OXYGEN THERAPY &

SUCTIONING PROCEDURES

Prepared by:
Trinidad J. Salcedo’23
OLFU-QC
 LEARNING OBJECTIVES & OUTCOMES
After the lecture, the students will be able to:

01 02 03
Define oxygen therapy Identify and discuss the 3. Describe how to safely
and suctioning and its clinical signs indicating perform oxygen therapy,
purposes. need for oxygen therapy oropharyngeal and
and suctioning. nasopharyngeal suctioning.

04 05
Perform properly the Perform competently in the
procedures by performing actual care of client with
return demonstrations. oxygen therapy in the
clinical setting.
 INTRODUCTION
OXYGEN THERAPY is a treatment that provides extra oxygen to
breathe in & also called supplemental oxygen.

Oxygen is a medication & requires a prescription from the

healthcare provider.

If the client is unable to clear the respiratory tract secretions with

coughing, the nurse should use suctioning method to clear the
airway.
SUCTIONING is the aspiration of secretions through a catheter or a
suction tip connected to a suction machine or a wall suction outlet.
 HOW TO
ADMINISTER O2
THERAPHY ?
Administering Oxygen by Nasal Cannula, Face Mask, or Face Tent
Guidelines for All Delivery Devices
1 Check physician’s order & gather equipment & supplies. Introduce self, verify
client’s identity, explain what procedure is to be done & why. Perform hand
hygiene, follow infection control measures. Provide privacy. Position client,
Provide comfort & safety. Perform respiratory assessment for baseline
data. Assist the client to a semi-fowlers position. Explain safety precautions to
client & support.
2 Set up oxygen equipment & humidifier:
a. Attach flow meter to wall outlet or tank.
b. Fill humidifier bottle with distilled water, if needed.
c. Attach humidifier bottle to base of flow meter.
d. Attach prescribed oxygen tubing & delivery device to humidifier.
3 Turn on the oxygen at the prescribed rate & ensure proper functioning.
a. Check that oxygen is flowing freely through tubing.
b. Set oxygen at flow rate ordered. If reservoir bag is attached, partially inflate
it with oxygen.
4 Apply the appropriate oxygen delivery device.
Administering Oxygen by Nasal Cannula, Face Mask, or Face Tent
Variation: Using a Nasal Cannula
1 Put cannula with outlet prongs curves downward, fitting into nares; & elastic band
around head or tubing over ears & under chin.
2 Tape cannula at sides of face.

3 Pad tubing & band over ears &cheekbones if needed. Turn on the oxygen at the
prescribed rate & ensure proper functioning.
a. Check that oxygen is flowing freely through tubing.
b. Set oxygen at flow rate ordered. If reservoir bag is attached, partially inflate
it with oxygen.
Variation: Using a Low-Flow Oxygen Nasal Cannula
1 Assess the client’s nares for encrustations and irritation. Apply a water-soluble
lubricant as required to soothe the mucous membranes
2 Assess the top of the client’s ears for any signs of irritation from the cannula strap.
If present, padding with a gauze pad may help relieve the discomfort.
Administering Oxygen by Nasal Cannula, Face Mask, or Face Tent
Variation: Using a High-Flow Oxygen Nasal Cannula
1 Add a heated humidification system to the high-flow oxygen nasal cannula to
prevent upper airways from drying.
2 Assess the air/oxygen blending in the system to ensure that the client who
requires a higher percentage of oxygen has a comfortable & more easily
tolerated alternative to a facemask.
Variation: Using a Face Mask
1 Check size of face mask to make sure it fits client.
2 Guide mask towards client’s face & apply from nose downward.
3 Fit mask & metal nose bracket to contours of client’s face.

