NasoOropharyngeal review for nursing procedure only.pptx

the ppt is use for learning only

1. 1 REVIEW ORONASOPHARYNGEAL SUCTION Presentation by HENG PANHA, TL ER,RR AND ICU

2. 2 OBJECTIVE Definition Implementation the procedure Complication Patient Teaching Content

3. 9/13/2024 ORIENDA POLICLINIC & MATERNITY 3 I. OBJECTIVE To understand why we do the procedure To know when to do the Oro nasopharyngeal With whom nurse could do the procedure To study about advantage and disadvantage of the procedure Review how to perform the procedure

4. 9/13/2024 ORIENDA POLICLINIC & MATERNITY 4 II. Definition Oronasopharyngeal suction removes secretions from the pharynx by a suction catheter inserted through the mouth or nostril. Use to helps the patient who can’t clear the airway effectively with coughing and expectoration should be performed as often as necessary, depending on the patient’s condition.

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6. Implementation the procedure Preparing of equipment: Wall suction or portable suction unit with connecting tubing Water-soluble lubricant ▪ sterile normal saline solution disposable sterile container sterile suction catheter (#10 to #16 French) sterile gloves overbed table Towel stethoscope disinfectant pad Optional: tongue blade, tonsil-tip suction device, nasopharyngeal or oropharyngeal airway (optional for frequent suctioning), gown, mask and goggles or mask with face shield. A commercially prepared kit contains a sterile catheter, a disposable container, and sterile gloves. 9/13/2024 ORIENDA POLICLINIC & MATERNITY 6

7. Preparation of equipment Gather and place the suction equipment on the patient’s overbed table or bedside stand. Position the table or stand on your preferred side of the bed to facilitate suctioning. Connect the tubing to the suctioning unit. Date and then open the bottle of normal saline solution. 9/13/2024 ORIENDA POLICLINIC & MATERNITY 7

8. Implementation Verify the practitioner’s order for oropharyngeal suctioning if your facility requires one. Review the patient’s blood gas or oxygen saturation values and vital signs. Check the history for contraindications, such as a deviated septum, nasal polyps, nasal obstruction, traumatic injury, facial trauma, epistaxis, or mucosal swelling. Gather and prepare the appropriate equipment. Perform hand hygiene. Confirm the patient’s identity using at least two patient identifiers. 9/13/2024 ORIENDA POLICLINIC & MATERNITY 8

9. Implementation Provide privacy . Explain the procedure to the patient (even if unresponsive) and family (if appropriate) according to their individual communication and learning needs to increase their understanding, allay their fears, and enhance cooperation Raise the patient’s bed to waist level during patient care to prevent caregiver back strain. Perform hand hygiene. Put on personal protective equipment, as appropriate, to comply with standard precautions. 9/13/2024 ORIENDA POLICLINIC & MATERNITY 9

10. Implementation (Cont.'s) Evaluate the patient’s respiratory status and ability to cough and deep-breathe to determine the patient’s ability to move secretions up the tracheobronchial tree. If you are suctioning through the nose, determine which nostril is more patent. Place the patient in the semi-Fowler or high Fowler position, if tolerated, to promote lung expansion and effective coughing. If the patient is unconscious, use the side-lying position with the patient facing you to help promote drainage of secretions. Place a towel across the patient’s chest. Turn on the suction from the wall or portable unit and set the pressure, typically to between 100 and 120 mm Hg ; higher pressures cause excessive trauma without enhancing secretion removal. 9/13/2024 ORIENDA POLICLINIC & MATERNITY 10

11. Implementation (Cont.'s) Occlude the end of the connecting tubing to check suction pressure. Using sterile technique, open the suction catheter kit or the packages containing the sterile catheter, container, and gloves. Perform hand hygiene. Put on sterile gloves;16 consider your dominant hand sterile and your nondominant hand nonsterile. Using your nondominant hand, pour the saline solution into the sterile container. With your nondominant hand, place a small amount of water-soluble lubricant on the sterile area of the catheter. The lubricant facilitates passage of the catheter during nasopharyngeal suctioning. Pick up the catheter with your dominant (sterile) hand and attach it to the connecting tubing. Use your nondominant hand to control the suction valve while your dominant hand manipulates the catheter. 9/13/2024 ORIENDA POLICLINIC & MATERNITY 11

