Tricks of the Trade - Nontraditional Uses of Suctioning

0907tricks1ACEP News
September 2007

By Michellelin, MD

Pipeline vacuum units, mounted on the wall, are common devices in emergency departments. Typically, negative-force suctioning can be used for clearance of airway secretions and gastric aspiration of blood. A wall-suction unit can generate pressure as high as 150 mm Hg. Vacuum suction, however, has innovative uses in other clinical scenarios.

Rectal Foreign-Body Extraction

An embarrassed patient presents with a zucchini lodged in his rectum. Manual extraction is unsuccessful. The zucchini is completely wedged against the rectal mucosa so that a Foley catheter cannot be inserted beyond it to help pull it out. The uninsured patient is hesitant to agree to general anesthesia and surgery for financial reasons.

Trick of the trade: The vacuum unit can be modified so that the suction hose is attached to a precut, appropriately sized rubber suction bulb, used typically in clearing newborn secretions. (See photo on p. 39.). The resulting funnel-like flange can be flattened to allow rectal insertion and then positioned over the zucchini.

With the patient mildly sedated, vacuum suction forms a strong seal between the object and the bulb flange. Generous mucosal lubrication, deep palpation of the lower abdomen, and gentle outward traction allows foreign body extraction without complications.

This trick was contributed by Dr. Kent Pressman, an emergency physician at St. Luke's Magic Valley Regional Health Center in Twin Falls, Idaho.

Malodorous Pus From Abscess Drainage

0907tricks3An intravenous drug user presents with a large fluctuant right humeral abscess 10 cm in diameter. A bedside incision and drainage procedure will need to be performed. Typically, when a closed-abscess cavity is opened, the foul odor of pus permeates the entire emergency department.

Trick of the trade: To minimize the exposure of pus to the open air, transfer the pus from within the closed abscess cavity to the closed-system reservoir canister. During incision and drainage, have an assistant immediately suction the expressed purulent material.

In large abscesses, the Yankauer suction catheter can be directly inserted into the abscess cavity to evacuate the pus. (See photo.) Further exploration for loculations can occur after the bulk of the malodorous purulent material is removed.

Irrigation Fluid Collection

0907tricks2A motorcyclist presents with a cervical spine fracture and a deep scalp laceration with particulate material embedded into the soft tissue, requiring copious volumes of normal saline irrigation to minimize the risk of infection. To minimize cervical spine movement, an irrigation basin is not positioned under the patient's head. Towels and sheets underneath the wound insufficiently absorb the fluid so that the gurney, sheets, and patient become soaked.

Trick of the trade: For wound irrigation of areas that cannot be repositioned over a fluid collection basin because of instability or pain, consider using suction.

Setting the vacuum unit on continuous suction, position the suction hose, with or without the rigid Yankauer suction catheter tip, near the runoff fluid during irrigation. (See photo on p. 38.) This immediately collects the fluid and minimizes spillage onto the surrounding towels and sheets. Without having to reposition the patient, doing this allows the gurney, sheets, and patient to remain dry during the procedure.

Dr. Lin practices emergency medicine at San Francisco General Hospital (SFGH)and is the associate residency director atthe UCSF-SFGH Emergency Medicine Residency Program. Contact Dr. Lin at mlin@sfghed.ucsf.edu for comments or suggestions for other "tricks of the trade."

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