OROPHARYNGEAL AND NASOPHARYNGEAL SUCTIONING

OVERVIEW

Suctioning of the pharynx is indicated to maintain a patent airway and to remove saliva,
pulmonary secretions, blood, vomitus, or foreign material from the pharynx.

- It is important that mucus be removed from the mouth and pharynx before the first
breath this way to prevent aspiration of the secretions.

If the infant continues to have an accumulation of mucus in the mouth or nose after these first steps,
you may need to suction further after the baby is placed under a warmer.

- Never suction vigorously, because this irritates the mucous membrane and could leave a
portal of entry for infection.

Suctioning can lead to hypoxemia, cardiac dysrhythmias, trauma, atelectasis, infection, bleeding, and
pain.

It is imperative to be diligent in maintaining aseptic technique and following facility guidelines and
procedures to prevent potential hazards.

Suctioning frequency is based on clinical assessment to determine the need for suctioning.

EQUIPMENT

 Portable or wall suction unit with tubing

 A commercially prepared suction kit with an appropriate size catheter or
o Sterile suction catheter with Y-port in the appropriate size (Neonate: 5F to 10F)
o Sterile disposable container
o Sterile gloves

 Sterile water or saline

 Towel or waterproof pad
 Goggles and mask or face shield
 Disposable, clean gloves
 Water-soluble lubricant
 PPE

ASSESSMENT

 Assess lung sounds. Patients who need to be suctioned may have wheezes, crackles, or gurgling
present.
 Assess oxygenation saturation level. Oxygen saturation usually decreases when a patient needs
to be suctioned.
  Assess respiratory status, including respiratory rate and depth. Patients may become tachypneic
when they need to be suctioned.
 Assess the patient for signs of respiratory distress, such as nasal flaring, retractions, or grunting.

NURSING DIAGNOSIS

- Determine the related factors for the nursing diagnosis based on the patient’s current status.

Appropriate nursing diagnoses may include:

