Performing Upper Airway Suctioning

For Oropharyngeal Suctioning 2

a. Lubricate the catheter tip with the normal saline solution. b. Using your dominant hand, gently but quickly insert the suction catheter along the side of the patient's mouth into the oropharynx. Inserting the suction catheter along the side of the mouth prevents gagging. c. Advance the suction catheter quickly to the premeasured distance—usually 7.5 to 10 cm (3 to 4 in.) in the adult—being careful not to force the catheter. Ensures that the suction catheter will reach the pharynx. Forcing the catheter during insertion may cause tissue trauma.

For Oropharyngeal Suctioning

11. Approximate the depth to which you will insert the suction catheter. *For Oropharyngeal Suctioning* Measure the distance between the edge of the patient's mouth and the tip of the patient's earlobe. Determines the proper distance you should insert the suction catheter for oropharyngeal suctioning.

pt 4

12. Using your nondominant hand, remove the oxygen delivery device, if present (for nasopharyngeal suctioning only). Have the patient take several slow, deep breaths. Deep breathing helps to hyperoxygenate the patient and helps prevent hypoxia during suctioning. 13. Lubricate and insert the suction catheter.

pt 5

14. Place a finger or thumb over the suction control port of the suction catheter and start suctioning the patient. Apply suction as you withdraw the catheter, using a continuous rotating motion. Limit suctioning to 10 to 15 sec. Using a continuous rotating motion while withdrawing the catheter prevents trauma to any one area of the airway. Limiting suctioning to less than 10 to 15 seconds prevents hypoxia. 15. After you withdraw the catheter, clear it by placing the tip of the catheter into the container of sterile saline and applying suction. Ensures patency of the catheter for repeat suctioning. 16. Lubricate the catheter and repeat suctioning as needed, allowing at least 20-second intervals between suctioning. Limit total suctioning time to 5 minutes. Several passes with the suction catheter may be needed to clear the airway of secretions. The total suctioning time should be limited to 5 minutes, however, to prevent hypoxia and trauma to the mucosal membranes.

pt 2

2. Place the linen-saver pad or towel on the patient's chest. Prevents soiling of the patient's gown during suctioning. 3. Put on a face shield or goggles and gown. Protects you from contamination with secretions that may splash during suctioning. Not all guidelines specify wearing a gown for this procedure. 4. Turn on the wall suction or portable suction machine, and adjust the pressure regulator according to agency policy, typically: Adults: 100 to 150 mm Hg Children: 100 to 120 mm Hg Infants: 50 to 95 mm Hg The suction regulator must be set appropriately to prevent tissue trauma and hypoxia and to function effectively to remove secretions. Higher pressures are associated with hypoxemia, tissue trauma, and atelectasis, yet do not improve removal of secretions. 5. Test the suction equipment by occluding the connection tubing. Ensures proper functioning before use.

pt 3

6. Open the suction catheter kit or the gathered equipment. If you are using the nasal approach, open the water-soluble lubricant. 7. Don procedure gloves; consider (and keep) your dominant hand clean; consider your nondominant hand to be contaminated. This is not a sterile suction procedure but care should be taken to keep the suction catheter free from other contaminants. Keeping the dominant hand clean prevents contaminating the upper airways with an unclean suction catheter. 8. Pour sterile saline into the sterile container, using your nondominant hand. Sterile saline is necessary to clear the suction catheter of secretions after suctioning. The outside of the saline container is not sterile; it would contaminate your dominant hand. 9. Pick up the suction catheter with your dominant hand, and use your other hand to hold the connection tubing (to suction) while you attach it. 10. Put the tip of the suction catheter into the sterile container of normal saline solution, and suction a small amount of normal saline solution through the suction catheter. Apply suction by placing a finger over the suction control port. When using a Yankauer-type device, the suction is continuous and there is no port to occlude. Ensures that the suction equipment is function

Pre-Procedure Assessment

Assess respiratory status, including rate, depth, and rhythm; breath sounds; color; and pulse oximetry results. Note signs that indicate the need for suctioning: restlessness, cyanosis, labored respirations, decreased oxygen saturation, increased heart and respiratory rates, visible secretions in the airway, and the presence of adventitious breath sounds during auscultation. You must be certain the patient requires suctioning. Suctioning should be performed only when necessary to prevent unnecessary oxygen desaturation and tissue trauma. Note: This procedure describes modified sterile technique: sterile supplies with clean procedure gloves. Although the oropharynx and nasopharynx are not sterile, you should keep the suction catheter free from other contaminants as much as possible. Some facilities require sterile gloves for this procedure.

Evaluation

Assess the color, consistency, and amount of secretions. Evaluate the patient's tolerance of the procedure. Note whether there were signs of respiratory distress during the procedure. Evaluate the effectiveness of the procedure by comparing breath sounds, vital signs, and pulse oximetry before and after the procedure.

