F-CON-048-2014

SAINT PAUL UNIVERSITY DUMAGUETE

COLLEGE OF NURSING

OOPHARYNGEAL SUCTIONING: PERFORMANCE RATING SCALE

Name: ______________________________ Yr. & Sec. _______ Date: _______ Score: _______
Clinical Instructor: ____________________ Time Started: ____ Time Ended: ________

Direction: Please rate the student based on the competencies listed below.

Raw Score Critical Level Difficulty Level

0 = Unable to perform 1 = Least Critical 1 = Easy
1 = Performed with prompting 2 = Critical 2 = Moderate
2 = Satisfactory performance 3 = Very Critical 3 = Hard
3 = Very Good performance

CRITERIA Raw C D Actual Highest

Score Score Possible REMARKS
(RxCxD) Score
1. Introduce self and identify the patient 2 1 6
2. Assess for clinical signs indicating the need for 3 1 9
suctioning.
3. Verify the doctor’s order for suctioning. 2 1 6
4. Explain to the client what you are doing to do, why it 2 1 6
is necessary and how the client can cooperate.
5. Gather the necessary materials. 2 1 6
6. Wash hands. 1 1 3
7. Position patient to fowler’s if conscious or head turn 2 1 6
to side for unconscious.
8. Place towel under the chin. 1 1 3
9. Ensure proper functioning. Adjust suction to 2 1 6
appropriate pressure.
10. Put on sterile gloves. 3 1 9
11. Attach the suction catheter to the suction tubing, 3 2 18
holding the suction catheter with the dominant hand
and suction port with the non-dominant hand.
12. Test pressure adequacy of the suction machine and 2 2 12
patency of suction catheter by applying suction to the
bottle of sterile water at the same time lubricating the
suction catheter.
13. Increase supplemental oxygen or instruct patient to do 2 1 6
deep breathing.
14. With dominant hand, gently insert the suction catheter 2 2 12
along the side of the mouth, keeping the thumb of non-
dominant hand off the suction port.
15. Advance the catheter about 4- 6inches towards the 2 2 12
pharynx, keeping the thumb of non-dominant hand off
the suction port.
16. Apply suction by intermittently occluding the suction 2 2 12
port with the thumb of non-dominant hand.
17. Withdraw gradually the suction catheter using a 2 2 12
rotating motion.
18. Re-oxygenate the client or have the patient take several 2 1 6
deep breaths.
19. Flush the suction tubing by submerging the tubing into 2 1 6
the same solution used to rinse the sterile catheter.
20. Remove gloves from dominant hand over the coiled 2 2 12
catheter, pulling it inside out.
21. Wash hands. 2 1 6
22. Provide oral care. 2 1 6
23. Assist patient to a comfortable position. 2 1 6
24. Reassess patient’s respiratory status. Auscultate breath 3 1 9
sounds; assess tissue perfusion and breathing pattern.
TOTAL SCORE 195

Clinical Instructor’s General Remarks:

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Date & Clinical Instructor’s Signature __________________________

Student’s Remarks:
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Date & Student’s Signature ___________________________________