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We are now going to have a look at manual suction units. We have got two real types of manual suction units. These are the cleanable, reusable, manual suction units. These, nowadays, are going out of fashion because of contamination. The crew have to clean it; it has to be sterilized. It has to be done properly. Consequently, there is a risk to the crew, and they are not the best of items anymore. We are going more towards the one use and throw away devices these days. But this one here is a very good unit but it has to be cleaned. The one thing to be aware of, you have to press the buttons to get it to actually suck and the outlet valve at the back is where, once you fill the unit, it will actually expel any excess fluids. So remember, if you over-suction with this device without cleaning it out, it will eject straight into your face because that is the point it is pointing at.

The other type we have, and I have got two different sorts here, are the one use only throw away. You can see very cheap, very simple, very flimsy. And they work, again, by using a suction handle while pulling. The airway unit itself goes into the mouth, fills the bottle, but then we throw the whole lot away. We don't keep anything. And finally, we have got the military grade, which is getting more and more common because there is nothing on it to break. All we do with this is take it out of the bag, we pull the tube out to its full length, and then we squeeze the bottle and it suctions on the end. Very effective, very clear, you can see the fluid that goes into the bag. Once the bag is full, that does not mean this unit is finished, we can actually cut the corner of the bag off, drain the fluid out, and carry on using it, but remember, obviously, it will now drain at the same time. So, it doesn't mean that when the bag is full it is finished. We can, actually, empty the bag and carry on using the unit. But once we finish with the patient, this unit then is disposed of into the yellow bio-hazard bag and disposed of correctly and a new one is put into the kit bag. These are becoming more and more common because they are very, very good and they don't tend to break. So now, to show the manual suctions in use.

Again, we are going to open the airway using exactly the same procedures before, head tilt, chin lift. Just one thing that can make life a lot easier is, actually, if you roll a blanket into the nape of the neck, the airway will naturally fall open and stay in that position for you, and that is a really useful technique just to keep the airway open. Again, we will use the manual suction, the airway is open. I can see inside. I insert the catheter only as far as I can see, in a sweeping motion for as short a time as possible, preferably no more than about 10 seconds, clear from the airway and the airway should now be patent to working. We use exactly the same technique with the disposable. Again, insert the catheter mount as far as you can see, only as far as you can see, in a sweeping motion whilst using the actual suction device itself. Once the airway is clear and patent, again, this will be kept. Use it on one patient only and then disposed of.

So don't throw it away until this patient is clear and into the hospital where they take over the suction and airway management from you. As far as the military grade suction unit is concerned, again, same, we tilt the tube out to its full length. We open the airway, insert as far as we can see, and then we start to suction again, only as far as we can see, in a sweeping motion. As long as you can hold your breath, once you need to breathe, the patient needs to breathe. And also, remember, that all of these units, it doesn't matter which one we are looking at, the actual size of the catheter can be replaced with a smaller or larger, depending on the job we are doing. Remember, the suction unit in the back of the ambulance, the automatic, we can actually turn the volume up or down. Well, you turn the volume up and down on these by changing the diameter of the catheter. If it is a small child, you put a very small catheter on. If it is an adult and there is a lot of fluid, a bigger catheter shifts a bigger amount of fluid quicker.