SUCTIONING

DEFINITION
ET SUCTIONING
Removal ofsecretion from tracheobronchial tube with the help of mechanical suction device.
OROPHARYNGEAL SUCTIONING& NASOPHARYNGEAL SUCTIONING
Removal of secretion from the oral cavity or nasal cavity and pharynx through the suction.
PURPOSES
1. Maintaining the patient airway by removing the secretion.
2. Prevention of respiratory tract infection from lodgement of secretion.
3. Facilitating the ventilation.
4. Obtaining the secretion for diagnostic purposes.
5. Preventing the infection.
INDICATIONS
1. Patient with ineffective cough and unable to clear the secretion spontaneously.
2. Retained secretions.
3. Maintain airway patency with secretion clearance.
4. To Stimulate cough.
CONTRA INDICATIONS
1. Severe bleeding disorder, unexplained haemoptysis.
2. Severe bronchospasm or laryngeal spasm, irritable airway.
3. Epiglottitis, croup.
4. Basal skull fracture.
5. Severe gag reflux.
6. Hemodynamic instability.
7. Occluded nasal passage.
8. Loose teeth.
9. Increased intra cranial pressure.
10. Tracheal, Oesophageal fistulae.

TECHNIQUES
1. Clean Technique- Nasal or Oral suctioning
2. Sterile Technique- Open artificial or permanent tracheostomy.
3. Inline/Close Suctioning- Mechanical ventilation in critical care.
 ARTICLES
A Clean tray containing:-
1. Sterile Suction Catheter.
2. Normal saline or sterile water.
3. Sterile glove
4. Mask
5. Gauze piece in the container
6. Stethoscope
A Sterile tray containing:-
1. Sterile bowl with Gauze piece
Other articles included:-
1. Suction Source: Portable suction,
wall suction unit
2. Connecting tubing
3. Disposable sterile container
4. Mackintosh with Towel
GOAL:
The goal of suction should be maximise the amount of secretions removed with minimal
adverse effects associated with the procedure.
PROCEDURE
ACTION
1. Assess the patient’s condition
2. Bring necessary equipment to the
bedside
3. Explain procedure to the patient
4. Provide privacy
5. Wash & dry hands & put on sterile
examination gloves, apron, and eye
protection/mask if indicated.
6. Close curtains around bed and close
door to room if possible
7. Determine the need for suctioning.
verify the suction order in the
patients chart, if necessary. for
postoperative patient, administer
pain medication before suctioning
PURPOSES
To remove secretions
To clear suction catheter
To prevent cross infection
To prevent cross infection
to wipe the secretions
To auscultate lung sounds
To wipe secretions
To collect secretions
To connect the suction catheter
To send culture if needed.
To prevent soiling of bed linen
RATIONALE
To get the base line data
To conserves time and energy.
Explanation reduce fear/anxiety and gain
cooperation.
To maintain patients dignity.
Minimises risk of cross infection.
Ensures the patients privacy
To minimize trauma to airway mucosa,
suctioning should be done only when
secretions have accumulated or adventitious
breath sounds are audible
8. Explain what you are going to do Explanation reduce fear
and the reasons for suctioning to the
patient. even if the patient does not
appear to be alert. Reassure patient
that you will interrupt procedure if
he or she indicates respiratory
difficulty.
9. Adjust level of bed to waist level of To prevent strain on back
the nurse
10. Place towel or waterproof pad across This protects bed linen
the patient’s chest
11. adjust suction to appropriate Higher pressure can cause excessive trauma,
pressure hypoxemia, and atelectasis.
for a wall unit for an adult:100-
120mm
hg(roman,2005);neonates:60-80
mm hg(ireton,2007).for a portable
unit for a adult:10-15cm
hg:neonates:6-8 cm hg:infants:8-10
cm hg:children:8-10cm
hg;adolescents:8-10 cm hg
put on a disposable, clean glove and
occlude the end of the connecting
tubing to check suction pressure.
place the connecting tubing in a
convenient location
12. open sterile suction package using Sterile normal saline or water is used to
aseptic technique. the open wrapper lubricate the outside of the catheter,
or container becomes a sterile field minimizing irritation of mucosa during
to hold other supplies. carefully introduction, it is also used to clear the
remove the sterile container. catheter between suction attempts
touching only the outside surface.
set it up on the work surface and
pour sterile saline into it.