4 Secure elastic band around client’s head so that the mask is comfortable but
snug.
5 Pad band behind ears & over bony prominences.
Administering Oxygen by Nasal Cannula, Face Mask, or Face Tent
Variation: Simple Face Mask
1 Verify a minimum of 5 L/min oxygen flow rate

2 Support client having anxiety about having mask covering face.

3 Assist client in eating & drinking with mask applied

4 Consider this mask helpful for a client with nasal breathing difficulties
Variation: Partial Rebreather Mask
1 Verify oxygen flow rate at 6 - 10 L/min

2 Check that oxygen reservoir bag remained one third to one half full during
inspiration.
3 Provide humidification to system as needed.
Administering Oxygen by Nasal Cannula, Face Mask, or Face Tent
Variation: Non - rebreather Mask
1 Verify oxygen flow rate at 10–15 L/min providing highest oxygen concentration
by mask
2 Check to make sure oxygen bag do not totally deflate during inspiration.
3 Support client requiring high supplemental oxygen concentration
Variation: Venturi Face Mask
1 Verify oxygen concentration appropriate for client, varying from 24% to 50%
2 Check oxygen flowmeter is set at appropriate oxygen L/min.
3 Empty condensation that may form in tubing with humidification.
Variation: Face Tent
1 Place tent over client’s face & secure ties around head.

2 Stay with client until client feel at ease with mask

Administering Oxygen by Nasal Cannula, Face Mask, or Face Tent
For All Face Masks & Tents
1 Inspect facial skin frequently for dampness or chafing, & should be dried &
treated as needed.
2 Assess the client regularly.
a. Assess client’s vital signs (including O2 Sat), level of anxiety, color, & ease of
respirations & provide support while client adjusted device.
b. Assess client in 15 to 30 minutes & regularly thereafter.
c. Assess client for clinical signs of hypoxia, tachycardia, confusion, dyspnea,
restlessness, confusion, dyspnea, restlessness & cyanosis.
3 Inspect equipment on regular basis.
a. Check liter flow & level of water in humidifier in 30 minutes & whenever
providing care to client. Change water prn.
b. Make sure that safety precautions are being followed
Variation: Providing Oxygen via a Tracheostomy with
a T-Tube or Tracheostomy Collar
1 Humidity provided with a tracheostomy mist collar.
2 Encourage client to wear a stoma protector.
 Administering Oxygen by CPAP / BIPAP
Variation: Continuous Positive Airway Pressure (CPAP) or
Biphasic Positive Airway Pressure (BiPAP)
1 CPAP provides single positive airway pressure to establish a minimal
airway value at end of exhalation.
2 BIPAP provides two positive airway pressures, one to assist peak
pressure on inhalation (e.g., 10 cm H2O) & a lower one (e.g., 5 cm H2O)
to establish a minimal airway value at end of exhalation
3 BIPAP provide set respiratory rate to augment breathing for client.
4 BIPAP auto titration device sense & measure client’s airflow & adjust
its pressure setting automatically to maintain airway patency.
5 Documented procedure, assessment data, and client’s response
 EQUIPMENT for O2 Therapy
• OXYGEN SOURCE –wall outlet or tank or cylinder
• Flow Meter
• Humidifier filled with distilled water or sterile water
• Oxygen Tubing
• Nasal Cannula or Simple Face Mask
• Plain Gauze / Micropore Tape
• O2 Precaution sign (NO SMOKING SIGN)
• Clean Gloves, Pulse Oximeter
Oxygen Source – O2 Cylinders/Tanks
Centralized Pipe System O2 Supply
 Procedure
PROCEDURE

1 Verify doctor’s order for O2 administration, delivery method, flow rate & duration
of O2 therapy.
2 Gather equipment & supplies, bring to bedside.

3 Identify the patient using at least 2 identifiers. Compare identifiers with

information from doctor’s order & MAR
4 Explain procedure to patient & family - purpose of O2 therapy & most especially
safety precautions. Hang” No Smoking Sign: O2 in Use”. Remove electrical
equipment to avoid short circuit or spark. Avoid use of volatile & flammable
materials/solution. Do not use grease, oil or petroleum products as lubricants.
5 Assess patient respiratory status. Position patient in semi-fowler’s position- for
adult & child. Infant - supine cuddled by mother.
6 Perform hand hygiene. Don gloves.
 Procedure
PROCEDURE

7 Attach O2 delivery device to oxygen tubing & attach to humidifier connected to O2

source. Check O2 is flowing freely from outlets of O2 device.
8A If using Nasal Cannula: Position tips of nasal cannula properly in patient’s & adjust
elastic head band around the head & fix plastic slide on cannula snugly for
patient’s comfort. (or fix around the ears & adjust slider below patient’s chin).
8B If using Face Mask: Adjust elastic band over ears until mask fits comfortably over
patient’s face & mouth by fitting it to the contour of face.
Maintain sufficient slack on O2 tubing & secure to patient’s clothes.
8C If using O2 Tent: Position tent securely & plastic should be tucked under mattress
to prevent escape of O2. Secure edges with blanket to avoid leakage. Determine
O2 concentration & with O2 analyzer.
For all devices: flow rate to prescribed flow rate & according to method of
delivery.
9 Tubing should be free from kinks & connections are airtight. Note for the presence
of bubbles in the humidifier as the O2 flows through the water.
 Procedure
PROCEDURE

