Oropharyngeal , nasopharyngeal and naso tracheal suctioning
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This document provides guidance on oropharyngeal, nasopharyngeal, and tracheal suctioning. It discusses the purposes of suctioning, including removing secretions to clear the airway and facilitate ventilation. Assessment factors like respiratory sounds and oxygen saturation are outlined. Proper planning includes delegation considerations and sterile technique for some procedures. Equipment needs and step-by-step implementation instructions are detailed for oral/oropharyngeal and nasopharyngeal/nasotracheal suctioning. Positioning, catheter insertion depth, and suction pressure levels are addressed.
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Oropharyngeal , nasopharyngeal and naso tracheal suctioning
- 1. OROPHARYNGEAL ,OROPHARYNGEAL , NASOPHARYNGEAL AND NASONASOPHARYNGEAL AND NASO TRACHEAL SUCTIONINGTRACHEAL SUCTIONING PREPARED BY: JESSICA M. SALDANA, RN., MANPREPARED BY: JESSICA M. SALDANA, RN., MAN
- 6. PURPOSESPURPOSES • To remove secretions that obstruct the airwayTo remove secretions that obstruct the airway • To facilitate ventilationTo facilitate ventilation • To obtain secretions for diagnostic purposesTo obtain secretions for diagnostic purposes • To prevent infection that may result fromTo prevent infection that may result from accumulated secretionsaccumulated secretions
- 7. ASSESSMENTASSESSMENT Assess for clinical signs indicating the need for suctioning:Assess for clinical signs indicating the need for suctioning: • RestlessnessRestlessness • Gurgling sounds during respirationsGurgling sounds during respirations • Adeventitious sounds when the chest is beingAdeventitious sounds when the chest is being auscultatedauscultated • Change in mental statusChange in mental status • Skin colorSkin color • Rate and pattern of respirationsRate and pattern of respirations • Pulse rate and rhythmPulse rate and rhythm • Decreased oxygen saturationDecreased oxygen saturation
- 8. PLANNINGPLANNING DelegationDelegation Oral suctioning using the yankuer suction tube andOral suctioning using the yankuer suction tube and oropharyngeal suctioning using a suction catheter canoropharyngeal suctioning using a suction catheter can be deligated to UAP and to the client or family, ifbe deligated to UAP and to the client or family, if appropriate, since this is not a sterile. The nurse needsappropriate, since this is not a sterile. The nurse needs to review the procedure and important points such asto review the procedure and important points such as not applying suction during insertion of the tube tonot applying suction during insertion of the tube to avoid trauma to the mucous membranes. In contrast,avoid trauma to the mucous membranes. In contrast, nasopharyngeal and nasotracheal suctioning uses sterilenasopharyngeal and nasotracheal suctioning uses sterile technique and requires application of knowledge andtechnique and requires application of knowledge and problem solving and should be performed by the nurseproblem solving and should be performed by the nurse or respiratory therapist.or respiratory therapist.
- 9. EQUIPMENTEQUIPMENT Oral and Nasopharyngeal/Nasotracheal SuctioningOral and Nasopharyngeal/Nasotracheal Suctioning • Towel or moisture resistant padTowel or moisture resistant pad • Portable or wall suction machine with tubing, collectionPortable or wall suction machine with tubing, collection receptacle, and suction pressure gaugereceptacle, and suction pressure gauge • Sterile disposable container for fluidsSterile disposable container for fluids • Sterile normal saline or waterSterile normal saline or water • Goggles or face shield, if approoriateGoggles or face shield, if approoriate • Moisture-resistant disposable bagMoisture-resistant disposable bag • Sputum trap, if specimen is to be collectedSputum trap, if specimen is to be collected
- 10. EQUIPMENTEQUIPMENT Oral and Oropharyngeal SuctioningOral and Oropharyngeal Suctioning • Yankauer suction catheter or suction catheter kitYankauer suction catheter or suction catheter kit • Clean glovesClean gloves Nasopharyngeal or Nasotracheal SuctioningNasopharyngeal or Nasotracheal Suctioning • Sterile glovesSterile gloves • Sterile suctrion catheter kit (# 12 to # 18 Fr. For adults, # 8 toSterile suctrion catheter kit (# 12 to # 18 Fr. For adults, # 8 to # 10 Fr. For children, and # 5 to # 8 for infants)# 10 Fr. For children, and # 5 to # 8 for infants) • Water soluble lubricantWater soluble lubricant • Y- connectorY- connector
