PERFORMANCE EVALUATION CHECKLIST

Suctioning Endotracheal Tube (ETT)

Name:____________________________ Group: _______ Date: ________ Rating: ______

Done Done Multiple

Correct but with Errors
PROCEDURE with No 1 Error Seen
Errors (2) (1)
(3)
ATTITUDE: 30% (15 points)
1. Displays readiness in performing the procedure
2. Displays conscientious efforts to correct mistakes.
3. Shows enthusiasm and interest in performing the procedure.
4. Employs professionalism, reliability and confidence in the procedure.
5. Answers rationale questions readily.

TOTAL
KNOWLEDGE AND SKILLS 70% (63 points)
1. Assess respiratory status, secretions, oxygen status.
2. Assembles and prepares equipment.
3. Washes hands.
4. Explains the procedure to the patient.
5. Positions the patient properly and places a towel across patient’s chest.
6. Turns on suction device and adjusts pressure. Turns off device.
7. Opens and prepares sterile suction catheter kit.
8. Pre-oxygenates patient with 100% oxygen using a manual resuscitation bag
or using the ventilator.
9. Wears sterile gloves.
10. Picks up catheter with dominant hand. Picks up connecting tube with
non-dominant hand. Attaches catheter to connecting tube.
11. Turns on suction device .
12. Places the end of the catheter into cup of saline and apply suction.
13. Inserts the catheter into the endotracheal tube without suction.
14. Advances the catheter until resistance is felt.
15. Retracts the catheter about 1 cm before applying suction.
16. Applies suction while withdrawing the catheter, using a continuous
rotating motion. This should take 5-10 seconds (no more than 10 seconds).
17. Hyperoxygenates the patient using a manual resuscitation bag for a full
minute or using the ventilator.
18. Rinses catheter thoroughly with saline.
19. Repeat suctioning as necessary after hyperoxygenation.
20. Turns off suction device.
20. Disposes materials, removes gloves, and washes hands.
21. Documents procedure.

TOTAL

Instructor’s Comments:
_________________________________________________________________________________
_________________________________________________________________________________
________________
Clinical Instructor’s Comment:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

________________________________________
Signature over printed name of the Student

________________________________________
Signature over printed name of Clinical Instructor

Prepared:

ANTHONY JOSEPH C. MERCADO, RN, MAN

MS Lecturer

Approved:

MICHELLE B. YU, DM, RN

Dean, College of Nursing