10 Observe for proper functioning of O2 delivery device. Needs repositioning if not

properly placed.
a. Cannula: Positioned properly in nares with humidification functioning.
b. Cannula Oxymizer: (Home use). Positioned under patient’s nose & worn as a
pendant.
c. Non Rebreathing Mask: Apply mask over patient’s mouth & nose to form tight
seal. Valves on mask close so exhaled air does not enter reservoir bag.
d. Partial Rebreathing Mask: Apply mask over patient’s mouth & nose to form tight
seal. Ensure that bag remains partially inflated.
e. Venturi Mask: Apply mask over patient’s mouth & nose to form a tight seal.
Select appropriate flow rate as ordered.
f. Face Tent: Apply tent under patient’s chin and over mouth & nose. It should be
loose, & a mist is always present.
11 Verify & double checking on the setting of flow meter & O2 source for proper set
up for prescribed flow rate most especially for young children.
12 Check cannula / mask every 8 hrs (q shift) & keep humidification container filled at
all times.
 Procedure
PROCEDURE

13 Monitor patient’s response to changes in O2 flow rate with pulse oximetry. Monitor
ABG if ordered.
14 Observe for decreased anxiety, improved LOC & cognitive abilities, decreased
fatigue, absence of dizziness, decrease RR improved color, improved O2
saturation & return & check to patient’s baseline VS.
15 Check adequacy of O2 flow every shift.

16 Observe patient’s external ears, bridge of nose, nares & nasal mucous
membranes breakdown. Assess for irritations & encrustations.
17 For home use Oxymizer Nasal Cannula: After giving health teachings. Use the
“Teach Back Technique”. “I want to be sure that I explained how to regulate your
flow rate clear. Can you please show me how will set the flow rate?”
18 Asses & document patient’s response, patient’s color, breathing pattern, chest
movements, vital signs & O2 saturation.
HOW TO PERFORM
SUCTIONING OF
SECRETIONS?
SUCTIONING:
Nasopharyngeal (through the nose) & oropharyngeal (through the
mouth) suctioning are done to clear secretions (mucus) from the
throat if a client is unable to cough out.
NASO PHARYNGEAL SUCTIONING - process of removing
secretions from the nasal cavity & pharynx.
OROPHARYNGEAL SUCTIONING - process of removing secretions
from the oral cavity & pharynx.
NASOTRACHEAL SUCTIONING (NTS) - process of removing
accumulated saliva, pulmonary secretions, blood, vomitus, & other
foreign material from the nasopharyngeal and tracheal area that
cannot be removed by patient’s spontaneous cough.
Yankauer - Hard-plastic tip with a handle usually used to suction
secretions in the mouth
Suction catheter - used to suction secretions in the nose & pharynx.
 PURPOSES OF SUCTIONING
1. Remove excess mucous secretions to maintain patent airway.
2. Remove secretions that obstructs the airway.
3. Collect sputum or secretions for diagnostic testing.
4. Facilitate ventilation
5. Prevent infection that may results from accumulated secretions.
Special Considerations:
Select the proper suction pressure for the type of suction units:

