Oropharyngeal , nasopharyngeal and naso tracheal suctioning

Step by step procedure by Kozier Oropharyngeal, nasopharyngeal and nasotracheal suctioning

1. OROPHARYNGEAL , OROPHARYNGEAL ,
NASOPHARYNGEAL AND NASO NASOPHARYNGEAL AND NASO
TRACHEAL SUCTIONINGTRACHEAL SUCTIONING
PREPARED BY: JESSICA M. SALDANA, RN., MANPREPARED BY: JESSICA M. SALDANA, RN., MAN

2. ORAL OROPHARYNGEALORAL OROPHARYNGEAL

3. Nasopharyngeal CatheterNasopharyngeal Catheter

4. Nasopharyngeal CatheterNasopharyngeal Catheter

5. Nasopharyngeal CatheterNasopharyngeal Catheter

6. PURPOSESPURPOSES
•To remove secretions that obstruct the airwayTo remove secretions that obstruct the airway
•To facilitate ventilationTo facilitate ventilation
•To obtain secretions for diagnostic purposesTo obtain secretions for diagnostic purposes
•To prevent infection that may result from To prevent infection that may result from
accumulated secretionsaccumulated secretions

7. ASSESSMENTASSESSMENT
Assess for clinical signs indicating the need for suctioning:Assess for clinical signs indicating the need for suctioning:
•RestlessnessRestlessness
•Gurgling sounds during respirationsGurgling sounds during respirations
•Adeventitious sounds when the chest is being Adeventitious sounds when the chest is being
auscultatedauscultated
•Change in mental statusChange in mental status
•Skin colorSkin color
•Rate and pattern of respirationsRate and pattern of respirations
•Pulse rate and rhythmPulse rate and rhythm
•Decreased oxygen saturationDecreased oxygen saturation

8. PLANNINGPLANNING
DelegationDelegation
Oral suctioning using the yankuer suction tube and Oral suctioning using the yankuer suction tube and
oropharyngeal suctioning using a suction catheter can oropharyngeal suctioning using a suction catheter can
be deligated to UAP and to the client or family, if be deligated to UAP and to the client or family, if
appropriate, since this is not a sterile. The nurse needs appropriate, since this is not a sterile. The nurse needs
to review the procedure and important points such as to review the procedure and important points such as
not applying suction during insertion of the tube to not applying suction during insertion of the tube to
avoid trauma to the mucous membranes. In contrast, avoid trauma to the mucous membranes. In contrast,
nasopharyngeal and nasotracheal suctioning uses sterile nasopharyngeal and nasotracheal suctioning uses sterile
technique and requires application of knowledge and technique and requires application of knowledge and
problem solving and should be performed by the nurse problem solving and should be performed by the nurse
or respiratory therapist.or respiratory therapist.

9. EQUIPMENTEQUIPMENT
Oral and Nasopharyngeal/Nasotracheal SuctioningOral and Nasopharyngeal/Nasotracheal Suctioning
•Towel or moisture resistant padTowel or moisture resistant pad
•Portable or wall suction machine with tubing, collection Portable or wall suction machine with tubing, collection
receptacle, and suction pressure gaugereceptacle, and suction pressure gauge
•Sterile disposable container for fluidsSterile disposable container for fluids
•Sterile normal saline or waterSterile normal saline or water
•Goggles or face shield, if approoriateGoggles or face shield, if approoriate
•Moisture-resistant disposable bagMoisture-resistant disposable bag
•Sputum trap, if specimen is to be collectedSputum trap, if specimen is to be collected

10. EQUIPMENTEQUIPMENT
Oral and Oropharyngeal SuctioningOral and Oropharyngeal Suctioning
•Yankauer suction catheter or suction catheter kitYankauer suction catheter or suction catheter kit
•Clean glovesClean gloves
Nasopharyngeal or Nasotracheal SuctioningNasopharyngeal or Nasotracheal Suctioning
•Sterile glovesSterile gloves
•Sterile suctrion catheter kit (# 12 to # 18 Fr. For adults, # 8 to Sterile suctrion catheter kit (# 12 to # 18 Fr. For adults, # 8 to
# 10 Fr. For children, and # 5 to # 8 for infants)# 10 Fr. For children, and # 5 to # 8 for infants)
•Water soluble lubricantWater soluble lubricant
•Y- connectorY- connector

