oral and nasopharyngeal suction - bcpft.nhs.uk

Oral & Nasopharyngeal Suction Policy

Version 1.1 January 2015

Oral and Nasopharyngeal Suction

Target Audience

Who Should Read This Policy

All clinical staff


Version 1.1 January 2015 2

Oral and nasopharyngeal Suction policy for children in the

Black Country Partnership Foundation NHS Trust

Contents Page 1. Introduction…………………………………………………………….. 4 2. Purpose………………………………………………………………… 4 3. Objectives……………………………………………………………… 4 4. Definitions……………………………………………………………… 4 5 Duties……………………………………………………………………. 4 6 Process…………………………………………………………………..6 7. Monitoring Compliance……………………………………………….. 9 8. Standards / Key Performance indicators…………………………….10 9. Equality impact Assessment and Data Protection………………….10 10. Links to other policies, procedures or legislation………………….11 11. References and Appendices……………………………………….. 11 Appendix 1 Oral and Nasopharyngeal suction…………………………11 competency document and Care Plan



1. Introduction 1.1 The policy is being put in place to enable health care professionals to care for children who are unable to maintain a clear airway themselves and may require suction to help remove secretions from their upper airway. 2. Purpose 2.1 The following clinical procedures provide nurses and carers of children requiring oral and nasopharyngeal suction with a framework that promotes safe, consistent practice and enables nurses and carers to support and guide the child and carers within the community setting. 2.2 It is the policy of Black Country Partnership Foundation Trust that these procedures will be followed to ensure the safe and appropriate administration of oral and nasopharyngeal suction. 2.3 The procedure advice document should be used in conjunction with the competence document for oral and nasopharyngeal suctioning. An individual should not carry out the task without being deemed competent by the trust having completed the competency document and deemed fit to practice. 3. Objectives 3.1 These procedures and guidance apply to all BCPFT staff and staff working on behalf of the trust caring for children requiring oral and nasopharyngeal suction. 3.2 The requirement for oral and nasopharyngeal suction will depend on the child’s individual needs, according to their individualised care plan. 3.3 These procedures must be read in conjunction with the BCPFT Management of Medical Devices and Infection Prevention Policies. 4. Definitions 4.1 By oral suction we mean suction of the mouth. Nasopharyngeal means suction of the nasal cavity. 5. Duties : Staff/ Groups / individuals. 5.1 All healthcare professionals are responsible for their own actions and must exercise their own professional judgment at all times. However, any decisions to vary from the agreed BCPFT procedures or guidelines should be documented in



the patients care plan, and include the reason for variance and the subsequent action taken. Individuals 5.2 The Individual line manager is responsible for ensuring that the procedures are made available to the staff they manage involved in the care of children requiring oral and nasopharyngeal suction. 5.3 The Childs nurse responsible for the care of the child requiring oral and/or nasopharyngeal suction should discuss and agree the responsibilities with the child and carers for routine administration of oral and nasopharyngeal suction and document in a care plan. 5.4 The Clinical Lead for Children, Young People and Families is responsible for reviewing the content of these procedures and for monitoring compliance, including training requirements. 5.5 The Clinical Lead/ Team Leader/ line manager is responsible for ensuring that the members of staff they manage undertake relevant supervision and training regarding the care of children requiring oral and nasopharyngeal suction, as part of a planned program and that this is fully documented. Staff 5.6 All healthcare professionals and support workers involved in the care of children requiring oral and nasopharyngeal suction have a personal responsibility and accountability to ensure that they are trained in the safe administration of oral and nasopharyngeal suction. 5.7 The specific team leader is responsible for ensuring individual children and/or their carers, have received instruction and are competent to administer oral and nasopharyngeal suction. 5.8 All staff are expected to deliver services and provide care in a manner which respects the individuality of each service user and their carers. In addition they should also treat the users of BCPFT services their carers and members of the workforce fairly and respectfully, regardless of age, gender, race, ethnicity, religion/belief, disability and sexual orientation. 5.9 All staff are expected to ensure that service users and their carers benefit from care that is focused upon respect for the individual. In order to achieve this, the seven factors of best practice from the Essence of Care* benchmark for privacy and dignity need to be taken into account when implementing the procedures covered in these procedures. * The Essence of Care: patient-focused benchmarking for health care practitioners, Department of



Health, 2003.