WALL UNIT PORTABLE UNIT

ADULT 100 mm/Hg to 150 mm/Hg 10 mm/Hg to 15 mm/Hg
CHILD 95 mm/Hg to 110 mm/Hg 5 mm/Hg to 10 mm/Hg
INFANT 50 mm/Hg to 95 mm/Hg 2 mm/Hg to 5 mm/Hg
SIZES - SUCTION CATHETERS
SUCTION CATHETER TIPS
 Oropharyngeal & Nasopharyngeal Suctioning
O N
Oropharyngeal (Oral)
● Purpose: to maintain a patent airway &
improve oxygenation by removing mucous
secretions & foreign material (vomitus or
gastric secretions) from the mouth & throat
(oropharynx).
● Slowly remove the catheter while "twirling" it
between your fingers to remove mucus.
Limit suctioning to 5 to 10 seconds. Once
the catheter is out, clean it by dipping it in
the sterile water or saline & suctioning.
Nasopharyngeal
● Purpose: To remove secretions
from the pharynx by a suction
catheter inserted through the
nostril.
● Indicated to maintain a patent
airway & to remove saliva,
pulmonary secretions, blood,
vomitus, or foreign material from
the pharynx.
 NURSING CONSIDERATIONS -Oropharyngeal & Nasopharyngeal
• Suctioning nasopharynx or oropharynx may be • Can lead to trauma to airways, HAI, cardiac
indicated if the pt. is able to raise secretions
dysrhythmia, hypoxia & even death.
from the airways but unable to clear from the
• Decrease complications by:
mouth, or suctioning of the trachea when
o Hyperinflation o Hyperoxygenation
unable to raise secretions from the airways.
o Hyperventilation
• Keep ventilation effective & as effortless as
o Gently rotate catheter, withdraw while
possible.
suctioning, suction for 5-10 seconds
• Aspirate secretions through a catheter
• Can irritate the mucosa.
connected to suction machine or wall suction
• No oxygen from the respiratory tract possibly
outlet.
causing hypoxemia (insufficient oxygen in blood)
• Assess signs of respiratory distress, inability
• Important to oxygenate patient before
to cough up & expectorate secretions, dyspnea,
suctioning, by applying supplemental O2 &
poor skin color, bubbling or rattling breath
taking deep breaths.
sounds, decreased O2.
• When performed correctly, provides comfort
• Monitor pt.’s color & heart rate, color, amount
by relieving respiratory distress.
& consistency of secretions. Stop immediately,
• When performed incorrectly, can increase
administer O2 & notify physician if pt. is
anxiety & pain & cause respiratory arrest.
cyanotic, excessively slow or rapid HR which
• Uncomfortable procedure, can be painful.
indicate hypoxemia or suddenly bloody
secretions which can indicate damage to the
mucosa.
 EQUIPMENT

