SUCTIONING OROPHARYNGEAL AND NASOPHARYNGEAL CAVITIES
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Nasopharyngeal suctioning is used to remove secretions from the nose and nasopharynx in patients who are unable to effectively clear their upper airway. Bronchiolitis is a common condition for which nasopharangeal suctioning is required.
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SUCTIONING OROPHARYNGEAL AND NASOPHARYNGEAL CAVITIES
- 1. SUCTIONING OROPHARYNGEAL & NASOPHARYNGEAL CAVITIES BY: ROMMEL LUIS C. ISRAEL III 1 BY: ROMMEL LUIS C. ISRAEL III
- 2. SUCTIONING 2 BY: ROMMEL LUIS C. ISRAEL III The aspiration of secretions through a rubber or polyethylene catheter connected to a suction machine or wall outlet Sterile technique
- 3. PURPOSES OF SUCTIONING 3 BY: ROMMEL LUIS C. ISRAEL III Remove secretions 1 Facilitate respiratory ventilation 2 Obtain secretions 3 Prevent infection 4
- 4. SUCTIONING MAY CAUSE THE OCCURRENCE OF: 4 BY: ROMMEL LUIS C. ISRAEL III Hypoxemia Vagal nerve stimulation
- 5. CATHETER 5 • Have a thumb port on the side • has several openings along the sides SUCTION APPARATUS INCLUDES: 1. Collection bottle 2. Tubing system connected to suction catheter 3. Gauge that registers the degree of suction 4. Either portable or wall mounted BY: ROMMEL LUIS C. ISRAEL III
- 6. TYPES OF CATHETER 1. OPEN-TIPPED CATHETER has an opening at the end and several openings along the sides effective for thick mucus plugs 2. WHISTLE-TIPPED CATHETER has a slanted opening at the tip BY: ROMMEL LUIS C. ISRAEL III 6
- 7. 2 TYPES OF SUCTIONING 7 1. OROPHARYNGEAL/NASOPHARYNGEAL SUCTIONING removes secretions from the upper respiratory tract 2. ENDOTRACHEAL SUCTIONING deeper suctioning removes secretions from the trachea & bronchi BY: ROMMEL LUIS C. ISRAEL III
- 8. EQUIPMENT 8 • Portable or wall sution machine with tubing & collection receptacle • Sterile suction catheter • Sterile gloves • Sterile disposable container for sterile fluids • Water soluble lubricant • Sterile NSS or water • Y-connector • Sterile gauze • Towel or pad • Moisture-resistant disposal bag • Sputum trap BY: ROMMEL LUIS C. ISRAEL III
- 9. PROCEDURE 1. Assess the need for suctioning 2. Prepare the patient. Place the towel over the pillow or under the chin • Suction only when necessary • Establish baseline data - chest - mental status - RR, PR Explain Positioning - conscious: semi-fowler’s with head turned to one side for oral suctioning - unconscious: lateral position, facing you BY: ROMMEL LUIS C. ISRAEL III 9
- 10. 3. PREPARE THE EQUIPMENT 10 BY: ROMMEL LUIS C. ISRAEL III Set the pressure on the suction gauge & turn on the suction Open the sterile suction package • - set up the cup or container, touching only its outside • - pour sterile water or saline into the container • - don the sterile gloves • - with your sterile gloved hand, pick up the catheter & attach it to the suction unit • - open the lubricant if performing nasopharyngeal suctioning
- 11. 4. MAKE AN APPROPRIATE MEASURE AND DEPTH FOR THE INSERTION & TEST THE EQUIPMENT 11 BY: ROMMEL LUIS C. ISRAEL III Measure distance between the tip of client’s nose & the earlobe 01 Mark the position on the tube with the fingers of the sterile glove 02 Test the pressure of the suction & the patency of the catheter 03
- 12. 5. LUBRICATE AND INTRODUCE THE CATHETER NASOPHARYNGEAL SUCTION - lubricate catheter tip with water soluble lubricant - pull the tongue forward, if necessary using gauze - do not apply suction during insertion - advance the catheter OROPHARYNGEAL SUCTION - Moisten tip with sterile water - Without applying suction, insert catheter into either the naris & advance it along the floor of the nasal cavity - Never force the catheter against an obstruction BY: ROMMEL LUIS C. ISRAEL III 12
- 13. BY: ROMMEL LUIS C. ISRAEL III 13
- 14. 6. PERFORM SUCTIONING Apply your finger to the suction control port to start suction & gently rotate the catheter Apply suction for 5 to 10 seconds, then remove your finger from the control and remove the catheter BY: ROMMEL LUIS C. ISRAEL III 14
- 15. 7. CLEAN THE CATHETER & REPEAT SUCTIONING AS ABOVE Wipe off the catheter with sterile gauze if thickly coated with secretions Flush the catheter with sterile water or saline Relubricate the catheter & repeat suctioning until the air passage passage is clear Allow 20-30 seconds intervals b/n each suction & limit suction to 5 minutes in total Alternate nares for repeat suctioning BY: ROMMEL LUIS C. ISRAEL III 15
- 16. 8. Encourage the client to breathe deeply & cough between suctions 9. Obtain specimen if required - attach the suction catheter to the rubber tubing of the sputum trap 10. Promote client comfort 11. Dispose of equipment & ensure availability for next suction 12. Assess the effectiveness of suctioning BY: ROMMEL LUIS C. ISRAEL III 16
- 17. 13. Document relevant data - record procedure Oropharyngeal suctioning for 5 minutes. 35 ml thick, greenish sputum. 20/min, wet. Cyanotic. No response to painful stimuli. Positioned in left Sims. BY: ROMMEL LUIS C. ISRAEL III 17
- 18. SUCTIONING AN ENDOTRACHEAL TUBE BY: ROMMEL LUIS C. ISRAEL III 18
