RESPIRATORY

FUNCTIONING

SUCTIONING
ASPIRATING SECRETIONS THROUGH A CATHETER
CONNECTED TO A SUCTION MACHINE OR WALL
SUCTION OUTLET.

OROPHARYNGEAL,
NASOPHARYNGEAL,
NASOTRACHEAL SUCTIONING

PURPOSES:
To remove secretions that obstruct the airway
To facilitate ventilation
To obtain secretions for diagnostic purposes
To prevent infection that may result from
accumulated secretions.

ASSESSMENT:
Assess for clinical signs indicating the need for
suctioning:
Restlessness
Gurgling sounds during respiration
Adventitious breath sounds when the chest is auscultated
Change in mental status
Skin color
Rate and pattern of respirations
Pulse rate and rhythm
Decreased oxygen saturation

EQUIPMENTS:
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
Goggles or face shield, if appropriate
Moisture-resistant disposal bag
Sputum trap if specimen is to be collected

EQUIPMENTS:
ORAL AND OROPHARYNGEAL SUCTIONING
Yankauer suction catheter or suction catheter kit
Clean gloves

NASOPHARYNGEAL OR NASOTRACHEAL SUCTIONING

Sterile gloves
Sterile suction catheter( #12-#18Fr for adults, #8-#10 Fr
for children and #5-#8 Fr for infants)
Water soluble lubricant
Y - connector

IMPLEMENTATION:
PERFORMANCE
1. Prior to performing the procedure, introduce self and verify the
clients identity using agency protocol. Explain to the client
what are you going to do.
2. Perform hand hygiene and observe other appropriate infection
control procedures.
3. Provide for client privacy.
4. Prepare the client.
.Position a conscious person who has a functional gag reflex in the
semi- fowlers position with the head turned to one side for oral
suctioning or with the neck hyperextended for nasal suctioning.

 Position an unconscious client in the lateral position facing

you.
Place the towel or moisture-resistant pad over the pillow or
under the chin.

5. Prepare the equipment.

Set the pressure on the suction gauge, and turn on the
suction. Many suction devices are calibrated to three pressure
ranges.
Wall unit
ADULT: 100-120 mmHg
CHILD: 95-110 mmHg
INFANT: 50-95 mmHg

 Portable unit
ADULT: 10-15 mmHg
CHILD: 5-10 mmHg
INFANT: 2-5 mmHg
FOR ORAL AND OROPHARYNGEAL SUCTION
Moisten the tip of the yankauer or suction catheter with
sterile water or saline.
Pull the tongue forward if necessary, with gauze
Do not apply suction (that is, leave your finger off the port)
during insertion.
Advance the catheter about 10-15 cm. along 1 side of the
mouth into the oropharynx.

 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

Open the lubricant if performing nasopharyngeal/ nasotracheal
suctioning.
Open the sterile suction package.
a. Set up the cup or container, touching only the outside.
b. Pour sterile water or saline into the container.
c. Put on the sterile gloves, or put on a non 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 catheter and test the equipment.
Measure the distance between the tip of the clients nose
and the earlobe, or about 13cm (5 in.) in adults.
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 to create
suction.
If needed, apply or increase supplemental oxygen.

7. Lubricate and introduce the catheter.

Lubricate the catheter tip with sterile water, saline, or
water-soluble lubricant.
Remove oxygen with the non dominant hand, if
appropriate.
Without applying suction, insert the catheter the
premeasured or recommended distance into either nares
and advance it along the floor of the nasal cavity.
Never force the catheter against an 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.
10. Obtain a specimen if required.
Use a sputum trap
Attach the suction catheter to the tubing of the sputum trap.

 Attach the suction tubing to the sputum trap air vent.

Suction the client.
Remove the catheter from the client.
connect the tubing of the sputum trap to the airvent.
Connect the suction catheter to the tubing.
Flush the catheter to remove the secretions from the tubing.
11. Promote client comfort.
12. Dispose the equipment and ensure the availability for the
next suction.
13. Assess effectiveness of suctioning.
14. Document relevant data.

TRACHEOSTOMY
PURPOSES:
To maintain patent airway and prevent airway obstructions.
To promote respiratory function.
To prevent pneumonia that may result from accumulated
secretions.
ASSESSMENT:
Assess the client for the presence of congestion on auscultation
of thorax. Note the clients ability or inability to remove the
secretions through.

EQUIPMENT:
Resuscitation bag connected to 100% oxygen.
Sterile towel
Equipment for suctioning
Goggles and mask
Gown
Sterile gloves
Moisture-resistant bag

IMPLEMENTATION:
PERFORMANCE
1. Prior to performing the procedure, introduce self and verify the
clients identity using agency protocol. Explain to the client what
are you going to do.
2. Perform hand hygiene and observe other appropriate infection
control procedures.
3. Provide for client privacy.
4. Prepare the client.
.If not contraindicated because of health, place the client in a semifowlers position to promote deep breathing, maximum lung
expansion, and productive coughing.

 If necessary, provide analgesia before suctioning. Endotracheal

suctioning stimulates the cough reflex which can cause pain for
clients who have had thoracic or abdominal surgery or who have had
thoracic or abdominal surgery or clients who have had traumatic
injury.
5. Prepare the equipment.
Attach the resuscitation apparatus to the oxygen source. Adjust the
oxygen flow to 100%.
Open sterile supplies in readiness for use.
Place the sterile towel, if used, across the clients chest below the
tracheostomy.
Turn on the suction and set the pressure in accordance with agency
policy.
WALL UNIT- ADULT: 100-120 mmHg CHILDREN AND INFANTS: 50-95
mmHg.

 put on goggles, mask and gown if necessary.

Put on sterile gloves.
Holding the catheter in the dominant hand and the
connector in the non dominant hand, attach the suction
catheter to the suction tubing.
6. Flush and lubricate the catheter.
Using the dominant hand, place the catheter tip in the
sterile saline solution.
Using the thumb of the nondominant hand, occlude the
thumb control and suction a small amount of the sterile
solution through the catheter.

7. If the client does not have copious secretions,

hyperventilate the lungs with a resuscitation bag before
suctioning.
Summon an assistant if one is available for this step.
Using your non dominant hand, turn on the oxygen to 1215 L/min.
If the client is receiving oxygen, disconnect the oxygen
source from the tracheostomy tube using your non
dominant hand.
Attach the resuscitator to the tracheostomy or
endotracheal tube.
Compress the Ambu bag 3-5x, as the client inhales.

 Observe the rise and fall of the clients chest to assess

the adequacy of each ventilation.
Remove the resuscitation device and place it on the bed
or the clients chest with the connector facing up.
8. If the client has copious secretions, do not
hyperventilate with a resuscitator.
Keep the regular oxygen delivery device on and increase
the liter flow or adjust the FiO2 to 100% for several
breaths before suctioning.
9.Quickly but gently insert the catheter without applying
any suction.

 With your non dominant thumb off the suction port, quickly but
gently insert the catheter into the trache through thw
tracheostomy tube.
Insert the catheter about 12.5 cm for adults, less for children, or
until the client coughs or you feel resistance.
10. Perform suctioning.
Apply suction for 5-10 secs.by placing the non dominant thumb
over the thumb port.
Rotate the catheter by rolling it between your thumb and
forefinger while slowly withdrawing it.
Withdraw the catheter completely and release the suction.
Hyperventilate the client.
Suction again, if necessary.

11. Reassess the clients oxygenation satus and repeat

suctioning.
12. Dispose equipment and ensure availability for the next
suction.
13. Provide client comfort and safety.
14. Document relevant data.

THORACENTESIS
An invasive procedure that involves insertion of
needle into the pleural space for the removal of
pleural fluid or air.
The nurse assists the client to assume a position that
allows easy access to the intercostal spaces. This is
usually a sitting position with the arms above the
head, which spreads the ribs and enlarges the
intercostal space.

TWO POSITIONS COMMONLY USED:

Arm is elevated and stretched forward
Client leans forward over a pillow.

A site on the lower posterior chest is often used

to remove fluid, and site on the upper anterior
chest is used to remove air.

Before the procedure:

Explain the procedure to the client. Normally, the client may
experience some discomfort and a feeling of pressure when
the needle is inserted. The procedure may bring considerable
relief if breathing has been difficult. The procedure takes only
a few minutes, depending primarily on the time it takes for
the fluid to drain from the pleural cavity.
To avoid puncturing the lungs, it is important for the client
not to cough while the needle is inserted. Explain when and
where the procedure will occur and who will be present.
Help position the client and cover the client as needed with a
bath blanket.

During the procedure:

Support the client verbally and describe the steps of the
procedure as needed.
Observe client for signs of distress such as dyspnea,
pallor, and coughing

Collect drainage and laboratory specimens.

Place a small sterile dressing over the site of the puncture.
After the procedure:
Assess PR and RR and skin color.
Dont remove more than 1000 ml of fluid from pleural cavity within
the first 30 minutes.
Observe changes in the clients cough, sputum, respiratory depth,
and breath sounds and note complaints if chest pain.
Position the client appropriately. Some agency protocols recommend
that the client lie on the unaffected side with the head of the bed
elevated 30 degrees for at least 30 mins.because this position
facilitates expansion of the affected lung and eases respirations.
Document all relevant information.