5.10 Before beginning an examination, providing care or treatment, staff must ensure that they obtain the consent of the person they are examining, caring for or treating. For consent to be valid, the person must:

– it is presumed that adults have capacity to consent unless it is shown otherwise. The Mental Capacity Act 2005 provides a test for assessing whether a person lacks capacity to take a particular decision at a particular time and the steps to be taken if the person lacks capacity. Young people aged 16 and 17 are presumed to have the competence to give consent for themselves. Younger children who understand fully what is involved in the proposed procedure can also give consent (although their parents will ideally be involved). In other cases someone with parental responsibility must give consent on the child’s behalf.

– this will include information about the benefits and risks, including side effects, of the proposed course of action, the implications of not receiving the examination, care or treatment and alternatives.

– there is a need to balance ensuring that all the person’s concerns are fully identified and addressed with not persisting in discussions to such an extent that the person feels harassed. Staff must also be aware of the possibility of undue influence from carer/s and friends.

5.11 If the person does not have capacity to consent, decisions must be made in the best interests of that person. The Mental Capacity Act 2005 provides structured and specific tests for capacity and a list of issues to be taken into account when determining what is in the person’s best interests. 5.12 For further information, see the BCPFT policies, procedures and guidelines on consent and the Mental Capacity Act. 6.Processes and Procedure 6.1 All routine oral and nasopharyngeal suction should be treated as a clean procedure. To reduce the risks of introducing micro-organisms which may cause infection, a ‘non-touch’ suctioning technique should be adopted. 6.2 Suction should only be given as required and in accordance with the child’s individualised care plan. 6.3 The need for suction may not always be obvious, and the child should be continually assessed.



6.4 The procedure for suctioning should be discussed and understood by the carers and preferably the child too. Informed consent to treatment should be determined verbally, for each procedure from the carers and preferably the child too, where possible. 6.5 Indications of a child’s need for suction include:

Visible secretions in the nose or mouth, which cannot be cleared by the child.

A child is having a convulsion and is producing excessive secretions.

A child is unable to swallow effectively unaided, for example has a history of difficulties or unconscious.

6.6 The Suction Machine 6.6.1 Manufacturer’s instructions must always be followed. 6.6.2 Different models of the suction machine may have different recommendations. Therefore the child’s care plan and/or manufacturer’s instructions should be checked before use, for details and information related to filters, cleaning and battery charging. 6.6.3 Suction machines using disposable ancillaries are recommended –disposable items should be changed at least once a week, unless they become visibly contaminated or the liner is full. Such items should be disposed of as clinical waste, ensuring disposable liner is sealed in accordance with manufacturer’s instructions. Personal protective equipment (PPE) should be used when performing changes. 6.6.4 For suction machines with non-disposable ancillaries – items should be washed according to manufacturer’s recommendations, unless visibly contaminated or the collection chamber is reaching three quarters full. PPE should be used when performing decontamination. 6.6.5 The suction machine should be serviced in accordance with manufacturer’s guidance on a yearly basis. A record of all services must be kept by the manager providing the machine. Machines should be checked for safety after each ‘episode’ of use before being issued to another child, even if the yearly service date is not due. 6.6.6 Each suction catheter should only be used once and then disposed of as clinical waste. Yankeur suckers can be used on the same service user/client and flushed thoroughly following use. The frequency of change should be based on the frequency of use and nature of secretions, though it is considered good practice by the See Saw team to change every twenty four hours, once opened from original packaging. If visible secretions cannot be cleared from a Yankeur



sucker, it should be discarded and a new one used. Such items should be disposed of as clinical waste as per disposal of BCPFT’s clinical waste guidelines. 6.6.7 The following equipment is required for oral and nasopharyngeal suction:

“Yankeur” sucker.

Disposable gloves, apron and appropriate facial protection (if appropriate)

Policy.

ooled boiled water. 6.7 The following procedure for oral and nasopharyngeal suction should be followed and repeated until excess saliva/mucus has been removed:

Action Rationale

Explain the procedure to the child using age appropriate play preparation and information

To inform the child of the Procedure

Assemble equipment within easy reach; ensuring suction machine is in correct working order and set to appropriate pressure. Child appropriate pressures should be documented in the individualized care plans.

For ease of administration Suction pressure that is too high may damage the mucosa and suction pressure that is too low will be ineffective.

Decontaminate hands by washing with soap, water and the use of alcohol hand gel. (using the 5 point Eyliffe technique) Put on disposable gloves, disposable apron and facial protection as appropriate.

To reduce the risk of introducing micro-organisms as this may be harmful to the child. Gloves and Apron will protect the healthcare worker and reduce risks to the child.

