1. SUCTIONING 1.

Preparation

 Oropharyngeal: mouth  Explain the procedure to patient that suctioning

 Nasopharyngeal: nose will relieve breathing difficulty and that the
procedure is painless but may stimulate the cough,
Definition gag or sneeze reflexes (that the procedure will
 Removal of secretions from the oral and nasal relive breathing problem)
cavity and upper part of pharynx through the  Provide semi fowler’s position to patient for
suction (machine) conscious person who has functional gag reflex
 Aspiration of secretion through a catheter with turns to one side for oral suctioning ow with
connected to a suction machine the neck hyperextended for nasal suctioning
 Preventing the infection  For unconscious client in the lateral position facing
you
Types of Machine
-Semi fowler’s (conscious)
 Portable
-Lateral (unconscious)
 Built in
-Turned head one side (oral)
Indication -Neck hyperextended (nasal)

1. Unable to expectorate coughed secretion  Place towel/ resistant pad over the pillow/ under
a. (stroke, bed-ridden, unconscious, child) the chin
2. Unable to swallow (paralysis…)
3. Makes light bubbling of rattling breath sounds 2. Prepare the equipment
(heard when the person inhales)
 Set the pressure on the suction gauge and turn on
Purposes the suction:

1. Remove secretions that obstruct airways Portable unit

2. Facilitate respiratory ventilation
3. Prevent infection that may result from Adult 8-15 mm of Hg 100-120
accumulated secretions Children 5-8 mm of Hg 50-100
(moist: can cause bacterial growth) Infant 3-5 mm of Hg 40-60
4. To obtain secretions for diagnostic purposes
Wall unit
*Move patient side to side every 2 hours
Adult 8-15 mm of Hg 10-15
Assessment Children 5-8 mm of Hg 5-10
Infant 3-5 mm of Hg 2-5
 Assess the client for restlessness
(restlessness= DOB)
Suction 5-10 seconds only
 Gurgling sounds during expectoration
Reinsert after 20-30 seconds
 Adventitious breath sounds when the chest is
5-10 seconds (inside)
auscultated
10-15 seconds (insert, suction,
 Change in mental status
discontinue, removed)
 Change in skin color
5 minutes limitation of suctioning
 Respiration rate and patter
 Open the suction package
 Pulse rate and rhythm a) Set up the cup or containers, touching
Articles only the outside
b) Pour sterile water or saline into the
 Portable suction wall unit container
 Clean tray c) Don the sterile gloves or put on nonsterile
-sterile suction catheter on nondominant hand on the non-
-normal saline/sterile water in a container dominant hand and then the sterile
-sterile gloves gloves on the dominant hand to maintain
-mask, face shield the sterility of the suction catheter.
-alcohol swab  With your sterile gloved hand pick-up catheter and
-stethoscope attach it to the suction unit
-gauze pieces  Open the lubricant if performing nasopharyngeal
-moisture-resistance disposal bag suctioning
-sputum trap for specimen
3. Make an approximately measure of the depth for the  Allow 20-30 seconds intervals between each
insertion of the catheter and test the equipment suction, and limit suction to 5 minutes in total (too
long may decrease oxygen supply during
 Measure the distance between the tip of the
suctioning)
client’s nose and the earlobe or about 13 cm for an
adult
 Mark the position on the tube with the fingers of
the sterile gloved hand
 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 the Y
connector or create suction

4. Lubricate and introduce the catheter to reduce friction

or ease insertion

 Nasopharyngeal suction, lubricate the catheter tip

with sterile water, saline or water-soluble
lubricant: for oropharyngeal suction, moisten the
tip with sterile water or saline

Oropharyngeal:

 Pull the tongue forward

 Do not apply suction
 Leave your finger off the port during insertion
advance the catheter about 10-15 cm (4-6) along
one side of the mouth into the oropharynx

Nasopharyngeal:

 Without applying suction, insert the catheter the

premeasured or recommended distance into
either naris and advance it along the floor of the
nasal cavity
 Never force the catheter against an obstruction. If
the nostril is obstructed, try the other.

5. Perform Suctioning

 Apply your finger to the suction control port to

start suction, and gently rotate the catheter
 Apply intermittent suction for 5-10 seconds; rotate
catheter; then remove your finger from the control
and remove the catheter
 A suction attempt should last for 10-15 seconds.
During this time the catheter is inserted, the
suction applied and discontinued and catheter
removed.
 It may be necessary during oropharyngeal
suctioning to apply to secretions that collect in the
vestibule of the mouth and beneath the tongue.

