

IT NEEDS TO HANG AT LEAST A FOOT
BELOW THE CLIENT'S LUNGS

WHERE THE INSERTION WILL BE.

SO IT USUALLY HANGS
ON THE FOOT OF THE BED

OR IT SITS IN A STAND
ON THE FLOOR

WHATEVER THE UNIT HAPPENS TO BE.

THE CHEST TUBE PIECE THEN
WILL BE THIS PIECE RIGHT HERE.

AND -- OH, LET ME
GRAB THIS AND SEE.

THEN YOU WOULD HAVE TO GET
THE REST OF THE EQUIPMENT
FROM THE PHYSICIAN.

THE PHYSICIAN IS GOING TO NEED
A CHEST TUBE AND A CHEST
TUBE INSERTION TRAY.

AND THOSE JUST COME OFF
OF THE CENTRAL SUPPLY CART.

AND IT WILL HAVE EVERYTHING
THE DOCTOR NEEDS EXCEPT
FOR THE DRESSING.

AND YOU WILL NEED TO GET
A DRESSING CART FOR
YOUR DRESSING.

THEY WILL AT LEAST NEED
AN ABD PAD, SOME GAUZE,

MAYBE SOME XEROFORM GAUZE

WHICH IS A VASELINE GAUZE
AND ELASTOPLAST TAPE.

OH, MY DRESSING IS NOT DOING TOO
GOOD, WHICH IS THIS THICKISH
KIND OF TAPE HERE.

ALRIGHT.