Airway & Respiratory, Cardiac & Resuscitation, Operations, Patient Care

Suction Catheter Saves Fingers

Issue 5 and Volume 35.

We do so much of what we do because … well, that’s how we’ve always done it. Think about it. We roll people onto backboards. We put ’em on oxygen. We carry ’em down stairs. And, we try our dangedest to vacuum their vomit with Yankauer suction tips. (How dumb is that?)

There’s probably been a Yankauer attached to every ambulance you’ve ever seen, Life-Saver’ all the way back to the days of “you call, we haul, that’s all.” You know what a Yankauer’s good for? Beer and spit. It was designed for use in ORs, to sanitize the airways of surgical patients who have been NPO for 12 hours.

Field patients are kind of like Muppets; they swallow all kinds of things. My friends and I went through an annual skills refresher a few weeks ago, and we tried to suction Campbell’s Chunky Chicken Soup (with white and wild rice) using various tips and catheters connected to a suction device. (Yum!)

The pump had plenty of power—500 mmHg of vacuum (to overcome obstructions) and 30 L/min of airflow (to move fluids out of the airway quickly or to restore the vacuum in the canister after it pumps up a lump). The machine was recently serviced and had a freshly charged battery. But a single grain of rice, stuck in the end of (you guessed it) a Yankauer, turned the whole mess into one big, humming doorstop in about a second.

In a situation like that, you can remove the suction tip and use the tubing. Of course, with its round end and no bypass ports, GACK! The tubing will just stick to the oral mucosa or the tongue. (We knew that could happen, but it got plugged with a piece of pimiento first.) Next option: fingers. Now, any first-year EMT knows there’s a big difference between manikin teeth and people teeth. People teeth don’t just pretend. So, if you’re smart, you’ll use a tongue depressor or an oral airway, like a shovel, to scoop those solids out of there.

You could carry a dental tip instead of a Yankauer. A dental tip has a minimum interior diameter of about 5/16 of an inch, instead of a silly millimeter. It’ll suck up the odd grain of rice, and it’s better at removing mucus or barf than a Yankauer is. Or, you could use one of those ginormous super-sucker hookups, with a 5/8-inch suction tip connected to a piece of that corrugated tubing they attach to patients on ventilators. (If you haven’t seen one, they’re pretty slick; they come in sets designed to connect most any suction canister to just about any pie hole.)

All of those connections are good for cleaning up beer. Anything’s better than a Yankauer for removing slime, like blood clots or boogers. But for solids, you pretty much need a Shop-Vac. Or a spoon.

Anybody who ever eats Cheerios has a spoon. If you’re in a residence, you can rummage through people’s kitchen drawers for one, although they’ll wonder why you didn’t bring your own. ’Course, if your patient seizes with a metal spoon in their mouth, you’re SOL. Get it out of there, quick, or you’ll break their teeth.

One night about three and a half years ago, Jeff Rehman, a paramedic with the North Metro Fire Rescue District (north of Denver), woke up with a great idea. He dreamt up a Yankauer with a spoon built into its business end. He headed for his station’s kitchen and built a prototype with spoons and soda straws, and during the next few months, he took his idea to several manufacturers. They all seemed to think he was goofy, until he contacted SSCOR.
SSCOR’s been in the suction biz for 30 years, and they understood Jeff’s idea right off. So will you.

Their answer is the S3 (for scoop, suction, sump). It’s about the size of a chubby Yankauer, but it’s soft, like silicone—not quite rigid. There’s a bendable stylette running down its middle that holds the catheter’s shape any way you want it to. A sliding clip, located about where your thumb would be during use, can either uncover or occlude a bypass port, depending on how you need to use the thing. And best of all, it’s a spoon.

So, here’s what you need to do. Whether you work in a busy ED or on the street, lose the Yankauer. As long as you’ve got to use something, you should consider reaching for one of these.

Instead of one of those. JEMS

This article originally appeared in May 2010 JEMS as Finger-Saver:
Paramedic invents answer to real urp.