- 11. IMPLEMENTATIONIMPLEMENTATION PerformancePerformance 1.1. Prior to performing the procedure, introduce self and verifyPrior to performing the procedure, introduce self and verify the client’s identity using agency protocol. Explain to thethe client’s identity using agency protocol. Explain to the client what you are going to do, why it is necessary, and howclient what you are going to do, why it is necessary, and how he or she can cooperate. Inform the client that suctioning willhe or she can cooperate. Inform the client that suctioning will relieve breathing difficulty and that the procedure is painlessrelieve breathing difficulty and that the procedure is painless but may be uncomfortable and stimulate the cough, gag, orbut may be uncomfortable and stimulate the cough, gag, or sneeze reflex.sneeze reflex. RATIONALERATIONALE:: Knowing that the procedureKnowing that the procedure will relieve breathing problems is often reassuring andwill relieve breathing problems is often reassuring and enlists the client’s cooperation.enlists the client’s cooperation. 2.2. Perform hand hygiene and observe other appropriate infectionPerform hand hygiene and observe other appropriate infection control procedures.control procedures. 3.3. Provide for client privacyProvide for client privacy
- 12. Yankauer suction catheterYankauer suction catheter
- 13. IMPLEMENTATIONIMPLEMENTATION 4.4. Prepare the clientPrepare the client • Position a conscious person who has a functional gag reflex in semiPosition a conscious person who has a functional gag reflex in semi Fowler’s position with the head turned to one side for oral suctioning orFowler’s position with the head turned to one side for oral suctioning or with the neck hyper extended for nasal suctioning.with the neck hyper extended for nasal suctioning. RATIONALE:RATIONALE: TheseThese positions facilitate the insertion of catheter and help preventpositions facilitate the insertion of catheter and help prevent aspiration of the secretionsaspiration of the secretions • Position an unconscious client in the lateral position, facing you.Position an unconscious client in the lateral position, facing you. RATIONALE:RATIONALE: This position allows the tongue to fall forward, soThis position allows the tongue to fall forward, so that it will not obstruct the catheter on insertion. The lateral positionthat it will not obstruct the catheter on insertion. The lateral position also facilitates drainage of secretions from the pharynx and preventsalso facilitates drainage of secretions from the pharynx and prevents the possibility of aspiration.the possibility of aspiration. • Place the towel or moisture resistant pad over the pillow or under the chinPlace the towel or moisture resistant pad over the pillow or under the chin
- 14. IMPLEMENTATIONIMPLEMENTATION 5.5. Prepare the equipment.Prepare the equipment. • Set the pressure on the suction gauge, and turn on the suction.Set the pressure on the suction gauge, and turn on the suction. Many suction devices are calibrated to three pressure ranges.Many suction devices are calibrated to three pressure ranges. • Wall unit:Wall unit: Adult: 100 to 120 mm.Hg.Adult: 100 to 120 mm.Hg. Child: 95 to 110 mm.Hg.Child: 95 to 110 mm.Hg. Infant: 50 to 95 mm.Hg.Infant: 50 to 95 mm.Hg. • Portable unit:Portable unit: Adult: 10 to 15 mm. Hg.Adult: 10 to 15 mm. Hg. Child: 5 to 10 mm. Hg.Child: 5 to 10 mm. Hg. Infant: 2 to 5 mm. Hg.Infant: 2 to 5 mm. Hg.
- 15. IMPLEMENTATIONIMPLEMENTATION For Oral and Oropharyngeal SuctionFor Oral and Oropharyngeal Suction • Moisten the tip of the Yankauer or suction catheter with sterileMoisten the tip of the Yankauer or suction catheter with sterile saline water or saline. RATIONALE: This reduces friction andsaline water or saline. RATIONALE: This reduces friction and eases insertion.eases insertion. • Pull the tongue forward, if necessary, using gauze.Pull the tongue forward, if necessary, using gauze. • Do not apply suction. RATIONALE: Applying suction duringDo not apply suction. RATIONALE: Applying suction during insertion causes trauma to th emucous membrane.insertion causes trauma to th emucous membrane. • Advance the catheter about 10 to 15 cm. ( 4 to 6 in.) along oneAdvance the catheter about 10 to 15 cm. ( 4 to 6 in.) along one side of the mouth into the oropharynx. RATIONALE:side of the mouth into the oropharynx. RATIONALE: Directing the catheter along the sides prevents gagging.Directing the catheter along the sides prevents gagging. • It maybe necessary during the oropharyngeal suctioning to applyIt maybe necessary during the oropharyngeal suctioning to apply suction to secretions that collect in the vestibule of the mouthsuction to secretions that collect in the vestibule of the mouth and beneath the tongue.and beneath the tongue.
