OROPHARYNGEAL & NASOPHARYNGEAL SUCTIONING

This method removes secretions from the upper respiratory tract. Even though the upper airways are not sterile, sterile technique is recommended for all suctioning to avoid introducing pathogens into the airways.

Purpose

To remove secretions that obstruct the airway.

To facilitate ventilation. To prevent infection that may result from

accumulated secretions.

Assessment

Restlessness Gurgling sounds during respiration Adventitious breath sounds when the chest is

auscultated Change in mental status

Skin color Rate and pattern of respirations Pulse rate

Discontinue the suctioning and apply oxygen if heart rate decreases by 20 beats per minute or increase by 40 beats per minute, if BP increases, or if cardiac arrhythmia is noted.

Suctioning may cause the occurrence of:

Hypoxemia – initially resulting in tachycardia and increased blood pressure, and later causing cardiac ectopy, bradycardia, hypotension, and cyanosis.

Vagal stimulation resulting in bradycardia. Equipment

Sterile towel/ Moisture resistant pad Sterile water Water soluble lubricant jelly Suction catheter Stethoscope Suction Unit/ Suction source

Implementation with Rationale

Explain to the client what you are going to do, why it is necessary, and how he or she can cooperate. Inform the client that suctioning will relieve breathing difficulty and that the procedure is painless but may be uncomfortable and stimulate the cough gag or sneeze reflex.

Wash hands and observe other appropriate infection control procedures.

Provide for client privacy Ascertain that the suction apparatus is

functional. Place suction tubing within the easy reach.

Prepare the Client.

Position a conscious person who has a functional gag reflex in the semi fowler’s position with the head turned to one side for oral suctioning or with the neck hyper extended for nasal suctioning.

Position an unconscious client in lateral position facing you.

Place the towel or moisture resistant pad over the pillow or under the chin.

Prepare the Equipment

Set the pressure on the suction gauge, and turn on the suction.

Wall Unit: Adult: 100 – 120 mmHg Child: 95 – 110 mmHg Infant: 50 – 95 mmHg Portable Unit: Adult: 10 -15 mmHg Child: 5 -10 mmHg Infant: 2 - 5 mmHg

Open the lubricant if performing nasopharyngeal suctioning.

Monitor oxygen saturation via oximeter and heart rate during suctioning.

Open the sterile suction package. Set up the cup container, touching only the

outside. Pour sterile water or saline into the container.

Aseptically glove both hands. Designate one hand (usually the dominant one) as “sterile” and other hand as “contaminated.”

With your sterile gloved hand, pick up the catheter and attach it to the suction unit.

Make an approximate measure of the depth for the insertion of the catheter and test the equipment.– Measure the distance between the tip of

the client’s nose and the earlobe, or about 13 cm.(5 inches) for an adult.

– Mark the position on the tube with the fingers of the sterile gloved hand.

– Test the pressure of the suction and the patency of the catheter by applying your sterile gloved finger or thumb to the port to create suction

Lubricate catheter with the anaesthetic jelly and pass the catheter into the nostril and back into the pharynx.

Oropharyngeal Suction

Pull the tongue forward if necessary using gauze.

Do not apply suction (that is leaving your finger off the port) during insertion

Advance the catheter about 10-15 cm (4-6 inches) along one side of the mouth into the oropharynx.

Nasopharyngeal Suction

Place the patient in a semi fowler’s position if possible.

Measure distance between the tip of the client’s nose and the earlobe or about 13 cm (15 inches) for an adult.

Without applying suction, insert the catheter at the premeasured or recommended distance into either nares and advance it along the floor of the nasal cavity.

Specific positioning of catheter for deep bronchial suctioning:– For left bronchial suctioning, turn the

patient’s head to the extreme right, chin up.

– For right bronchial suctioning, turn the patient’s head to the extreme left, chin up.

– Never apply suction until catheter is in the trachea. Once correct position is ascertained, apply suction and gently rotate catheter while pulling it slightly upward. Do not remove catheter from the trachea.

Perform Suctioning:

Apply your finger to the suction control thumb to start suction, and gently rotate catheter.

Apply suction for 5-10 seconds while slowly withdrawing the catheter then remove your fingers from the control and remove the catheter. A suction attempt should last only 10 to 15 seconds. During this time, the catheter is inserted, the suction applied and discontinued, and the catheter removed.

Clean the catheter and repeat suctioning as above

Wipe off the catheter with sterile gauze if it is thickly coated with secretions.

Flush the catheter with sterile water or saline. Relubricate the catheter, and repeat

suctioning until the air passage is clear .

Allow 20 to 30 seconds intervals between suctioning and limit suctioning to 5 minutes in total.

Alternate nares for repeat suctioning. Encourage the client to breathe deeply and

to cough between suctions.

Obtain a specimen if required. Use a sputum trap.

Promote client comfort. Offer to assist the client with oral or nasal hygiene and assist the client to a position that facilitates breathing.

Dispose of equipment and ensure availability for the next suction.

Empty and rinse the suction container as needed. Change the catheter and container daily.

Assess the effectiveness of suctioning. Auscultate the client’s breath sounds to ensure they are clear of secretions. Observe skin color, dyspnea and level of anxiety.

Document relevant data. Record the procedure, the amount, consistency, color and odor of sputum.

Unexpected Situations and Associated Interventions

The catheter or sterile gloves touches an unsterile surface.

Patient begins to cough and appears cyanotic.

The patient vomits during suctioning.

Secretions appear to be stomach contents. Epistaxis is noted with continued suctioning

Infant and Child Considerations

For infants, use 6F to 8F catheter. For children, use 8F to 10F catheter.