Delegation

Do not delegate oropharyngeal and nasopharyngeal suctioning to an LPN or NAP, because these procedures require professional-level theoretical knowledge, assessment skills, and problem-solving ability. However, the NAP (and the client or family) can use a Yankauer tube to suction the oral cavity because there is less risk for trauma to mucosa than with oro- or nasopharyngeal suctioning.

Documentation

Document the date, time, and reason you performed suctioning. Note the suction technique you used and the catheter size. Note color, consistency, and odor of secretions. Document the patient's respiratory status before and after the procedure. Document the patient's tolerance of the procedure and any complications that occurred as a result of the procedure, with resulting interventions. Sample documentation 3/15/18 2200 Resp. labored, rate 28 breaths/min. Pulse oximetry on room air 92%. Breath sounds with rhonchi scattered throughout. Gurgling audible in upper airways. Patient unable to mobilize secretions with coughing. Suctioned by nasopharyngeal route using a 14-Fr. catheter. Approximately 30 mL thin, tan, odorless secretions obtained. After suctioning, resp. nonlabored, rate 20 breaths/min, and lungs clear on auscultation, with no gurgling audible. Pulse oximetry 96%. Patient tolerated procedure with no difficulty.—————————C. F. Hiam, RN

For Nasopharyngeal Suctioning

Each time you repeat suction, alternate nares. Prevents trauma that would occur if you used only one naris. 17. Coil the suction catheter in your dominant hand. Pull the sterile glove off over the coiled catheter. (Alternatively, wrap the catheter around your dominant, gloved hand, and hold the catheter as you remove the glove over it.) Discard the glove containing the catheter in a biohazard receptacle designated by your agency. Coiling the catheter inside the glove prevents contamination with secretions. 18. Using your nondominant hand, clear the connecting tubing of secretions by placing the tip into the container of sterile saline. Ensures patency and prepares the equipment for future use. 19. Dispose of equipment in biohazard waste container/bag and make sure new suction supplies are readily available for future suctioning needs. The patient may require suctioning at any time, so equipment must be readily available. 20. Provide mouth care. Promotes patient comfort and clears the mouth of any secretions the patient may have expectorated. 21. Discard your other glove and remaining supplies. 22. Position the patient in a comfortable position and allow him to rest. Promoting comfort and allowing for a period of rest helps the patient recover from suctioning, which may be very tiring.

Patient Teaching

Explain the importance of administering supplemental oxygen to the patient before suctioning. Inform the patient that coughing typically increases with suctioning. Demonstrate oropharyngeal or nasopharyngeal suctioning to the caregiver and ask for a return demonstration if suctioning will be required at home.

For Nasopharyngeal Suctioning

Measure the distance between the tip of the patient's nose and the tip of the patient's earlobe. Helps determine the correct distance to insert the suction catheter for nasopharyngeal suctioning.

NOTE:

Note: Upper airway suctioning may be done via the oropharyngeal or nasopharyngeal route. However, nasal suction is usually required only to improve oxygenation in infants because most adult airway obstruction occurs in the mouth and oropharynx. Vigorous nasal suction can induce epistaxis (nosebleed) and further complicate an already difficult airway.

Equipment

Portable or wall suction device with connection tubing and a collection canister Linen-saver pad or towel Sterile suction catheter kit (12- to 18-Fr for adults, 8- to 10-Fr for children, and 5- to 8-Fr for infants). If a kit isn't available, collect the following: sterile suction catheter of the appropriate size and a sterile container. If you plan to suction both the oropharynx and the nasopharynx, you need a separate sterile catheter for each. Yankauer device can be used for oropharyngeal suction. Pour-bottle of sterile normal saline solution Sterile basin or other container for fluids Face shield or goggles and gown Procedure gloves Water-soluble lubricant for nasopharyngeal suctioning Sputum trap, if a specimen is needed Biohazard bag

Procedure pt 1

Procedure Steps 1. Position the patient. Explain that suctioning may stimulate coughing or gagging, but that coughing helps mobilize secretions. *For Oropharyngeal Suctioning* Position the patient in a semi-Fowler's or high Fowler's position, with his head turned toward you. Facilitates insertion of the suction catheter and prevents straining your back. Also promotes lung expansion and effective coughing. *For Nasopharyngeal Suctioning* Position the patient in semi-Fowler's or high Fowler's position with his neck hyperextended, unless contraindicated.

For Nasopharyngeal Suctioning 2

d. Lubricate the catheter tip with the water-soluble lubricant. Eases passage of the suction catheter through the naris. Water-soluble lubricant is preferred because it will dissolve if it accidentally enters the lungs, whereas an oil-based lubricant (e.g., petroleum jelly or lotion) will not dissolve in the respiratory tract and causes complications if it enters the lungs. e. Using your dominant hand, gently but quickly insert the suction catheter into the naris. Prevents trauma to the naris. f. Advance the suction catheter, aiming downward to the premeasured distance—usually 13 to 15 cm (5 to 6 in.) in the adult—and being careful not to force the catheter. If you meet resistance, you may need to try the other naris. Advancing the suction catheter the premeasured distance ensures that the suction catheter will reach the pharynx. Forcing the catheter during insertion may cause tissue trauma.