SKILL: Oropharyngeal and Nasopharyngeal Suctioning

PREPARATION

1. Assess for clinical signs indicating the need for suctioning

 Restlessness

 Gurgling sounds during respiration

 Skin color

 Rate and pattern of respiration

 Pulse rate and rhythm

 Decreased oxygen saturation

2. Assemble equipment: to save time and be organized

For oral and nasopharyngeal:
 Towel
 Suction machine
 Sterile disposable container
 Sterile saline
 Sterile gloves
 Suction catheter
 Lubricant

PROCEDURE

1. Introduce yourself and verify the client’s identity and explain procedure.
To reduce client’s anxiety and to encourage cooperation of the client

2. Perform hand hygiene. To avoid the spread of microorganism and avoid cross contamination

3. Provide for client privacy by closing the door or window to preserved client’s integrity

4. Prepare the client.

 For conscious patient:
Supine (nakahiga)
 For unconscious patient:
Lateral (nakaside)

5. Prepare the equipment.

 Open lubricant
 Moisten catheter tip
 6. Open sterile suction package
 Set up the cup touching only the outside
 Pour sterile saline

 Put on sterile gloves

 Pick up the catheter and attach to suction unit.

7. Lubricate and introduce the catheter

 Lubricate the catheter tip

8. Perform suctioning
 Apply your finger to the suction control port to start suction and gently rotate the catheter
 Apply suction for 5-10 seconds while slowly withdrawing the catheter, then remove your finger from the
control and remove the catheter.
(suction attempt should last only 10-15 seconds, catheter is inserted, applied, and discontinued and
removed)

9. Rinse the catheter, and repeat suctioning.

 Rinse and flush the catheter with sterile saline

 Relubricate the catheter and repeat suctioning

 Allow sufficient time between each suction, limit suctioning to 5 minutes in total.
 Encourage deep breathing and coughing

10. Promote client comfort

 Oral/Nasal hygiene
 Assist client into a position that facilities breathing

11. Dispose of equipment and ensure availability for the next suction

12. Assess the effectiveness of suctioning

 Auscultate client’s breath sounds

 Observe skin color, dyspnea, oxygen saturation, level of anxiety

13. Document relevant data to prove that the procedure is done to the client and to serve as a data.
Record:
 Amount
 Consistency
 Color
 Odor