Disposable suction kit or

Sterile Kidney dish or bowl Wall suction or portable suction unit
Sterile normal saline solution Connecting tubing
Disposable sterile container Sterile suction catheter (#10 to #16
Nasopharyngeal or oropharyngeal airway Fr (French) for an adult)
(optional for frequent suctioning) Overbed table
Sterile gloves Waterproof trash bag
Clean gloves Towel or Inco Pad
Other PPE-Face shield, apron
Sterile Gauze or Tissue
 PROCEDURES:
A. ASESSMENT
1. Assess indications for suctioning:
▪ Audible secretions during respiration
▪ Adventitious breath sounds
2. Assess your facility's policy to determine
whether a physician's order is required for
oropharyngeal suctioning.
3. Assess the client's blood gas or oxygen
saturation values & check vital signs.
4. Assess the client's ability to cough & deep
breathe to determine the ability to move
secretions up the tracheobronchial tree.
5. Assess the client's history for a deviated
septum, nasal polyps, nasal obstruction,
traumatic injury, epistaxis, or mucosal
swelling,
B.PREPARATION
1.Gather all equipment needed & bring at the
bedside.
2. Confirm client’s wrist band using two client
identifiers according to your facility's policy.
Rationale: Checking identification ensures
client safety through concept of correct
procedure for correct client.
3. Explain the procedure to the client even if
the client is unresponsive. Inform the client
that suctioning may stimulate transient
coughing or gagging, but explain that coughing
helps to mobilize secretions.
Rationale: Explanation minimizes anxiety &
fear, which can increase oxygen consumption
 PROCEDURES:
C. PROCEDURAL STEPS
1.Open the suction kit & other materials on the
over bed table, connect & place the suction
equipment within reach.
a)Position the table or stand on your preferred
side of the bed to facilitate suctioning.
b)Connect the tubing to the suction unit.
c) Open the bottle of normal saline solution.
d) Open the waterproof trash bag.
e)Pressure of suction equipment to prevent
trauma to mucous membrane of airways.
f) Appropriate size of sterile suction catheter.
2.Position patient:
Conscious – Semi or High fowler’s,if tolerated,
to promote lung expansion & effective
coughing.
Unconscious, position the client on his side /
lateral facing you to help promote drainage of
secretions.
3.Perform Hand hygiene. Don appropriate PPE.
4. Turn on the suction from the wall or portable
unit & set the pressure according to your
facility's policy. The pressure may be set
between 100 & 150 mm Hg. Occlude the end of
the connecting tubing to check suction
pressure.
5. Length of catheter - Nose-Earlobe (13 cm) or
5 inches. Lubricate- Naso- water soluble
lubricant or Oro- sterile water or NSS.
6. Place a towel across the client's chest.
7. Using strict aseptic technique, open the
suction catheter kit or the packages containing
the sterile catheter, container, & gloves.
Don the gloves; consider your dominant hand
sterile & your nondominant hand nonsterile.
Using your nondominant hand, pour the saline
solution into the sterile container.
 PROCEDURES:
C. PROCEDURAL STEPS
8. Pick up the catheter with your dominant
(sterile) hand & attach it to the connecting
tubing .Use your non-dominant hand to control
the suction valve while your dominant hand
manipulates the catheter.
9. Lubricate 3" to 4" of the catheter tip with
irrigating solution
Rationale: Lubrication prevents mucosal
trauma when catheter is inserted.
10. Instruct the client to cough & breathe
slowly & deeply several times before
beginning suction.
Rationale: Coughing helps loosen secretions &
may decrease amount of suction necessary,
while deep breathing helps minimize or
prevent hypoxia.
11. Raise the tip of the client's nose with your
non-dominant hand to straighten the
passageway & facilitate insertion of the
catheter. Without applying suction, gently
insert the suction catheter into the client's
nares. Roll the catheter between your fingers
to help it advance through the turbinates.
Continue to advance the catheter,
approximately 5" to 6" (12.7 to 15 cm), until you
reach the pool of secretions or the client
begins to cough.
12. Using intermittent suction, withdraw
catheter from the nose with a continuous
rotating motion to minimize invagination of the
mucosa into the catheter's tip & side ports.
Rationale: Apply suction for only 10 to 15
seconds at a time to minimize tissue trauma.
 C. PROCEDURAL STEPS
13. Between passes, wrap the catheter
around your dominant (sterile) hand to
prevent contamination & clear the lumen of
the catheter by dipping it in water &
applying suction.
14. Repeat the procedure, up to 3 times,
until gurgling or bubbling sounds stop &
respirations are quiet.
Rationale: Allow 30 seconds to 1 minute to
allow reoxygenation & re-ventilation.
15. If the client has no history of nasal
problems, alternate suctioning between
nostrils to minimize traumatic injury. If
repeated nasopharyngeal suctioning is
required, the use of a nasopharyngeal or
oropharyngeal airway will help with
catheter insertion, reduce traumatic injury
& promote a patent airway.
16. After completing suctioning, pull your sterile
glove off over the coiled catheter & discard it &
the nonsterile glove along with the container of
water. Rationale: Glove removal reduces transfer
of microorganisms.
17. Flush the connecting tubing with normal saline
solution.
18. Discard the used items & replace with new