11. IMPLEMENTATIONIMPLEMENTATION
PerformancePerformance
1.1.Prior to performing the procedure, introduce self and verify Prior to performing the procedure, introduce self and verify
the client’s identity using agency protocol. Explain to the the client’s identity using agency protocol. Explain to the
client what you are going to do, why it is necessary, and how client what you are going to do, why it is necessary, and how
he or she can cooperate. Inform the client that suctioning will he or she can cooperate. Inform the client that suctioning will
relieve breathing difficulty and that the procedure is painless relieve breathing difficulty and that the procedure is painless
but may be uncomfortable and stimulate the cough, gag, or but may be uncomfortable and stimulate the cough, gag, or
sneeze reflex. sneeze reflex. RATIONALERATIONALE: : Knowing that the procedure Knowing that the procedure
will relieve breathing problems is often reassuring and will relieve breathing problems is often reassuring and
enlists the client’s cooperation.enlists the client’s cooperation.
2.2.Perform hand hygiene and observe other appropriate infection Perform hand hygiene and observe other appropriate infection
control procedures.control procedures.
3.3.Provide for client privacyProvide for client privacy

12. Yankauer suction catheterYankauer suction catheter

13. IMPLEMENTATIONIMPLEMENTATION
4.4.Prepare the clientPrepare the client
•Position a conscious person who has a functional gag reflex in semi Position a conscious person who has a functional gag reflex in semi
Fowler’s position with the head turned to one side for oral suctioning or Fowler’s position with the head turned to one side for oral suctioning or
with the neck hyper extended for nasal suctioning. with the neck hyper extended for nasal suctioning. RATIONALE: RATIONALE: These These
positions facilitate the insertion of catheter and help prevent positions facilitate the insertion of catheter and help prevent
aspiration of the secretionsaspiration of the secretions
•Position an unconscious client in the lateral position, facing you. Position an unconscious client in the lateral position, facing you.
RATIONALE: RATIONALE: This position allows the tongue to fall forward, so This position allows the tongue to fall forward, so
that it will not obstruct the catheter on insertion. The lateral position that it will not obstruct the catheter on insertion. The lateral position
also facilitates drainage of secretions from the pharynx and prevents also facilitates drainage of secretions from the pharynx and prevents
the possibility of aspiration.the possibility of aspiration.
•Place the towel or moisture resistant pad over the pillow or under the chinPlace the towel or moisture resistant pad over the pillow or under the chin

14. IMPLEMENTATIONIMPLEMENTATION
5.5.Prepare the equipment.Prepare the equipment.
•Set the pressure on the suction gauge, and turn on the suction. Set the pressure on the suction gauge, and turn on the suction.
Many suction devices are calibrated to three pressure ranges. Many suction devices are calibrated to three pressure ranges.
•Wall unit:Wall unit:
Adult: 100 to 120 mm.Hg.Adult: 100 to 120 mm.Hg.
Child: 95 to 110 mm.Hg.Child: 95 to 110 mm.Hg.
Infant: 50 to 95 mm.Hg.Infant: 50 to 95 mm.Hg.
•Portable unit:Portable unit:
Adult: 10 to 15 mm. Hg.Adult: 10 to 15 mm. Hg.
Child: 5 to 10 mm. Hg.Child: 5 to 10 mm. Hg.
Infant: 2 to 5 mm. Hg.Infant: 2 to 5 mm. Hg.

15. IMPLEMENTATIONIMPLEMENTATION
For Oral and Oropharyngeal SuctionFor Oral and Oropharyngeal Suction
•Moisten the tip of the Yankauer or suction catheter with sterile Moisten the tip of the Yankauer or suction catheter with sterile
saline water or saline. RATIONALE: This reduces friction and saline water or saline. RATIONALE: This reduces friction and
eases insertion.eases insertion.
•Pull the tongue forward, if necessary, using gauze.Pull the tongue forward, if necessary, using gauze.
•Do not apply suction. RATIONALE: Applying suction during Do not apply suction. RATIONALE: Applying suction during
insertion causes trauma to th emucous membrane.insertion causes trauma to th emucous membrane.
•Advance the catheter about 10 to 15 cm. ( 4 to 6 in.) along one Advance the catheter about 10 to 15 cm. ( 4 to 6 in.) along one
side of the mouth into the oropharynx. RATIONALE: side of the mouth into the oropharynx. RATIONALE:
Directing the catheter along the sides prevents gagging.Directing the catheter along the sides prevents gagging.
•It maybe necessary during the oropharyngeal suctioning to apply It maybe necessary during the oropharyngeal suctioning to apply
suction to secretions that collect in the vestibule of the mouth suction to secretions that collect in the vestibule of the mouth
and beneath the tongue.and beneath the tongue.