 Ineffective Airway Clearance

 Ineffective Breathing Pattern
 Impaired Gas Exchange
 Risk for Aspiration

IMPLEMENTATION

1. Bring necessary equipment to the bedside stand or overbed table.

 Bringing everything to the bedside Bringing everything to the bedside conserves
time and energy. Arranging items nearby is convenient, saves time, and avoids
unnecessary stretching and twisting of muscles on the part of the nurse.
2. Perform hand hygiene and put on PPE, if indicated.
 Hand hygiene and PPE prevent the spread of microorganisms. PPE is required
based on transmission precautions.
3. Identify the patient.
 Identifying the patient ensures the right patient receives the intervention and
helps prevent errors.
4. Close curtains around bed and close the door to the room, if possible.
 This ensures the patient’s privacy.
5. Determine the need for suctioning. Verify the suction order in the patient’s chart, if necessary.
 Only suction a neonate who shows clear signs that suctioning is appropriate.
6. Adjust bed or radiant warmer to comfortable working height, usually elbow height of the
caregiver (VISN 8 Patient Safety Center, 2009). Move the bedside table close to your work area
and raise it to waist height.
 Having the bed at the proper height prevents back and muscle strain. The
bedside table provides a work surface and helps maintain sterility of objects on
the work surface.
7. Place towel or waterproof pad across the patient’s chest.
 This protects bed linens.
8. Assemble suction canister and connecting tubing to suction source. Set suction levels as follows:
80–100 mm Hg for infants and children under 10–12 years, 100–120 mm Hg for older children.
Ensure appropriate resuscitation equipment (mask, valve, bag) is at bedside.
 Higher pressures can cause excessive trauma, hypoxemia, and atelectasis.
9. Open sterile suction package using aseptic technique. The open wrapper or container becomes a
sterile field to hold other supplies. Carefully remove the sterile container, touching only the
outside surface. Set it up on the work surface and pour sterile saline into it.
  Sterile normal saline or water is used to lubricate the outside of the catheter,
minimizing irritation of mucosa during introduction. It is also used to clear the
catheter between suction attempts.
10. Place a small amount of water-soluble lubricant on the sterile field, taking care to avoid touching
the sterile field with the lubricant package.
 Lubricant facilitates passage of the catheter and reduces trauma to mucous
membranes.
11. Increase the patient’s supplemental oxygen level or apply supplemental oxygen per facility
policy or primary care provider order.
 Suctioning removes air from the patient’s airway and can cause hypoxemia.
Hyperoxygenation can help prevent suction induced hypoxemia.
12. Put on face shield or goggles and mask. Put on sterile gloves. The dominant hand will
manipulate the catheter and must remain sterile. The nondominant hand is considered clean
rather than sterile and will control the suction valve (Y-port) on the catheter.
 Handling the sterile catheter using a sterile glove helps prevent introducing
organisms into the respiratory tract; the clean glove protects the nurse from
microorganisms.
13. With dominant gloved hand, pick up sterile catheter. Pick up the connecting tubing with the
nondominant hand and connect the tubing and suction catheter.
 Sterility of the suction catheter is maintained.
14. Moisten the catheter by dipping it into the container of sterile saline. Occlude Y-tube to check
suction. Dipping catheter into sterile saline.
 Lubricating the inside of the catheter with saline helps move secretions in the
catheter. Checking suction ensures equipment is working properly.
15. Apply lubricant to the first 2 to 3 inches of the catheter, using the lubricant that was placed on
the sterile field.
 Lubricant facilitates passage of the catheter and reduces trauma to mucous
membranes.
16. Determine the correct distance to advance suction 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.
17. Remove the oxygen delivery device, if appropriate. Do not apply suction as the catheter is
inserted. Hold the catheter between your thumb and forefinger.
 Using suction while inserting the catheter can cause trauma to the mucosa and
remove oxygen from the respiratory tract. Correct distance for insertion ensures
proper placement of the catheter.
18. Using a downward motion, aiming toward midline, advance the catheter into the nare no
further than the premeasured distance. (For oropharyngeal suction pull the tongue forward
using gauze. Advance the catheter about 10–15 cm along one side of the mouth.) Suction the
oropharynx first then the nasopharynx. Do not force the catheter through the nares.
 Always suction the mouth of a newborn before the nose, because suctioning the
nose first may trigger a reflex gasp, possibly leading to aspiration if there is
 mucus in the posterior throat. Follow mouth suctioning with suction to the
nose, because the nose is the chief conduit for air in a newborn.
 Suctioning mouth before nose prevents possible aspiration of oral secretions.
19. Apply intermittent suctioning by covering the suction control hole with thumb. Gently rotate the
catheter while withdrawing the catheter. Limit continuous suction within the airway to no more
than 5 (infants)–15 (child) seconds.
 Turning the catheter as it is withdrawn minimizes trauma to the mucosa.
Suctioning for longer than 10 to 15 seconds robs the respiratory tract of oxygen,
which may result in hypoxemia.
 Suctioning too quickly may be ineffective at clearing all secretions.
20. Replace the oxygen delivery device using your nondominant hand, if appropriate, and have the
patient take several deep breaths.
 Suctioning removes air from the patient’s airway and can cause hypoxemia.
Hyperventilation can help prevent suction-induced hypoxemia
21. Flush catheter with saline (Figure 6). Assess effectiveness of suctioning and repeat, as needed,
and according to patient’s tolerance. Wrap the suction catheter around your dominant hand
between attempts.
 Flushing clears the catheter and lubricates it for the next insertion.
Reassessment determines the need for additional suctioning. Wrapping
prevents inadvertent contamination of the catheter.
22. Allow at least a 20-30 seconds interval if additional suctioning is needed. Limit suctioning to a
total of 5 minutes. Alternate the nares, unless contraindicated, if repeated suctioning is
required.
 The interval allows for reventilation and reoxygenation of airways. Excessive
suction passes contribute to complications. Alternating nares reduces trauma.
23. When suctioning is completed, remove gloves from the dominant hand over the coiled catheter,
pulling them off inside out. Remove glove from nondominant hand and dispose of gloves,
catheter, and container with solution in the appropriate receptacle.
 This technique reduces transmission of microorganisms.
24. Turn off suction. Remove supplemental oxygen placed for suctioning, if appropriate. Remove
face shield or goggles and mask. Perform hand hygiene.
 Proper removal of PPE and hand hygiene reduces risk of transmission of
microorganisms.
25. Reassess patient’s respiratory status, including respiratory rate, effort, oxygen saturation, and
lung sounds.
 This assesses effectiveness of suctioning and the presence of complications
26. Remove additional PPE, if used. Perform hand hygiene.
 Removing PPE properly reduces the risk for infection transmission and
contamination of other items. Hand hygiene prevents the spread of
microorganisms
27. Documentation
 Document the time of suctioning, your before and after intervention
assessments, reason for suctioning, route used, and the characteristics and
amount of secretions.
EVALUATION

 The expected outcome is met when the patient exhibits improved breath sounds and a
clear and patent airway.
 In addition, the oxygen saturation level is within acceptable parameters, and the patient
does not exhibit signs or symptoms of respiratory distress or complications.

REMINDERS

o Avoid suctioning for 30 minutes to 1 hour after feeding.

o Do not suction for longer than 10 seconds at a time.
o Suction only when necessary.
o Do not exceed suction pressure of 100 mmHg.
o Oxygen source and bag and mas should be available.
o Always suction the mouth of a newborn before the nose to prevent aspiration.