supplies so they will be ready for the next
suctioning.
Rationale: Having the supplies at the bedside
facilitates a quick response.
19. Remove personal protective equipment &
perform hand hygiene.
20. Let the client rest after suctioning while
continuing to observe. The frequency & duration
of suctioning depend on the client's tolerance for
the procedure.
21. Document date, time, purpose & technique ;
amount, color, consistency, & odor (if any) of the
secretions; patient’s response.
 Oropharyngeal, Nasopharyngeal & Nasotracheal Suctioning
1 Preparation:
a. Check physician’s order & gather equipment & supplies.
b. Introduced self, verify client’s identity, explain the purposes of procedure .
c. Perform hand hygiene & follow infection control measures.
d. Provide privacy.
e. Provide comfort & safety for client & self. Raise bed to appropriate height.
2 Prepare client.
a. Position conscious patient with functional gag reflex in semi-Fowler position
with head turned to one side for oral suctioning or with neck hyperextended for
nasal suctioning.
b. Position unconscious client in lateral position facing self.
c. Place towel or moisture-resistant pad over pillow or under chin.
3 3. Prepared the equipment.
a. Turned suction device on & set to appropriate negative pressure on suction gauge.
For Oral & Oropharyngeal Suction
b. Apply clean gloves.
c. Moisten tip of Yankauer or suction catheter with sterile water or saline.
d. Pull tongue forward, if necessary, using gauze.
 Oropharyngeal, Nasopharyngeal, and Nasotracheal Suctioning
3 e. Do not apply suction during insertion.
Cont f. Advance catheter about 10 to15 cm (4 to 6 in.) along one side of mouth
into oropharynx.
g. Apply suction to secretions that collect in vestibule of mouth & beneath
the tongue, if necessary.
h. Remove & discard gloves. Perform hand hygiene.
For Nasopharyngeal & Nasotracheal Suction
b. Open lubricant.
c. Open sterile suction package.
d. With sterile gloved hand, pick up sterile suction catheter & attach it to
suction connecting tubing being held in non-sterile gloved hand.
e. Test pressure of suction & patency of catheter by applying sterile
gloved finger or thumb to port or open branch of Y-connector to create
suction.
f. As needed, apply or increase supplemental oxygen.
4 Lubricate & introduce the catheter.
a. Lubricate catheter tip with sterile water or saline.
b. Remove oxygen with non-dominant hand, if appropriate.
c. Without applying suction, insert catheter into either naris & advance
it along floor of nasal cavity
Oropharyngeal, Nasopharyngeal, and Nasotracheal Suctioning
5 Perform suctioning:
a. Apply finger to the suction control port to start suction & gently
rotated the catheter.
b. Apply intermittent suction for 5 to 10 seconds while slowly
withdrawing the catheter. Remove finger from the control & remove
the catheter
6 Rinse catheter & repeat suctioning as before.
a. Rinse & flush catheter & tubing with sterile water or saline.
b. Relubricate catheter & repeat suctioning until air passage is
clear.
c. Allow sufficient time between each suction for ventilation &
oxygenation. Limit suctioning to a total of 5 minutes.
d. Encourage client to breathe deeply & cough between suctions.
Use supplemental oxygen, if appropriate.
 Oropharyngeal, Nasopharyngeal, and Nasotracheal Suctioning
7 7. Obtain specimen if required.
a. Use a sputum trap.
b. Attach suction catheter to tubing of sputum trap.
c. Attach suction tubing to sputum trap air vent.
d. Suction client.
e. Remove catheter from client. Disconnect sputum trap
tubing from suction catheter. Remove suction tubing from
trap air vent.
f. Connect tubing of sputum trap to air vent.
g. Connect suction catheter to tubing.
h. Flush the catheter to remove secretions from tubing
 Oropharyngeal, Nasopharyngeal, and Nasotracheal Suctioning
8 Promote client comfort.
a. Offer to assist client with oral or nasal hygiene.
b. Assist client to position that facilitates breathing
9 Dispose of equipment & ensure availability for next suction.
a. Dispose of catheter, gloves, water, & waste container.
b. Empty & rinse suction collection container as needed or indicated by
protocol.
c. Ensure supplies are available for next suctioning.
10 Assess effectiveness of suctioning.
a. Auscultate client’s breath sounds & ensure they were clear of
secretions.
b.Observe skin color, RR, HR, level of anxiety, & O2 Saturation levels.
11 Return bed to lowest height. Perform hand hygiene.
12 Document procedure, client’s response & assessment data in client’s
record.
 Oropharyngeal, Nasopharyngeal, and Nasotracheal Suctioning
Variation: Suctioning an Infant with a Bulb Syringe
1 A bulb syringe is used to remove secretions from an infant’s nose or mouth.

2 Obtain an assistant if needed.

3 Don gloves & place saline nose drops in a naris

4 Deflate the bulb. Insert the tip of the bulb syringe into the infant’s naris.

5 Release the bulb & remove the syringe from the naris. Expel the secretions
into the proper receptacle.
6 Repeat the procedure in the other naris.
Assess the child’s ability to breathe easily.
Repeat the suctioning as necessary.
REFERENCES:
From FUNDA Module CU 11
Thanks!
Pearson Ltd, Skills Checklist, My Lab 2015
Maternal & Child health Nursing-Pilliteri
Fundamentals of Nursing-Potter & Perry
Fundamentals of Nursing – Kozier & Erbs, 2016, 2022

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