Suctioning Is aspirating secretions through a catheter connected to a suctioning machine or wall outlet.

Oropharyngeal or nasopharyngeal suctioning removes secretions from the respiratory tract Endotracheal suctioning is used to remove secretions from the trachea and bronchi. Dyspnea, bubbling or rattling breath sounds, poor skin color (cyanosis), pr decreased SaO2 may indicate need for suctioning

Suctioning Oropharyngeal and Nasopharyngeal Cavities Purposes y y y y To remove secretions that obstruct the airway To facilitate ventilation To obtain secretions for diagnostic purposes To prevent infection that may result from accumulated secretions

Assessment Assess for clinical signs indicating the need for suctioning y y y y y y y 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 and rhythm

Planning Delegation The nurse needs to review the procedure and important points such as: y y Equipment y y y y Towel or moisture pad Suction machine Sterile disposable container fluids Sterile NSS or water Insertion of the tube to avoid trauma to the mucous membrane Uses Sterile technique requires application

Allows tongue to fall forward. Inform the patient that suctioning will relieve breathing difficulty. Prepare the patient y Position conscious person with semi-fowler s position. y Do not apply suction during insertion. facing you. Provide privacy 5. may be painless but uncomfortable and may stimulate gag. Prevents gagging For Nasopharyngeal y Lubricate the tip with sterile water of saline and insert y Without applying suction. May cause trauma to the mucous membrane y Advance the catheter about 10-15cm (4-6 in. Prepare the equipment y Set the pressure on the suction. why it is necessary. Lubricate and introduce the catheter For Oropharyngeal Suction y Moisten the tip with sterile water or saline and insert.y y y y Sterile gloves Goggles. and also facilitates drainage of secretions 4. and turn on the suction y Open the lubricant of performing nasopharyngeal suctioning y Open the sterile water or PNSS and pour into a container y Put on the sterile gloves 6. if appropriate Sterile catheter Water-soluble lubricant Implementation Performance 1. so that it will no obstruct the insertion. Wash hands and observe other infection control procedures 3. how to cooperate. Make an approximate measure of the depth for the insertion of the catheter and test the equipment. insert the catheter the premeasured distance into either naris and advance it along the nasal cavity y Never force the catheter against an obstruction. cough reflex. y Measure the distance between the tip of the patient s nose and the earlobe y Mark the position on the tube with the fingers of the sterile gloved hand y Test the pressure of the suction and patency of the catheter 7. Position facilitate the insertion of the catheter and help prevent aspiration of secretions y Position unconscious person to a lateral position.) along one side of the mouth into the oropharynx. Explain to the patient what you are going to do. Try the other naris . Knowing the procedure is often reassurance and enlists patient s cooperation 2.

Dispose of equipment and ensure availability for the next suction 12. Document relevant data y Record the procedure: the amount. the record frequency of suctioning Evaluation y y y Conduct appropriate follow-up Compare findings Report significant deviations from normal to the physician Lifespan Considerations Infant and children y y An assistant should always be present while tracheostomy care is performed Always keep packages sterile . white mucus. Ensures that all surfaces are reached and prevents trauma y Apply suction for 5-10 seconds while slowly withdrawing the catheter. green-tinged mucus. thick. Decreases the patient s oxygen supply y Encourage the patient to breathe deeply and to cough between suctioning. Perform suctioning y Apply your finger to the suction control port to start suction. record only once. dyspnea. and odor of sputum (e. or blood-flecked mucus) and the patient s breathing status before and after the procedure y If procedure is carried out frequently. Clean the catheter and repeat the suctioning as above y Wipe catheter with sterile gauze if it is thickly coated with secretions y Flush the catheter with sterile water or saline y Relubricate and repeat y Allow 20-30 second intervals between each suction and limit suctioning to 5 minutes in total. Assess the effectiveness of suctioning y Auscultate the patient s breath sounds to ensure they are clear of secretions. consistency. where they can be reached with the suction 10. and level of anxiety 13.g. color. and gently rotate the catheter. Observe skin color.. then remove your finger from the control and remove catheter 9. Coughing and breathing help carry secretions from the trachea and bronchi into the pharynx. foamy.8. however. Promote patient comfort y Offer to assist the patient with oral or nasal hygiene y Assist the patient to a position that facilitates breathing 11.

if so. review the documentation of the procedure .Elders y Older adult skin is more fragile and prone to breakdown. invasive technique requiring application of scientific knowledge and problem solving Equipment y y y Ambu bag connected to 100% oxygen Sterile water (optional) Equipment for suctioning (similar with oro/nasopharyngeal suctioning equipment) Implementation Preparation y Determine if the patient has been suctioned previously and. Note the patient s ability or inability to remove the secretions through coughing Planning Delegation Suctioning a tracheostomy or endotracheal tube is a sterile. Care of the skin at the tracheostomy stoma is very important Home Care Considerations y y y y Clean technique is used for tracheostomies for older than 1 month Stress the importance of good hand washing Tap water may be used for rinsing the inner cannula Inform the caregiver of the signs and symptoms that may indicate an infection of the stoma site or lower airway Suctioning a Tracheostomy or Endotracheal tube Purposes y y y Maintain a patent airway and prevent airway obstructions Promote respiratory function (optimal exchange of oxygen and carbon dioxide into the lungs) Prevent pneumonia that may result from accumulated secretions Assessment y y Assess the patient for the presence of congestion on auscultation of the thorax.