- 19. PROCEDURE 1. Wash your hands, then assemble and set up the suction equipment. - Check the suction and the tubing by aspirating water through the connecting tubing. - On the bedside table, place an open package of 4x4 gauze, a sterile suction catheter, a suction set or sterile basin, a container of sterile water or normal saline, and sterile gloves. - Set up the suction set or sterile basin. Fill the sterile container with the sterile water or normal saline. BY: ROMMEL LUIS C. ISRAEL III 19
- 20. BY: ROMMEL LUIS C. ISRAEL III 20
- 21. 21 2. Using aseptic technique, open the catheter package just enough to expose the connecting end and connect the catheter to the suction tubing. - Don the sterile gloves. - Using aseptic technique, remove the catheter from the package and hold it in your dominant hand. - Test the catheter by aspirating some of the sterile solution. BY: ROMMEL LUIS C. ISRAEL III
- 22. 3. Pick up a piece of the gauze with your non-dominant hand and grasp the patient's tongue. Gently pull the tongue out of the mouth. 4. As the patient inhales, introduce the catheter (with suction diverted) toward the posterior of the mouth and down the throat into the trachea. 5. Apply suction and gently rotate the catheter to aspirate secretions. Remember to suction for only 5-10 seconds at a time. Withdraw the catheter and rinse between suctioning by aspirating sterile solution. This will keep the catheter moist and free of secretions that may block the lumen. BY: ROMMEL LUIS C. ISRAEL III 22
- 23. PROCEDURE 6. Repeat the procedure until the secretions have been cleared. Remember that frequent catheter introductions irritate the tracheal mucosa, so suction thoroughly to avoid repeated insertions. 7. Observe the patient closely . Listen to the patient's breath sounds. BY: ROMMEL LUIS C. ISRAEL III 23
Editor's Notes
- Hypoxemia: tachycardia, high BP, bradycardia, hypotension, cyanosis Vagal nerve stimulation: bradycardia
- 1 - used to control the suction 2 - to distribute the negative pressure of the suction over a wide area thus preventing excessive irritation of any one area of the respiratory mucous membrane
- Indicated when the client is unable to cough or swallow and makes light bubbling or rattling breath sounds that signal the accumulation of secretions Deep suctioning requires more skill & carried out by a critical care nursing specialist
- When secretions are audible during respiration or when adventious sounds are auscultated - auscultate the chest, assess client’s mental status, observe the rate & pattern of RR, PR & rhythm Explain that suctioning will relive breathing difficulty & that procedure is painless but may stimulate the cough, gag or sneeze reflex. Knowing that the procedure will relieve breathing problems is often reassuring & enlists cooperation Positioning conscious: has a functional gag reflex; neck hyperextended for nasal suctioning; these position faclitates the insertion of the catheter & help prevent aspiration of secretions Unconscious: this position allows the tongue to fall forward so that it will not obstruct the catheter on insertion. Lateral position facilitates drainage of secretions from the pharynx & prevents the possibility of aspiration
- Many suction devices are calibrated to 3 pressure gauges: Wall unit: adults: 100 to 120 mm Hg; child – 95-110; infant – 50-95 Portable unit: adult: 10-15 mm Hg; child – 5-10; infant – 2-5
- 13 cm/ 5 inches for adult Pressure: By applying your sterile gloved finger or thumb to the port or open branch of the y connector to create suction
- Moisten: reduces friction & eases insertion Do not apply suction: doing so causes trauma to the mucous membrane Advance the catheter: 4 to 6 inches; directing the catheter along the side prevents gagging If one nostril is obstructed, try the other
- Gentle rotation ensures that all surfaces are reached & prevents trauma to any one area of the respiratory mucosa due to prolonged suction A suction attempt should lasts only 10 -15 seconds. During this time the cathetr is inserted, the suction applied & discontinued and the catheter removed
- Applying suction for too long may cause secretions to increase or decrease the oxygen’s supply
- Coughing & deep breathing – help carry secretions from the trachea & bronchi into the pharynx where they can be reached with the suction catheter Offer to assist with oral or nasal hygiene Dispose catheter, gloves, water & water container. Wrap the catheter around your sterile glove & roll it inside the glove for disposal Auscultate the client’s breathing sounds to ensure thay are clear of secretions
- Record: amount, consistency, color, odor of sputum ( foamy, white mucus; thick, green-tinged mucus or blood-flecked mucus) & the client’s breathing status before & after procedure
- Gently - this will provide a view of the oropharynx & raise the epiglottis to permit easier insetion of the catheter into the trachea; as an alternative method, the catheter may be introduced through the nose The patient will probably cough at this point. If coughing brings up sufficient secretions to clear the air passages, the procedure may be discontinued at this point. If not, relax the tongue a bit and instruct the patient to breathe normally. This will keep the catheter moist and free of secretions that may block the lumen.
- 6. Remember that frequent catheter introductions irritate the tracheal mucosa, so suction thoroughly to avoid repeated insertions. 7. for changes in color or respiration, disorientation, or agitation. These could be signs of anoxia. which should become quieter as secretions are removed.