- 16. IMPLEMENTATIONIMPLEMENTATION For Nasopharyngeal and Nasotracheal SuctionFor Nasopharyngeal and Nasotracheal Suction • Open the lubricant if performing nasopharyngeal/nasotrecheal suctioningOpen the lubricant if performing nasopharyngeal/nasotrecheal suctioning • Open the sterile suction packageOpen the sterile suction package a. Set up the container, touching only the outside.a. Set up the container, touching only the outside. b. Pour sterile water or saline into the container.b. Pour sterile water or saline into the container. c. Put on sterile gloves, or put on a non sterile gloves on the non dominantc. Put on sterile gloves, or put on a non sterile gloves on the non dominant hand. RATIONALE: The sterile glove hand maintains the sterility of thehand. RATIONALE: The sterile glove hand maintains the sterility of the suction catheter, and the un sterile gloves prevents the transmission ofsuction catheter, and the un sterile gloves prevents the transmission of microorganism to the nurse.microorganism to the nurse. • With your sterile gloved hand, pick up the catheter and attach it to theWith your sterile gloved hand, pick up the catheter and attach it to the suction unit.suction unit. 6.6. Make an approximate depth of insertion of the catheter and test theMake an approximate depth of insertion of the catheter and test the equipment.equipment. • Measure the distance betwteen the tip of the client’s nose and the earlobe, orMeasure the distance betwteen the tip of the client’s nose and the earlobe, or about 13 cm ( 5 in.) for an adult.about 13 cm ( 5 in.) for an adult. • Mark the position on the tube with the fingers of the sterile gloved hand.Mark the position on the tube with the fingers of the sterile gloved hand.
- 17. IMPLEMENTATIONIMPLEMENTATION • Test the pressure of the suction and the patency of the catheter byTest the pressure of the suction and the patency of the catheter by applying your sterile gloved finger or thumb to the port or open branch ofapplying your sterile gloved finger or thumb to the port or open branch of the Y- connector to create suction.the Y- connector to create suction. 7.7. Lubricate and introduce the catheter.Lubricate and introduce the catheter. • Lubricate the catheter tip with saline water, or sterile water or water solubleLubricate the catheter tip with saline water, or sterile water or water soluble lubricant. RATIONALE: This reduces friction and eases insertion.lubricant. RATIONALE: This reduces friction and eases insertion. • Remove oxygen with the non dominant hand, and if appropriate.Remove oxygen with the non dominant hand, and if appropriate. • Without applying suction, inset the catheter the pre measured orWithout applying suction, inset the catheter the pre measured or recommend distance into their naris and advance it along the floor of therecommend distance into their naris and advance it along the floor of the nasal cavity. RATIONALE: This avoids the nasal turbinates.nasal cavity. RATIONALE: This avoids the nasal turbinates. 8.8. Perform suctioning.Perform suctioning. • Apply your finger to the suction control port to start suction, and gentlyApply your finger to the suction control port to start suction, and gently rotate the catheter. RATIONALE: Gentle rotation of the catheter ensuresrotate the catheter. RATIONALE: Gentle rotation of the catheter ensures that all surfaces are reached and prevents trauma to any one area of thethat all surfaces are reached and prevents trauma to any one area of the respiratory mucosa due to prolonged suction.respiratory mucosa due to prolonged suction. • Apply suction for 5 to 10 seconds while slowly withdrawing the catheter ,Apply suction for 5 to 10 seconds while slowly withdrawing the catheter , then remove the finger from the control and remove the catheter .then remove the finger from the control and remove the catheter .
- 18. IMPLEMENTATIONIMPLEMENTATION 9.9. Rinse the catheter and repeat suctioning asRinse the catheter and repeat suctioning as above.above. • Rinse and flush the catheter and tubing withRinse and flush the catheter and tubing with sterile water or saline.sterile water or saline. • Relubricate the catheter, and repeat suctioningRelubricate the catheter, and repeat suctioning until the air passage is clear.until the air passage is clear. • Allow sufficient time between each suctionAllow sufficient time between each suction
- 19. • THE ENDTHE END