and also prevent secretions from sticking to the inside of the catheter 7. hyperventilate lungs with a resuscitation bag before suctioning. and set the pressure in accordance with agency policy y Put on goggles. attach the suction catheter to the suction tube 6. suction is not applied during insertion of the catheter . provide analgesia before suctioning. place the catheter tip in the sterile saline solution y Using the thumb of the non-dominant hand. This determines that suction equipment is working properly. across the patient s chest below the tracheostomy y Turn on the suction. Flush and lubricate the catheter y Using the dominant hand. Adjust the oxygen flow to 100% flush y Open the sterile supplies in readiness for use y Place the sterile towel. Provide privacy 4. use the ventilator for hyperventilation and hyperoxygenation 8. Coughing helps loosen and move secretions y If necessary. Explain to the patient what you are going to do. and how to cooperate. mask. do not hyperventilate with a resuscitator. If the patient has copious secretions. if used. Inform the patient that suctioning usually causes some intermittent coughing and that this assists in removing the secretions 2. which can cause pain for patients who have had thoracic or abdominal surgery 5. Prepare equipment y Attach the resuscitation apparatus to the oxygen source. Lubrication eases insertion and reduces trauma during insertion. To prevent tissue trauma and oxygen loss. Deep breathing oxygenates lungs. occlude the thumb control and suction a small amount of sterile solution through catheter. if necessary y Put on sterile gloves y Holding the catheter in the dominant hand and the connector in the non-dominant hand. Hyperventilating a patient who has copious secretions can force the secretions deeper into the respiratory tract 9.Performance 1. place the patient to a semi-fowler s position to promote deep breathing. and counter acts the hypoxic effects of suctioning and may induce coughing. Quickly but gently insert the catheter without applying any suction y With your non-dominant thumb off the suction port. why it is necessary. and maximum expansion. If the patient is on a ventilator. If the patient does not have copious secretions. and gown. Endotracheal suctioning stimulates the cough reflex. Prepare the patient y If not contraindicated because of health. Wash hands and observe other appropriate infection control procedures 3. quickly but gently insert the catheter into the trachea through the tracheostomy tube.

This provides an opportunity for reoxygenation of the lungs y Flush the catheter and repeat suctioning until the air passage is clear and the breathing is relatively effortless and quiet y After each suctioning. including the amount and description of suction returns and any relevant assessment y . pick up the resuscitation bag with your non-dominant hand and ventilate the patient with no more than three breaths Dispose of the equipment and ensure the availability for the next suction y Flush the catheter and suction tubing y Turn off the suction and disconnect the catheter from the suction tubing y Wrap the catheter around your sterile hand and peel the glove off so that it turns inside out over the catheter y Discard the glove and the catheter Provide for client comfort and safety y Assist the client to a comfortable. Suction time is restricted to 10 seconds or less to minimize oxygen loss y Rotate the catheter by rolling it between your thumb and forefinger while slowly withdrawing it. Insert the catheter about 12. or until the patient coughs or you feel resistance. 12. 13. less for children.) for adults. a semi fowler s position is frequently indicated y If the person is unconscious. withdraw the catheter about 1-2 cm before suctioning Perform suctioning y Apply intermittent suction for 5-10 seconds by placing the non-dominant thumb over the thumb port.5cm (5in. This prevent tissue trauma by minimizing the suction time against any part of the trachea y Withdraw the catheter completely and release the suction y Hyperventilate the patient y Then suction again Reassess the patient s oxygenation status and repeat the suctioning y Observe the patient s respirations and skin color y Encourage the patient to breathe deeply and to cough between suctions y Allow 2-3 minutes between suctioning as possible. Resistance usually means that the catheter tip has reached the bifurcation of the trachea. safe position that aids breathing. 14. y If the person is conscious. sim s position aids in the drainage of secretions from the mouth Document relevant data y Record the suctioning.10. y To prevent damaging the mucous membranes at the bifurcation. 11.

Chapter 48. and Practice. Procedure 48-2 & 48-3 . Watch closely for signs of hypoxemia. thus increasing their susceptibility to hypoxemia related to suctioning. which can aid in the removal of secretions by coughing or suctioning Source: Fundamentals of Nursing: Concepts. stop suctioning and hypoxygenerate Do a thorough lung assessment before and after suctioning to determine effectiveness of suctioning and to be aware of any special problems y Home Care Considerations y y y y Whenever possible. Seventh Edition by: Barbara Kozier. the client should be encourage to clear the airway by coughing Clean gloves should be used when endotracheal suctioning is performed in the home environment Instruct the caregiver on how to determine the need for suctioning and the correct process of suctioning to avoid potential complications of suctioning Stress the Importance of adequate hydration as it thins secretions. Shirlee Snyder. If noted. Unit X.Evaluation y y y Perform a follow-up examination of the patient to determine the effectiveness of the suctioning Compare findings Report significant deviations from normal to the physician Lifespan Considerations Infants and Children y Have an assistant gently restrain the child to keep the child s hand out of the way. The assistant will need to keep the child s head in the midline position Elders y Elders often have cardiac and/or pulmonary disease. pg 1315-1321. Audrey Berman. Process. Glenora Erb.

Suctioning Oropharyngeal and Nasopharyngeal Cavities. Tracheostomy or Endotracheal tube Submitted by: Group V Submitted to: .

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