The Painful Tracheal Intubation #3: The Trauma of Suctioning

Hello!
I am very happy to see that my previous article, "The Painful Tracheal Intubation #2: To the Intensive Care Unit Due to Worsening Respiration," has reached so many people!

This time, I will continue the story of my child, who was diagnosed with laryngomalacia, whose respiratory condition worsened, leading to tracheal intubation.

■ What is "tracheal intubation" again?
Tracheal intubation is a medical procedure in which a specialized tube (tracheal tube) is inserted into the trachea to secure the airway.

It is performed when the airway is obstructed, as it was for my child, or when spontaneous breathing is difficult.

This procedure allows for respiratory support and management via a ventilator.

There are two types of tracheal intubation: oral and nasal. In emergencies, oral intubation is generally chosen.
My son also had an oral intubation at this time.

(Incidentally, my son later transferred hospitals for surgery, and after that surgery, he had a nasal intubation.)

Since oral intubation prevents the mouth and tongue from moving freely, even though it is an emergency procedure, I think it is a great stress for the patient.

Generally, tracheal intubation is performed for surgeries under general anesthesia, but the tube is removed after surgery, and then the patient wakes up from the anesthesia.

However, when a child's condition gradually worsens and leads to intubation like my child's, they are conscious, so the discomfort around the mouth from the tracheal tube is immense and painful.

■ The pain of "suctioning"
Regarding the pain, in addition to the constant pain of having a tube inserted, there is "phlegm suctioning."

When intubated, you cannot swallow saliva.
Also, you cannot speak.

In other words, because you cannot expel phlegm or saliva on your own, secretions are mechanically removed from the patient's mouth, nose, and trachea using a suction device and tube to "prevent airway narrowing or obstruction due to secretions."

By doing this, breathing becomes easier and suffocation is prevented.

In my child's case, in addition to being intubated, a catheter (tube) was inserted for suctioning every 1 to 2 hours, meaning he had two tubes inserted.

Every time, my child would roll his eyes and gag during suctioning.

Even though it is an essential procedure to prevent phlegm from clogging the airway, it is extremely painful for the accompanying family to watch.

This is a story from before my child was born, but my grandmother was hospitalized and needed phlegm suctioning.

My grandmother was semi-conscious during her hospitalization, but when the nurse approached her saying,
"Let's do some phlegm suctioning now~"
she would shake her head like a child, saying no.

My mother (my grandmother's daughter), who was accompanying her, could not bear to see her suffering and would turn her face away and cry every time suctioning was performed.

It is that painful, even for adults.

■ My son, who was sedated and kept sleeping
Because the pain from suctioning is so great, it is common to sedate intubated patients with an IV drip to keep them in a drowsy, sleeping state.

Even so, patients may try to remove the tube due to the discomfort around their mouth, so physical restraints are used to tie down both hands. (Of course, the family signs a consent form.)

My child was also sedated after intubation, and although he would open his eyes in shock from the pain during suctioning, he was mostly asleep otherwise.

And, except when I was visiting, both of his hands were tied.

At that time, I was completely ignorant.
For a child who is intubated,

・ That suctioning is necessary
・ That sedation is necessary
・ That physical restraint is necessary

I learned all of these for the first time.

It is embarrassing, considering I had worked in a hospital for six years before going on maternity leave.

This sequence of "tracheal intubation" leading to "suctioning -> sedation -> physical restraint" is still a trauma for me today.

Because my child was in this state,

・ I couldn't hear his voice
・ I couldn't hold him
・ He couldn't drink milk (only IV drip)
・ I couldn't see his smile

With everything missing, as a parent, there was nothing I could do for him.
The only thing I could help with was changing his diaper when the nurse did it.

Since he was connected to vital medical equipment, even as a parent, I couldn't touch him freely.

All I could do was talk to him, hold his hand, stroke his head, or rub his feet.

■ I just couldn't get used to the suctioning by the nurses
By the way...
Both with my child and my grandmother, the nurses' technique during suctioning always felt mechanical to me, and I didn't have a good impression of those nurses at the time.

Of course, the nurses were just doing their jobs, and they would talk to the patient's family, saying things like, "You feel refreshed now, don't you?"

Now, I have nothing but gratitude for the nurses who performed the procedures that the patient's family disliked, as they saved my child's life.

Recently, the existence of medically complex children has been highlighted in the community, and we have more opportunities to see suctioning in our daily lives through media and other channels.

I have no discomfort at all watching suctioning performed by moms and dads, or by nurses and caregivers.

・Is it because of the trust between the person performing the suctioning and the child being cared for?

・Is it because the child can move to some extent and the suctioning is done from the tracheostomy site?

・Is it because it is being done in the community, such as at home or school, rather than in the extraordinary space of being hospitalized?

・Is it because I have become able to view suctioning more neutrally myself?

As time has passed, I can think of various reasons.

■Trying to rely on Department Director T from the same medical office
However, at that time, I felt like I was losing myself, and I could not take a philosophical view by telling myself, "It is to make breathing easier."

Watching my own child being intubated and suctioned was too painful, and thinking about whether there was anything I could do, I decided to ask Department Director T, a pediatrician at the hospital where I worked and was currently on childcare leave.

Since Department Director T was from the same medical office as the university hospital where my child was admitted, I hoped that I might be able to get some good advice.