Attach appropriate sized sterile suction catheter or Yankeur sucker to suction tubing, using a non touch technique.

To prevent contamination.

Remove outer packaging from catheter, ensuring that the end of the tube to be passed into the oral nasal cavity is not handled.

To prevent contamination

Introduce the catheter into the mouth/nose and operate the suction machine. Taking care to remain within

To ensure safe practice, prevents trauma and provides effective suction.



the mouth/ nasopharyngeal passage Slowly withdraw the catheter, each pass taking approximately 5-10 seconds. Observe for service use colour and bleeding from the oral cavity. Only apply suction pressure once the catheter is in the oral cavity using a ‘Y’ connector or eyehole on catheter Observe secretions for signs of infection, obtain sample for microbiology where appropriate.

This avoids aspiration of large amounts of oxygen from the distal airways. To prevent deterioration in condition and trauma to airway. For early identification of infection and instigation of correct treatment.

Pull disposable gloves over sterile catheter and discard as clinical waste.

In accordance with Healthcare Waste Management Policy.

Wearing new gloves irrigate the suction tubing /apparatus with sterile water or cool boiled water.

To clean tubing.

Dispose of all used equipment as clinical waste and decontaminate hands by washing with soap and water.

In accordance with Healthcare Waste Management Policy. To reduce the risk of cross contamination/ infection.

Following the procedure reassure both the child and their carers. All episodes of suction should be clearly documented in the child’s notes stating any observations of secretions from the child that are made.

To alleviate anxiety and promote concordance. To show trends of suctioning and note reasons for. Reactions to and outcomes of the suctioning procedure.

6.8 The healthcare professional responsible for the child receiving oral and nasopharyngeal suction must be aware of the possible adverse effects of performing suctioning, including:

7. Monitoring Compliance. 7.1 As part of an individuals PDR a discussion should be had in regards to current competence.



7.2 The procedure advice document should be used in conjunction with the competence document for oral and nasopharyngeal suctioning. An individual should not carry out the task without being deemed competent by a competent practitioner. 7.3 Competence must be reassessed yearly. 8 Standards and Key Performance indicators 8.1 Record of maintenance of suction machines for each individual. 8.2 Record of suction procedure being carried out, and outcomes, in individual evaluation record. 8.3 The Children’s Clinical lead is responsible for reviewing the content of this procedure and for monitoring compliance, including training requirements. 9 Equality impact assessment and Data protection statement.

9.1 Equality Impact Assessment and Data Protection

The Black Country Partnership NHS Foundation Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group. The Equality Impact Assessment for this policy has been completed and is readily available on the Intranet.

If you require this in a different format e.g. larger print, Braille, different languages or audio tape, please contact the Equality & Diversity Team on 0121 612 8067 or email [email protected]

Please refer to the Trust's Mandatory and Risk Management Training Needs Analysis for further details on training requirements, target audiences, and update frequencies Data protection/freedom of information

mailto:[email protected]



This statement reflects legal requirements incorporated within the Data Protection Act and Freedom of Information Act that apply to staff who work within the public sector. All staff have a responsibility to ensure that they do not disclose information concerning the Trust’s activities or about service users in its care to unauthorised individuals. This responsibility applies whether you are currently employed or after your employment ends and in certain aspects of your personal life e.g. use of social networking sites etc.

The Trust seeks to ensure a high level of transparency in all its business activities but reserves the right not to disclose information where relevant legislation applies.

10. Related BCPFT policies and procedures 10.1 This document must be followed in conjunction with the following BCPFT Policies:

BCPFT Waste Management Policy.

BCPFT Personal Protective Equipment Policy.

BCPFT Policy for Management of Medical Devices.

BCPFT guidelines for the Mental Capacity Act

Competence document for oral and nasopharyngeal suctioning 11. References and Appendices

Manual of Clinical Nursing Procedures.6th Edition 2000.

Times November 25th 1998 Vol. 94 No.47.

Education. Sept 30th 1998, Vol. 13, No.2


ORAL / NASO-PHARYNGEAL SUCTION COMPETENCY Name of Community Children’s Nurse/ Carer: Child: NHS number:

AREA OF CONCERN

REQUIRED SKILLS & KNOWLEDGE LEVEL REACHED

I P CP CE CT

Carer to understand the reasons for oral and /or nasal suction.

Carer to demonstrate an awareness of: -

Anatomy and physiology of the mouth and naso-pharynx

2) Carer to understand when suction is appropriate.

Carer can describe why suction is required.

Carer can describe indications for suction.

