The document outlines the steps for performing oropharyngeal and nasopharyngeal suctioning procedures. Key steps include assessing the need for suctioning based on signs and symptoms, positioning the client comfortably, applying proper hand hygiene and using aseptic technique, setting the appropriate suction pressure, lubricating and inserting the catheter into the nose or mouth, and encouraging coughing to clear secretions. The procedure aims to clear secretions and promote oxygenation while preventing trauma and transmission of microorganisms.

1. Suctioning Procedure Oropharyngeal Nasopharyngeal

2. STEPS Assign signs and symptoms of upper and lower airway obstruction requiring nasotracheal or orotracheal suctioning, including RR or adventitious sounds, nasal secretions, drooling, gastric secretions, or vomitus in mouth Rationale Physical signs and symptoms result from pooling of secretions in upper and lower airways.

3. Assess signs and symptoms associated with hypoxia and hypercapnia. Rationale Physical signs and symptoms resulting from decreased oxygen to tissues indicate need for suctioning. Step 2

4. Step 3 Determine factors that normally influence upper or lower airway functioning Fluid Status Lack of Humidity Infection Anatomy Rationale Fluid overload may increase amount of secretions. Dehydration promotes thicker secretions The environment influences secretion formation and gas exchange, necessitation airway suctioning when cannot clear secretions effectively . Clients with respiratory infections are prone to increased secretions that are thicker and sometimes more difficult to expectorate Abnormal anatomy can impair normal drainage or secretions.

5. Step 4 Assess client’s understanding of procedure (when applicable) Rationale: Reveals need for client instruction and also encourages cooperation. Step 5 Obtain physicians order if indicated by agency policy. Rationale Some institutions require a physicians order for tracheal suctioning

6. Step 6 Help client assume position comfortable for nurse and client (usually semi-Fowler’s or sitting upright with head hyperextended, unless contraindicated). Rationale Reduces stimulation of gag reflex, promotes client comfort and secretion drainage, and prevents aspiration. Lessens strain on nurses’ back. Hyperextension fascilitates insertion of catheter into trachea.

7. Step 7 Place pulse oximeter on client’s finger. Take reading and leave pulse oximeter in place. Rationale Provides baseline SpO 2 to determine client’s response to suctioning. Step 8 Place tower across client’s chest. Rationale Reduces transmission of microorganisms by protecting gown from secretions.

8. Step 9 Perform hand hygiene. Rationale Reduces transmission of microorganisms.

9. Step 10 Preparation for all types of suctioning Open suction kit or catheter with use of aseptic technique. Do not allow the suction catheter to touch any unsterile surfaces. Unwrap or open sterile basin and place on bedside table. Fill basin with approx 100ml of sterile normal saline solution or water. Rationale Prepares catheter and prevents transmission of microorganisms.

10. Step 10 continued… Preparation for all types of suctioning Connect one end of connecting tubing to suction machine. Place other end in convenient location near client. Check that equipment is functioning properly by suctioning a small amount of water from basin. Rationale Equipment must be in proper working order to prevent delay in the procedure.

11. Step 10 continued… Preparation for all types of suctioning Turn on suction device. Set regulator to appropriate negative pressure: wall suction, 80 – 120mmHg; portable suction, 7 – 15 mmHg for adults. Rationale Elevated pressure settings increase risk of trauma to mucosa and can induce greater hypoxia.

12. Step 11 – Oropharyngeal Suctioning Apply clean disposable glove to dominant hand. Consider applying mask or face shield. Attach suction catheter to connecting tube. Remove oxygen mask if present. Insert catheter into client’s mouth. With suction applied, move catheter around mouth, including pharynx and gum line, until secretions are cleared. Suction of oral cavity does not require sterile glove use. Suction may cause splashing of body fluids. If catheter does not have a suction ctrl, apply intermittent suction, take care not to allow suction tip to invaginate oral mucosal surfaces with continuous suction.

13. Step 11 – Oropharyngeal Suctioning cont’d… Encourage client to cough, and repeat suctioning if needed. Replace oxygen mask if used Suction water from basin through catheter until clear from secretions Place catheter in a clean dry area for reuse with suction turned off or within client’s reach, with suction on, if client is capable of suctioning self. Coughing moves secretions from lower to upper airways into the mouth. Clearing secretions before they dry reduces probability of transmission of microorganisms and enhances delivery of preset suction pressures . Facilitates prompt removal of secretions when needed in the future.

14. Nasopharyngeal Suctioning If indicated, increase supplemental oxygen therapy to 100% or as ordered by physician. Encourage client’s deep breathing. Preoxygenation and deep breathing assist in reducing suction-induced hypoxemia. Preoxygenation should be used with caution in oxygen sensitive clients such as those with chronic heart and lung conditions and those with pneumonia.

15. Nasopharyngeal Suctioning… Open lubricant. Squeeze small amount onto open sterile catheter package without touching package. Apply sterile glove to each hand Prepares lubricant while maintaining sterility. Water soluble lubricant is used to avoid lipoid aspiration pneumonia. Excessive lubricant can occlude catheter. Reduces transmission of microorganisms and allows nurse to maintain sterility of suction catheter.

16. Nasopharyngeal Suctioning… Pickup suction catheter with dominant hand without touching nonsterile surfaces. Pick up connecting tubing with nondominant hand. Secure catheter to tubing. Lightly coat distal 6 to 8 cm (2-3in) of catheter with water-soluble lubricant. Maintains catheter sterility. Connects catheter to suction. Lubricates catheter for easier insertion.

17. Nasopharyngeal Suctioning… Measure the distance from the tip of the nose to the tip of the earlobe 13 cm (5in) Follow natural course of naris; slightly slant catheter downward and advance to back of pharynx. When pulling back the catheter, slightly roll the tube between the thumb and index finger. Proper placement ensures removal of pharyngeal secretions. Rolling the tube back and forth ensures suctioning in all areas.

18. Nasopharyngeal Suctioning… Encourage client to cough. Allow for rest periods and repeat this procedure until airway is cleared. Limit suction time to 3-5 mins. Reapply oxygen as needed. Coughing facilitates removal of secretions Rest periods allow for rest and reoxygenation Repeated passes with the suction catheter assist in clearing the airway of excessive secretions and promotes oxygenation.

19. Nasopharyngeal Suctioning… Rinse catheter and connecting tubing with normal saline or water until cleared. Reassess client’s respiratory status. Clearing secretions before they dry reduces probability of transmission of microorganisms and enhances delivery of preset suction pressures.