Suctioning Technique

SUCTIONING

• aspiration of secretions through a catheter connected to a suction machine or wall suction outlet

Rationale for suctioning include: to remove secretions that obstruct the airway to facilitate ventilation (either via nasopharynx, oropharynx,

tracheostomy or endotracheal tube) to obtain secretions for diagnostic purposes to prevent infection that may result from accumulated

secretions

• Although the upper airways (oropharynx and nasopharynx) are not sterile, sterile technique is recommended for all suctioning to avoid introducing pathogens into the airways

• Suction catheters may be either open tipped or whistle tipped. The whistle-tipped catheter may be more effective for removing thick mucous plugs. Most suction catheters have a thumb port on the side to control the suction.

Open tip suction catheter

Whistle tip suction catheter

SUCTIONING

• Measure the depth for insertion (tip of nose to earlobe) which usually measures approximately 5” or 13 cm.

• Rotate the catheter when suctioning (not when inserting the catheter)

• Encourage deep breathing and coughing

• Always use the least amount of pressure necessary when suctioning (use appropriate suction settings)

Assessing the need for suctioning

• Oropharyngeal and nasopharyngeal suctioning removes secretions from the upper respiratory tract

• The nurse should auscultate the lung fields and note any adventitious sounds (crackles, rhonchi, rales, wheezing), NOT “coarse” breath sounds.

• Also, upper airway needs to be adequately assessed for any obstruction by secretions

• Other clinical signs indicating the need for suctioning may include: – restlessness– gurgling sounds during

respiration– skin color (pallor, cyanosis)– rate and pattern of respirations

(retractions, use of accessory muscles, flaring, grunting, etc.)

– pulse rate and rhythm– decreased SaO2 levels (O2

saturation)– change in mental status

• Too frequent suctioning may cause irritation of mucous membranes and increase secretions.

• A suction attempt should last =< 10 seconds.

• There should be 20-30 second intervals between each suction (non-respiratory or O2 dependent)

• Limit suctioning to 5 minutes in total

• Applying suction for too long may cause increased secretions &/or decrease the client’s oxygen demand.

Complications of suctioning

• Hypoxemia• Trauma to the airway• Nosocomial infection• Cardiac dysrhythmia (related to the

hypoxemia)

• Perform vital signs pre-suctioning (baseline) and post-suctioning

• Positioning: – Conscious person (+ gag reflex):

• Oropharyngeal suctioning: in semi-Fowler’s position with head turned to one side

• Nasopharyngeal suctioning: with the neck hyper-extended (nasopharyngeal suctioning). This will facilitate insertion of the catheter and help prevent aspiration.

– Unconscious client should be placed in a lateral position, facing you (risk for vomiting).

Oro / nasopharyngeal suctioning

SUCTIONING OF THE NEWBORN

ORAL SUCTIONING

Insertion of suction catheter into the mouth in order to remove sputum, saliva or aspirate

ORAL SUCTIONINGPROCEDURE

Turn the baby’s head to one side. Suction gently and quickly (5 to 10 seconds). = bradycardia. Suction the MOUTH first before the nose.

ASPIRATION. REMEMBER: newborns are NASAL BREATHERS.

NASOPHARYNGEAL

SUCTIONING Intended to remove accumulated saliva, pulmonary

secretions, blood, vomitus, and other foreign material from the trachea and nasopharyngeal area that cannot be removed by the patient's spontaneous cough or other less invasive procedures.

PROCEDURE: Position with the neck hyper-extended (nasopharyngeal suctioning). This will facilitate insertion of the catheter and help prevent aspiration Insert the catheter without applying suction into either naris and advance

it along the floor of the nasal cavity. (This avoids the nasal turbinates). Never force the catheter against an obstruction. If one nostril is

obstructed, try the other.

OROPHARYNGEAL SUCTIONING

used when the patient is able to cough effectively but is unable to clear secretions.

PROCEDURE: Pull the tongue forward, using gauze if necessary. Do not apply suction during insertion. (Applying suction during insertion causes trauma to mucous membranes). Advance the catheter about 10–15 cm along one side of the

mouth into the oropharynx, and suction the secretion that collect in the vestible of the mouth and under tongue.

GAVAGE FEEDING OF THE NEWBORN

forced feeding or irrigation through a tube passed into the stomach.

a procedure in which a tube passed through the nose or mouth into the stomach

used to feed a newborn with weak sucking, uncoordinated sucking and swallowing, respiratory distress, tachypnea, or repeated apneic spells.

GAVAGE FEEDING OF THE NEWBORN

GAVAGE FEEDING PROCEDURE

placement is checked by radiography or by instillation of air and auscultation of the stomach

infant is held in a low Fowler's position, preferably by the mother, and is restrained only if necessary.

feeding syringe is held 18 centimeters above the infant's head, and the flow is initiated by pressure on the plunger

to prevent air from entering the stomach when the feeding is completed, the tube is pinched closed as it is withdrawn.

GAVAGE FEEDING PROCEDURE

The infant is burped gently by patting or rubbing the back and then positioned on the right side in the crib.

Postural drainage and percussion are avoided for at least 1 hour after feeding.

The time, amount, and kind of feeding and the size of tube used are entered in the nursing care plan.