Carer to demonstrate appropriate choice of suction time and to give rational for decision.

Carer to show understanding of problems of inappropriate suction



Name of Community Children’s Nurse/ Carer: Child: NHS number:

AREA OF CONCERN REQUIRED SKILLS & KNOWLEGE LEVEL REACHED

I P CP CE CT 3) Carer to demonstrate theoretical and practical aspects of suctioning.

Use and maintenance of Laerdal Suction Unit

Setting appropriate suction pressure

Selection of appropriate suction catheter

Carer to identify areas of the mouth and nose appropriate to apply suction

Identify maximum distance catheter can be inserted

Safe hand washing technique

Safe suctioning technique

Effective suctioning

Signs of infection

How to obtain sputum sample

Carer to identify potential problems of suctioning

Bleeding

Choking

Vomiting

Trauma Infection

5) Carer to understand and demonstrate actions to be taken after suction.

Ensure Child Comfortable

Restock equipment

Swilling tubing

Cleaning and charging of equipment

Documentation

When and who to inform if any issues



ASSESSORS

Name______________________Initials_________Designation____________Signature___________________________ Name______________________Initials_________Designation____________Signature___________________________ Name______________________Initials_________Designation____________Signature___________________________

DECLARATION

I certify that I have received training and consider myself proficient in all aspects of the Oral/ Naso-pharyngeal Suctioning Competency

Name___________________________________Signature________________________________ Date_____________________________________ KEY I – Initial Training

P- Practical Training

CP- Competent to Practice*

CE- Competent and Experienced

CT- Competent to Teach

*Minimum level of achievement required to practice unsupervised

Oral/ Naso-pharyngeal Suction Competency – adapted from Coventry NHS Teaching PCT/Warwickshire PCT and Solihull NHS Care Trust Community Children’s Nursing Team. Changed by See Saw Team January 2012


SEE SAW TEAM

Name: NHS No.:

DOB:

Nursing need

____________ requires oral/nasal suction

Aim

To maintain a safe, clear airway

Action

Oral/nasal suction should be provided within Trust policy

____________ requires oral/nasal suction when …………….

___________ requires oral suction using their Laerdal/devillebis Suction Unit and yankeur sucker (size ………...) and/or suction catheter (size………)

Administration Guidelines

Wash hands, wear non sterile gloves and apron before commencing suction.

Check suction machine is set at appropriate pressure. Before using machine ensure user has had appropriate training on machine and completed trust competencies for the giving of oral/nasal suction.

Prepare equipment required for suctioning i.e. appropriate sized catheter for child.

Carer to identify areas of the mouth/nose appropriate to apply suction.

Commence suction ensuring suction is activated on withdrawal from mouth/nasal passage.

When suctioning there is always a risk of causing minor trauma. If this occurs stop suctioning, give the patient a break if possible and ensure parents are made aware.

Ensure carer is aware of signs of respiratory distress and deterioration of the patient. If deterioration is evident stop suctioning and follow plan as previously agreed with family/consultant.

Dispose of suction catheter in glove used, place in bin as per trust policy on disposal of waste and clean yankeur with water after use and dispose of within 24 hours unless indicated otherwise. Ensure suction tubing is also flushed through after use.

Disposal of ancillaries as per trust guidelines.

Nurse Name: Date:

Parent(s) Name: Date:

ORAL/NASAL SUCTION CARE PLAN



Policy Details Corporate Governance only

* For more information on the consultation process, implementation plan, equality impact

assessment, or archiving arrangements, please contact Corporate Governance

Review and Amendment History

Version Date Details of Change

1.1 January 2015

Reformatted to meet new Trust policy template

1.0 March 2012

New policy for BCPFT

Title of Policy Oral & Nasopharyngeal Suction

Unique Identifier for this policy

State if policy is New or Revised Revised

Previous Policy Title where applicable n/a

Policy Category Clinical, HR, H&S, Infection Control etc.

Children’s Services

Executive Director whose portfolio this policy comes under

Executive Director of Nursing, AHPs and Governance

Policy Lead/Author Job titles only

See Saw Team Leader

Committee/Group responsible for the approval of this policy

CYPF Quality and Safety Group

Month/year consultation process completed *

Month/year policy approved January 2015

Month/year policy ratified and issued January 2015

Next review date January 2016

Implementation Plan completed *

Equality Impact Assessment completed *

Previous version(s) archived *

Disclosure status

Key Words for this policy

oral and nasopharyngeal suction - bcpft.nhs.uk

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