12. Implementation (Cont.'s) Dip the catheter into the sterile normal saline solution to moisten the inside of the catheter. Instruct the patient to cough and to breathe slowly and deeply several times before you begin suctioning. 9/13/2024 ORIENDA POLICLINIC & MATERNITY 12

13. Implementation (Cont.'s) For nasal insertion Raise the tip of the patient’s nose with your nondominant hand to straighten the passageway and facilitate insertion of the catheter. Without applying suction, gently insert the suction catheter into the patient’s nostril 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 15.2 cm) until you reach the pool of secretions or the patient begins to cough. 9/13/2024 ORIENDA POLICLINIC & MATERNITY 13

14. Implementation (Cont.'s) For oral insertion Without applying suction, gently insert the catheter into the patient’s mouth. Advance it 3″ to 4″ (7.6 to 10.2 cm) along the side of the patient’s mouth until you reach the pool of secretions or the patient begins to cough. Suction both sides of the patient’s mouth and pharyngeal area. 9/13/2024 ORIENDA POLICLINIC & MATERNITY 14

15. Implementation (Cont.'s) Completing the procedure Using intermittent suction, withdraw the catheter from either the mouth or the nose with a continuous rotating motion to minimize invagination of the mucosa into the catheter’s tip and side ports. Apply suction for no longer than 10 seconds at a time to minimize tissue trauma. Between passes, wrap the catheter around your dominant hand to prevent contamination. If secretions are thick, clear the lumen of the catheter by dipping it in normal saline solution and applying suction. Repeat the procedure, up to three times, until gurgling or bubbling sounds stop and respirations are quiet. Allow 30 seconds to 1 minute to allow reoxygenation and reventilation . 9/13/2024 ORIENDA POLICLINIC & MATERNITY 15

16. After completing suctioning, pull your sterile glove off over the coiled catheter and discard it. Flush the connecting tubing with normal saline solution. Then discard the container of normal saline solution and remove your other glove. Return the bed to the lowest position to prevent falls and maintain patient safety. Remove and discard other personal protective equipment, if worn. Perform hand hygiene. Reassess the patient’s respiratory status to evaluate the patient’s tolerance and the effectiveness of the procedure. Clean and disinfect your stethoscope using a disinfectant pad. Perform hand hygiene. Document the procedure. 9/13/2024 ORIENDA POLICLINIC & MATERNITY 16

17. Implementation (Cont.'s) Documentation Record the date, time, reason for suctioning, and technique used the amount, color, consistency, and odor (if any) of the secretions the patient’s respiratory status before and after the procedure any complications and the nursing actions taken the patient’s tolerance of the procedure. Document any patient teaching and the patient’s understanding of the teaching. 9/13/2024 ORIENDA POLICLINIC & MATERNITY 17

18. Special considerations If the patient has no history of nasal problems, alternate suctioning between nostrils to minimize traumatic injury. If the patient requires repeated oronasopharyngeal suctioning, the use of a nasopharyngeal or oropharyngeal airway will help with catheter insertion, reduce traumatic injury, and promote a patent airway. If the patient has excessive oral secretions, consider using a tonsil-tip suction device, which allows the patient to remove oral secretions independently. Let the patient rest after suctioning while you continue to observe. The frequency and duration of suctioning depend on the patient’s tolerance of the procedure and on complications . 9/13/2024 ORIENDA POLICLINIC & MATERNITY 18

19. Complicatons : Pain at the site Inflamation Increased dyspnea caused by hypoxia and Anxiety may result from this procedure. bloody aspirate can result from prolonged or traumatic suctioning. 9/13/2024 ORIENDA POLICLINIC & MATERNITY 19

20. Patient teaching Oronasopharyngeal suctioning may be performed in the home using a portable suction machine. Under these circumstances, suctioning is a clean rather than a sterile procedure. Properly cleaned catheters can be reused, putting less financial strain on the patient. Whether the patient requires disposable or reusable suction equipment, make sure that the patient and caregivers have received proper teaching and support. 9/13/2024 ORIENDA POLICLINIC & MATERNITY 20

21. Refference Lippincott/2019/Nursing Procedures eight edition / Oronasopharyngeal suction/page 2378/Wolters Kluwer Picture from Google 9/13/2024 ORIENDA POLICLINIC & MATERNITY 21

22. 22 THANK YOU!