6. Clean the catheter and repeat suctioning as above

 Wipe off the catheter with sterile gauze if it is

thickly coated with secretions. Dispose the used
gauze in a moisture-resistant bag
 Flush the catheter with sterile water or saline
 Relubricate the catheter and repeat suctioning
until the air passage is clear
Preparation 0 1 2 Comments
1. Assess for clinical signs indicating the need for suctioning:
 Restlessness
 Gurgling sounds during respiration
 Adventitious sounds when the chest is auscultated
 Change in mental status
 Skin color
 Rate and pattern of respirations
 Pulse rate and rhythm
 Decreased oxygen saturation
2. Assemble equipment:
For oral and nasopharyngeal/nasotracheal suctioning:
 Towel or moisture-resistant pad
 Portable or wall suction machine with tubing, collection receptacle, and suction
pressure gauge
 Sterile, disposable container for fluids
 Sterile normal saline or water
 Sterile gloves
 Goggles or face shield, if appropriate
 Moisture-resistant disposal bag
 Sputum trap, if specimen is to be collected

Oral and oropharyngeal suctioning:

 Yankauer suction catheter kit
 Clean gloves

Naspharyngeal or nasotracheal suctioning:

 Sterile gloves
 Sterile suction catheter kit
 Water-soluble lubricant (for nasopharyngeal suctioning)
 Y-connector
Procedure
1. Introduce yourself and verify client’s identity. Explain to the client what you are
going to do, why it is necessary, and how the client can cooperate.
2. Perform hand hygiene, and observe other appropriate infection control
procedures.
3. Provide client privacy.
4. Prepare the client.
Position a conscious person who has a functional gag reflex in the semi-Fowler’s
position, with head turned to one side for oral suctioning.
Place the towel or moisture-resistant pad over the pillow or under chin.
5. Prepare the equipment and put on clean gloves.
Set the pressure on the suction gauge, and turn on the suction.
For oral and oropharyngeal suction:
Moisten the tip of the Yankauer suction catheter with sterile water or saline.
If the client is unconscious, pull tongue forward, if necessary, using gauze.
However, if he/she is conscious, instruct the client to pull his/her tongue.
Do not apply suction (leave your finger of the port) during the insertion.
Advance the catheter about 10-15 cm
(4-6 inches) along one side of the mouth and beneath the tongue
It may be necessary during oropharyngeal suctioning to apply suction to secretions
that collect in the vestibule of the mouth and beneath the tongue.
For nasopharyngeal and nasotracheal suction:
Position a conscious person who has a functional gag reflex in the semi-Fowler’s
position or with neck hyperextended for nasal suctioning.
Open the lubricant, if performing nasopharyngeal/ nasotracheal suctioning.
Open the sterile suction package:
Set up the cup or container, touching only the outside.
Pour sterile water or saline into the container.
 Put on the sterile gloves, or put a non-sterile glove on the nondominant hand and
then a sterile glove on the dominant hand.
With your sterile-gloved hand, pick up the catheter, and attach it to the suction
unit.
6. Make an appropriate measure of the depth for the insertion of the catheter, and test the equipment.
Measure the distance between the tip of the client’s nose and the earlobe.
Mark the position on the tube with the fingers of the sterile-gloved.
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 the Y-connector (the
suction control) to create suction.
If needed, increase supplemental oxygen.
7. Lubricate and introduce the catheter.
Lubricate the catheter tip wit sterile water, saline, or water-soluble lubricant.
Remove oxygen with your nondominant hand, if appropriate.
Without applying suction, insert the catheter the premeasured or recommended
distance into either naris, and advance it along the floor of the nasal cavity.
Never force the catheter against the obstruction. If one nostril is obstructed, try the
other.
8. Perform suctioning
Apply your finger to the suction control port to start suction, and gently rotate the
catheter.
Apply suction for 5-10 seconds while slowly withdrawing the catheter, then remove
your finger from the control and remove the catheter.
A suction attempt should last only 10-15 seconds. During this time, the catheter is
inserted, the suction applied and discontinued, and the catheter removed.
9. Rinse the catheter, and repeat suctioning as above.
Rinse and flush the catheter and tubing wit sterile water or saline.
Relubricate the catheter, and repeat the suctioning until the air passage is clear.
Allow sufficient time between each suction, and limit suctioning to 5 minutes in
total.
Encourage the client to breathe deeply and to cough between suctions.
10. Obtain a specimen, if required. Use a sputum trap as follows:
Attach the suction catheter to the tubing of the sputum trap.
Attach the suction tubing to the sputum trap air vent.
Suction the client. The sputum tap will collect the mucus during suctioning.
Remove the catheter from the client. Disconnect the sputum trap tubing from the
suction catheter. Remove the suction tubing from the trap air vent.
Connect the tubing of the sputum trap to the air vent.
Connect the suction catheter to the tubing.
Flush the catheter to remove secretions from the tubing.
11. Dispose of equipment and ensure availability for the next suction.
Dispose of the moisture pad/towel, catheter, gloves, water, and waste container.
Wrap the catheter around your sterile-gloves hand and hold the catheter as the
glove is removed over it for disposal.
Rinse the suction tubing as needed by inserting the end of the tubing into the used
water container. Empty and rinse the suction collection container as needed or
indicated by protocol. Change the suction tubing and container daily.
Ensure that supplies are available for the next suctioning.
12. Observe hand hygiene and infection control practices.
13. Promote client comfort.
Offer to assist the client with oral or nasal hygiene.
Assist the client to a position that facilitates breathing.
14. Assess the effectiveness of suctioning.
Auscultate the client’s breath sounds to ensure they are clear of secretions.
Observe skin color, dyspnea, level of anxiety, and oxygen saturation levels.
15. Document relevant data.
Record:
The amount, consistency, color, and odor of sputum.
 The client’s breathing status before and after the procedure.
 Frequency of suctioning must be recorded.
TOTAL: AVERAGE: