Suctioning

> Aspirating secretions through a

catheter connected to a suction
machine or wall suction outlet.
SUCTIONING
Oropharyngeal
Nasopharyngeal
Tracheosotomy
Endotracheal tube
Suctioning

 Wall suction unit

 Portable suction unit

Pressure ranges of suction machines
 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
Suctioning
Oropharyngeal or nasopharyngeal suctioning
 removes secretions from the upper
respiratory tract.

Endotracheal suctioning  removes

secretions from the trachea & bronchi
Suction Catheters
 open tipped
 More effective for removing thick mucous plugs
 whistle tipped
 Less irritating to respiratory tissues
 oral suction tube or Yankauer device
 Used to suction the oral cavity
Yankauer device
Sizes of Suction Catheter
 Adults
 Fr. 12, 14, 16 & 18
 Children
 Fr. 8 & 12
 Infants
 Fr. 5 & 8
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
When suctioning is needed?
 Assess for signs of respiratory distress or
evidence that the client is unable to cough
up & expectorate secretions.
 Dyspnea
 Bubbling or rattling breath sounds
 Poor skin color (cyanosis)
 Decreased O2 Sat
Good nursing judgment is necessary
 Because suctioning
 Irritates mucous membranes
 Can increase secretions if performed too
frequently
PROCEDURE
1. Explain the procedure.
2. Wash hands
3. Provide privacy
4. Prepare the client. (positioning)
1. Conscious client (oral suctioning) Semi-fowler’s with the
head turned to one side. (nasal suctioning) neck is hyper-
extended
2. Unconscious client, lateral position, facing you.
 Place the towel or moisture-resistant pad over
the pillow or under the chin.
Procedure:
5. Prepare the equipment.
 Set the pressure on the suction gauge, & turn on the
suction.
 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 on a non-sterile glove