13. place a small amount of water-
soluble lubricant on the sterile field.
taking care to avoid touching the
sterile field with the lubricant
package
14. increase the patients supplemental
oxygen level or apply supplemental
oxygen for facility policy
Lubricant facilities passage of the catheter
and reduces trauma to mucous membranes
Suctioning removes air front the patients
airway and can cause hypoxemia. Hyper
oxygenation can help prevent suction
induced hypoxemia.
15. Put on face shield or goggles and
mask. put on sterile gloves. The
dominant hand will manipulate the
catheter and must remain sterile. The
non dominant hand is considered
clean rather than sterile and will
control the suction valve(y port) on
the catheter .
16. With dominant gloved hand, pick up
sterile catheter. pick up the
connecting tubing with the non
dominant hand and connect the
tubing and suction catheter
17. Moisten the catheter by dipping it
into the container of sterile saline.
occlude y-tube to check suction
18. Encourage the patient to take several
deep breaths
19. Apply lubricant to the first 2 to 3cm
of the catheter, using the lubricant
that was placed on the sterile field.
20. Remove the oxygen delivery device,
if appropriate. Do not apply suction
as the catheter is inserted. Holed the
catheter between your thumb and
forefinger.
21. Insert the catheter:
a. For nasopharyngeal suctioning,
gently insert catheter through the
naris and along the floor of the
nostril toward the trachea. Roll the
catheter between your fingers to help
advice it. Advance the catheter
approximately 5 to 6 to reach the
pharynx.
b. For oropharyngeal suctioning, insert
catheter through the mouth, along
the side of the side of the mouth
towards the trachea. Advance the
catheter 3 to 4 to reach the pharynx.
Handling the sterile catheter using a sterile
glove helps prevent introducing organisms
Into the respiratory tract; the clean glove
protects the nurse from microorganisms
Sterility of the suction catheter is
maintained
Lubricating the inside of the catheter with
saline helps move secretions in the catheter.
checking suction ensures equipment is
working property
Suctioning removes air from the patients
airway and can cause hypoxemia
hyperventilation can help prevent suction
induced hypoxemia.
Lubricant facilitates passage of the catheter
and reduces trauma to mucous membranes.
Using suction while inserting the catheter
can cause trauma to the mucosa for insertion
ensures proper placement of the catheter.
The general guideline for determining
insertion distance for nasopharyngeal
suctioning for an individual patient is to
estimate the distance from the patient’s
earlobe to the nose.
a) Technical insertion of catheter will
avoid trauma and other
complications
b) Technical insertion of catheter will
avoid trauma and other
complications
 22. Apply suction by intermittently To Minimizes trauma to the mucosa.
occluding the Y port on the catheter
with the thumb of your nondominant
hand and gently rotate the catheter as
it is being withdrawn. Do not suction
for more than 10 to 15 seconds at
atime.
23. Replace the oxygen delivery device Hyperventilation can help prevent suction-
using your non dominant hand, if induced hypoxemia.
appropriate, and have the patient
take several deep breath.
24. Flush catheter with saline. Flushing clears catheter and lubricates it for
next insertion.
25. Allow at least 30 seconds to 1 min The interval allows for re ventilation and re
interval if additional suctioning is oxygenation of airways.
needed. No more than three suction
passes should be made per
suctioning episode. Alternate the
nares, unless contraindicated, if
repeated suctioning is require. Do
not force catheter through the nares.

26. Turn Off suction.
27. Offer oral hygiene after suctioning.
28. Reassess patient’s respiratory status.
29. Remove additional PPE, if used.
Perform hand hygiene.
Proper removal of PPE and hand hygiene
reduces risk of transmission of
microorganisms.
To prevent infection
to find the effectiveness of procedure
Removing PPE properly reduces the risk for
infection transmission and contamination of
other items.

AFTER PROCEDURE:
1. After suctioning is complete, pull your sterile glove off over the coiled catheter and
discard it, the non sterile glove, and the container of water.
2. Flush the connecting tubing with normal saline solution. Discard the used items and
replace with new supplies so they are ready for next suctioning.
3. Remove personal protective equipment and wash your hands.
4. Let the client rest after suctioning while you continue to observe him. The frequency
and duration of suctioning depend on the clients tolerance for the procedure on any
complications.
5. Record the date, time, reason for suctioning and technique used: amount, colour,
consistency odour of the secretions.
6. The clients respiratory status before and after the procedure.
DOCUMENTATION:
S.N TIME NURSING ACTION SIGNATURE
O
1. 8 am Patient had 2 idly and milk

2. 8.30 am Medication given

3. 10am Vital signs monitored

4. 11.00am Patient complaints severe cough

5. 11.00 am Informed to doctor advice to do suction

Oral suction done, cleared the airway

Suction done for 10 seconds (done 3 suctions

with regular interval)
Volume: 80 ml along with normal saline
Colour – pale yellow
Consistency - thick
14 Fr size suction catheter
100-120 mm hg pressure used

6. Reduced cough
Patient has no complaints

Haritha . P
1.00PM

COMPLICATIONS:
 Hypoxaemia
 Atelectasis
 Bradycardia
 Tachycardia
 Increased ETT CO2 and transcutaneous CO2
 Blood pressure fluctuations
 Decreased tidal volume
 Airway mucosal trauma
 ETT dislodgement
 Pneumothorax
 Bacteraemia
 Pneumonia
  Fluctuations in intracranial pressure and cerebral blood flow velocity 

BIBLIOGRAPHY
1. A text book of fundamentals of nursing, the art and science of nursing care, author by
Taylor Lillis Seventh edition published by Wolters Kluwer page numbers 1391 to
1394.
2. A text book of fundamentals of nursing, author by Potter & Perry Fourth edition
published by Elsevier.
3. A text book of fundamentals of nursing, author by Kozier&Erbs Eleventh Edition
Published by Pearson.