OROPHARYNGEAL AND NASOPHARYNGEAL SUCTIONING Definition: __________________________________________________________________________________________________________________

Indications: This procedure is indicated when the client: 1. ____________________________________________________________________________________________________________________ 2. ____________________________________________________________________________________________________________________ 3. ____________________________________________________________________________________________________________________ 4. ____________________________________________________________________________________________________________________

Purposes: 1. ____________________________________________________________________________________________________________________ 2. ____________________________________________________________________________________________________________________ 3. ____________________________________________________________________________________________________________________ 4. ____________________________________________________________________________________________________________________

Special Considerations: 1. ____________________________________________________________________________________________________________________ 2. ____________________________________________________________________________________________________________________ 3. ____________________________________________________________________________________________________________________ 4. ____________________________________________________________________________________________________________________

Equipments: • Towels or pads • Emesis basin lined with paper • Portable or wall suction machine: includes a collection bottle, a tubing system connected to the suction catheter, and a gauge that registers the degree of suction • Sterile disposable container for sterile fluids

• • •

Sterile Sterile Sterile   

normal saline or water gloves suction catheter For adults - #12 to # 18 For children - # 8 to # 10 For infants - # 5 to # 8

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Note: If both oropharynx and nasopharynx are to be suctioned, one sterile catheter is required for each. Types of Suction Catheter 1. Open-tipped catheter – has an opening at the end and several openings along the sides. It is effective for thick mucus plugs, but it can irritate the tissue. 2. Whistle-tipped catheter – has a slanted opening at the tip. Most catheters have a thumb port on the side, which is used to control the suction. Several openings along the sides of the tip of the suction catheter ensures distribution of negative pressure of the suction over a wide area, thus preventing excessive irritation of any area of the respiratory mucous membrane. • • • • Water-soluble lubricant or glass of sterile water Y-connector Sterile gauzes Moisture-resistant disposable bag • • • Sputum trap or cup, if specimen is to be collected Sterile forceps (in cases where institution practices such or in absence of gloves) Resuscitation bag (Ambu bag) connected to 100% oxygen

PROCEDURE A. Prepare the client. 1. Wash hands and observe other appropriate infection control procedures (e.g., gloves, goggles. 2. Gather necessary equipment and supplies.

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3. Explain to the client, regardless of level of consciousness, the purpose and rationale of the procedure. Provide information that suctioning will relieve breathing difficulty and the procedure is painless but may stimulate the cough, gag, or sneeze reflex. 4. Assess for signs and symptoms indicating upper airway secretions: gurgling respirations, restlessness, vomitus in the mouth, and drooling. Monitor HR, RR, color, and ease of respirations. 5. Position the client correctly. PROCEDURE RATIONALE 1 2 3 4 5

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For oropharyngeal and nasopharyngeal suctioning: a. 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 hyperextended for nasal suctioning. b. Position an unconscious client in the lateral position facing you.

6. Place the towel or pad over the pillow or under the chin. Provide emesis basin under the chin or side of the face. B. Prepare the equipment. 7. Set the pressure on the suction gauge and turn on the suction. Many suction devices are calibrated to three pressure ranges: 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

8. Hyperoxygenate client before inserting catheter and suctioning.

9. Open the sterile suction package.

PROCEDURE 10. Set up the cup or container, touching only its outside.

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11. Pour sterile water or saline into the sterile container.

12. Don the sterile gloves, or don a nonsterile glove on the non-dominant hand and sterile glove on the dominant hand. 13. With you sterile gloved hand, pick up the catheter, and attach it to the suction unit.

14. Open the lubricant if performing nasopharyngeal suctioning. C. Make an approximate measure of the depth for the insertion of the catheter and test the equipment. For oropharyngeal and nasopharyngeal suctioning: 15. Measure the distance between the tip of the client’s nose and the earlobe or about 13cm (5in) for an adult. The appropriate distance for an infant or small child is 4 to 8 cm (1.6 to 3.2 in) or 8 to 12 cm (3.2 to 4.8 in) for an older child. For nasal tracheal suctioning, measure the distance between the tip of the client’s nose to the earlobe and then along the side of the neck to the thyroid cartilage (Adam’s apple). For oral tracheal suctioning, measure from the mouth to the midsternum. 16. Mark the position on the tube with the fingers of the sterile gloved hand. PROCEDURE 17. Test 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 of the Y connector (the RATIONALE 1 2 3 4 5

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suction control) to create suction.

D. Lubricate and introduce the catheter. For nasopharyngeal suction: a. Lubricate the catheter tip with water-soluble lubricant. b. Without applying suction, insert the catheter the premeasured or recommended distance into either nares, and advance it along the floor of the nasal cavity. c. Never force the catheter against an obstruction. If one nostril is obstructed, try the other.

For an orpharyngeal suction: a. Moisten tip with sterile water or saline.

b. Pull the tongue forward, if necessary, using gauze. c. Do not apply suction during insertion. d. Gently advance the catheter about 4 to 6 inches along one side of the mouth into the oropharynx. E. Perform suctioning. 18. Apply your finger to the suction control port to start suction, and gently rotate the catheter. Suction intermittently as catheter is withdrawn. PROCEDURE 19. Apply suction for 5 to 10 seconds; then remove your finger form 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. RATIONALE 1 2 3 4 5

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It may be necessary during oropharyngeal suctioning to apply suction to secretions that collect in the vestibule of the mouth and beneath the tongue.

F. Clean the catheter, and repeat suctioning as above. 20. Wipe off the catheter with sterile gauze if it is thickly coated with secretions. Dispose of the gauze in a moisture-resistant bag.

21. Flush the catheter with sterile water or saline.

22. Relubricate the catheter, and repeat suctioning until the air passage is clear. Note: Allow 20- to 30-second intervals between each suction, and limit suction to 5 minutes in total.

23. Alternate nares for repeat suctioning.

24. Encourage client to breathe deeply and to cough between suctions.

PROCEDURE G. Obtain a specimen if required. a. Attach the suction catheter to the rubber tubing of the sputum trap. b. Attach the suction tubing to the sputum trap air vent.

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c. Suction the client’s nasopharynx or oropharynx. The sputum trap will collect the mucus during suctioning. d. Remove the catheter from the client. Disconnect the sputum trap rubber tubing from the trap air vent. e. Connect the rubber tubing of the sputum trap to the air vent. f. Flush the catheter to remove secretions from the tubing.

H. Promote client comfort. 25. Offer to assist the client with oral or nasal hygiene.

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Dispose of equipment and ensure availability for the next suction. 26. Dispose of the catheter, gloves, water and waste container. Wrap the catheter around your sterile glove and roll it inside the glove for disposal. 27. To ensure that equipment is available for the next suctioning, change suction collection bottles and tubing daily or more frequently as necessary.

PROCEDURE J. Assess the effectiveness of suctioning. 28. Auscultate the client’s breathing sounds to ensure they are clear secretions. Observe for restlessness or presence of oral secretions. K. Wash hands.

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L. Document relevant data. a. Record the procedure: the amount, consistency, color, and odor of sputum (e.g., foamy, white mucus: thick, green-tinged mucus; or blood-flecked mucus), client’s breathing status before and after the procedure and the client’s reaction to the procedure. b. If the technique is carried out frequently, e.g., q1h, it may be appropriate to record only once, at the end of the shift; however, the frequency of the suctioning must be recorded.

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