AZIZ FATIMAH NURSING COLLEGE

Aziz Fatimah Hospital Gulistan Colony, Sheikhupura Road, Faisalabad.

Tel: 041-8780910. 8845446. 8780815 Ext. (425) Mobile: 0304-6974129 Email: principal.afnc@afh.com.pk

Performance Checklist Suctioning

Student: ________________ Instructor: __________________

Pt. Name: ______________________Age/Sex ______ Ward: _______MR#___________

Wt. _____kg Ht. ______cm Temp. ___________ P/R________ R/R__________

SPO2 ______% DATE: ____________

Procedure Steps Yes No Recommendation

Verified the healthcare provider’s order.
Knocked on door; performed hand hygiene; introduced
self; identified patient; provided for patient’s privacy;
explained procedure to patient.
Prepared equipment on bedside table
Places the patient in appropriate position
Conscious client ----Semi-Fowler’s position.
Unconscious Client -----Side lying
Nasal/Tracheostomy-----hyperextended Neck Position
Assess Client:
 R/R depth, rhythm, breath sounds
 O2 Saturation/ ABG’s and pallor
 Mouth and Nostril for Crusting, ulcer and Debris
Treatment:
 Steam inhalation
 Bronchodilators
Procedure:
 Chest physiotherapy
 Postural drainage
Places a towel or linen-saver pad over the patient’s chest.
Dons sterile gloves (alternatively, puts a sterile glove on
the dominant hand and a clean glove on the other hand).
Hyper-oxygenate client by increasing/ giving up to 100%
O2 pre procedure, if not contraindicated
Opened the wrappers of catheter from distal end and
attaches it with the suction unit.

Assessed around
tracheostomy site
(peristomal area); used
4 x 4 gauze and
 AZIZ FATIMAH NURSING COLLEGE
Aziz Fatimah Hospital Gulistan Colony, Sheikhupura Road, Faisalabad.
Tel: 041-8780910. 8845446. 8780815 Ext. (425) Mobile: 0304-6974129 Email: principal.afnc@afh.com.pk

cotton-tipped swabs
saturated in NS to
clean
exposed surfaces of
the outer cannula and
stoma under faceplate
2 to 4 inches in a
circular pattern from
stoma site outward.
Assessed around
tracheostomy site
(peristomal area); used
4 x 4 gauze and
cotton-tipped swabs
saturated in NS to
clean
exposed surfaces of
the outer cannula and
 AZIZ FATIMAH NURSING COLLEGE
Aziz Fatimah Hospital Gulistan Colony, Sheikhupura Road, Faisalabad.
Tel: 041-8780910. 8845446. 8780815 Ext. (425) Mobile: 0304-6974129 Email: principal.afnc@afh.com.pk

stoma under faceplate

2 to 4 inches in a
circular pattern from
stoma site outward.
Un-wrapped the catheter without touching it to any non-
sterile surfaces.
Measure the tube for distance of insertion (from tip of the
nose to ear lobe)
For tracheostomy suctioning insert about 3 inches for
infant and children
Lubricate with distilled water/ 0.9% saline to check for the
patency of catheter, and suction pressure.
Suction for not more than 5 second.
Apply suction pressure during withdrawal and twist the
catheter while pulling it out.
Assess the secretions for COCA
Ensure that the entire procedure does not exceed 5 mins.
Documented in nursing notes the care being given.

Maintained professionalism (e.g., ID badge worn,

therapeutic communication & caring behavior maintained).

RECOMMENDATION:

Sig._______________ Sig._______________ Sig._______________

Ward Supervisor, AFH Clinical Instructor, AFNC Acting Principal,

AFNC