16. IMPLEMENTATIONIMPLEMENTATION
For Nasopharyngeal and Nasotracheal SuctionFor Nasopharyngeal and Nasotracheal Suction
•Open the lubricant if performing nasopharyngeal/nasotrecheal suctioningOpen the lubricant if performing nasopharyngeal/nasotrecheal suctioning
•Open the sterile suction packageOpen the sterile suction package
a. Set up the container, touching only the outside.a. Set up the container, touching only the outside.
b. Pour sterile water or saline into the container.b. Pour sterile water or saline into the container.
c. Put on sterile gloves, or put on a non sterile gloves on the non dominant c. Put on sterile gloves, or put on a non sterile gloves on the non dominant
hand. RATIONALE: The sterile glove hand maintains the sterility of the hand. RATIONALE: The sterile glove hand maintains the sterility of the
suction catheter, and the un sterile gloves prevents the transmission of suction catheter, and the un sterile gloves prevents the transmission of
microorganism to the nurse.microorganism to the nurse.
•With your sterile gloved hand, pick up the catheter and attach it to the With your sterile gloved hand, pick up the catheter and attach it to the
suction unit.suction unit.
6.6.Make an approximate depth of insertion of the catheter and test the Make an approximate depth of insertion of the catheter and test the
equipment.equipment.
•Measure the distance betwteen the tip of the client’s nose and the earlobe, or Measure the distance betwteen the tip of the client’s nose and the earlobe, or
about 13 cm ( 5 in.) for an adult.about 13 cm ( 5 in.) for an adult.
•Mark the position on the tube with the fingers of the sterile gloved hand. Mark the position on the tube with the fingers of the sterile gloved hand.

17. IMPLEMENTATIONIMPLEMENTATION
•Test the pressure of the suction and the patency of the catheter by Test the pressure of the suction and the patency of the catheter by
applying your sterile gloved finger or thumb to the port or open branch of applying your sterile gloved finger or thumb to the port or open branch of
the Y- connector to create suction.the Y- connector to create suction.
7.7.Lubricate and introduce the catheter.Lubricate and introduce the catheter.
•Lubricate the catheter tip with saline water, or sterile water or water soluble Lubricate the catheter tip with saline water, or sterile water or water soluble
lubricant. RATIONALE: This reduces friction and eases insertion.lubricant. RATIONALE: This reduces friction and eases insertion.
•Remove oxygen with the non dominant hand, and if appropriate.Remove oxygen with the non dominant hand, and if appropriate.
•Without applying suction, inset the catheter the pre measured or Without applying suction, inset the catheter the pre measured or
recommend distance into their naris and advance it along the floor of the recommend distance into their naris and advance it along the floor of the
nasal cavity. RATIONALE: This avoids the nasal turbinates.nasal cavity. RATIONALE: This avoids the nasal turbinates.
8.8.Perform suctioning.Perform suctioning.
•Apply your finger to the suction control port to start suction, and gently Apply your finger to the suction control port to start suction, and gently
rotate the catheter. RATIONALE: Gentle rotation of the catheter ensures rotate the catheter. RATIONALE: Gentle rotation of the catheter ensures
that all surfaces are reached and prevents trauma to any one area of the that all surfaces are reached and prevents trauma to any one area of the
respiratory mucosa due to prolonged suction.respiratory mucosa due to prolonged suction.
•Apply suction for 5 to 10 seconds while slowly withdrawing the catheter , Apply suction for 5 to 10 seconds while slowly withdrawing the catheter ,
then remove the finger from the control and remove the catheter .then remove the finger from the control and remove the catheter .

18. IMPLEMENTATIONIMPLEMENTATION
9.9.Rinse the catheter and repeat suctioning as Rinse the catheter and repeat suctioning as
above.above.
•Rinse and flush the catheter and tubing with Rinse and flush the catheter and tubing with
sterile water or saline.sterile water or saline.
•Relubricate the catheter, and repeat suctioning Relubricate the catheter, and repeat suctioning
until the air passage is clear.until the air passage is clear.
•Allow sufficient time between each suctionAllow sufficient time between each suction

19. •THE ENDTHE END