on the non-dominant hand & then a sterile glove on the

dominant hand.(the sterile gloved hand maintains the
sterility of the suction catheter, & the unsterile glove
prevents the transmission of the microorganisms to the
nurse.
Procedure:
 With your sterile gloved hand, pick up the catheter
& attach it to the suction unit.
6. Make an approximate measure of the depth for
the insertion of the catheter & test the equipment.
 Measure the distance between the tip of the client’s
nose & the earlobe, or about 13cm (5in.) for an adult.
 Mark the position on the tube with the fingers of the
sterile gloved hand.
 Test the pressure of the suction & the patency of the
catheter by applying your sterile gloved finger or thumb
to the port to create suction.
Procedure:
7. Lubricate & introduce the catheter.
 This reduces friction & eases insertion.
FOR OROPHARYNGEAL SUCTION
 Do not apply suction ( that is, leave your finger off the
port) during insertion. (Applying suction during
insertion causes trauma to the mucous membrane).
 Advance the catheter about 10 to 15cm (4-6in.) along
one side of the mouth into the oropharynx. (Directing
the catheter along the side prevents gagging).
Procedure:
FOR NASOPHARYNGEAL SUCTION
 Without applying suction, insert the catheter
the premeasured or recommended distance
into either naris & advance it along the floor
of the nasal cavity. (This avoids the nasal
turbinates).
 Never force the catheter against an
obstruction. If nostril is obstructed, try the
other.
Procedure:
8. Perform suctioning.
 Apply your finger to the suction control port to start
suction, & gently rotate the catheter. (Gentle rotation of
the catheter ensures that all surfaces are reached &
prevents trauma to any one area of the respiratory
mucosa due to prolonged suction.
 Apply suction for 5-10 seconds while slowly withdrawing
the catheter, then remove your finger from the control &
remove the catheter.
 A suction attempts should last only 10-15 seconds.
During this time, the catheter is inserted, the suction
applied & discontinued, & the catheter removed.
 Procedure:
9. Clean the catheter & repeat suctioning as above.
 Wipe off the catheter with sterile gauze if it is thickly coated with secretions.
Dispose in a moisture-resistant bag.
 Flush the catheter with sterile water or saline.
 Re-lubricate the catheter, & repeat suctioning until the air passage is clear.
 Allow 20-30 seconds intervals between each suction & limit suctioning to
5 minutes in total.
(applying suction for too long may cause secretions to increase or
decrease the client’s oxygen supply).
 Alternate naris for repeat suctioning.
 Encourage the client to breathe deeply & to cough between suctions.
(Coughing & deep breathing help carry secretions from the trachea &
bronchi into the pharynx, where they can be reached with the suction
catheter.
 Procedure:
10. Obtain a specimen if required using sputum trap.
11. Promote client comfort.
12. Dispose of equipment & ensure availability for the next
suction.
 Wrap the catheter around your sterile gloved hand & hold the
catheter as the glove is removed over it for disposal.
 Rinse the suction tubing as needed.
 Empty & rinse the suction collection container as needed or indicated
by protocol.
 Change the suction tubing & container daily.
 Ensure that supplies are available for the next suctioning (suction kit,
gloves, water or saline).
 Procedure:
13. 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).
14. Document relevant data.
 Record the procedure.
 Amount, consistency, color, & odor of sputum (e.g., foamy, white
mucus; thick, green-tinged mucus; or blood-flecked mucus) & the
client’s breathing status before & after the procedure.
 If the procedure is carried out frequently (e.g., qhour), it may be
appropriate to record only once, at the end of the shift; however,
the frequency of the suctioning must be recorded.
Suctioning a Tracheostomy or
Endotracheal Tube
A. Attach the resuscitation apparatus (ambu
bag) to the O2 source, adjust the O2 flow to
100% flush.
 Open the sterile supplies
 Place sterile towel across the client’s chest, turn on
the suction, and put on sterile gloves
 Holding the catheter in the dominant hand & the
connector in the nondominant hand, attach the
suction cath to the suction tubing.
Suctioning a Tracheostomy or
Endotracheal Tube
B. Flush & lubricate the catheter
 If the client does not have copious secretions, hyperventilate
the lungs with a resuscitation bag before suctioning. (If the
patient has copious secretions do not hyperventilate for it will
force the secretions deeper into the respiratory tract)
 Summon an assistant, if one is available for this step.
 Using your non-dominant hand, turn on the oxygen to 12 to 15
L/min.
 If the client is receiving oxygen, disconnect the O2 source
from the tracheostomy tube using your non-dominant hand.
 Attach the resuscitator to the tracheostomy or endotracheal
tube.
Suctioning a Tracheostomy or
Endotracheal Tube
 Compress the Ambu bag 3 to 5 times as the
client inhales. This is best done by a second
person who can use both hands, thus
providing a greater inflation volume.
 Observe the rise & fall of the client’s chest
to assess the adequacy of each ventilation.
 Remove the resuscitation device & place it
on the bed or the client’s chest with the
connector facing up.
Suctioning a Tracheostomy or
Endotracheal Tube
C. Quickly but gently insert the catheter
without applying any suction.
 insert the catheter about 12.5 cm (5 in.) for
adults, less for children, or until the client coughs
or you feel resistance. (resistance usually
means that the catheter tip has reached the
bifurcation of the trachea).
 To prevent damaging the mucous membranes at
the bifurcation, withdraw the catheter about 1-
2cm before applying suction.
Suctioning a Tracheostomy Tube
Suctioning a Tracheostomy or
Endotracheal Tube
D. Perform suctioning
> apply intermittent suction for 5-10 seconds.
> rotate the catheter by rolling it between your
thumb & forefinger while slowly withdrawing it.
( this prevents tissue trauma)
> withdraw the catheter completely & release the
suction.
> hyperventilate the client
> then suction again.
Suctioning a Tracheostomy or
Endotracheal Tube
E. Reassess the client’s oxygenation status &
repeat suctioning
 encourage the client to breathe deeply & to cough
between suctions.
 allow 2-3 minutes between suctions when possible, for
re-oxygenation of the lungs.
F. Dispose of equipment & ensure availability
for the next suction.
G. Document
 Good luck!!!!

Practice…………
Theena
Melanie