education

1.  SUCTIONING
ARITIFICIAL AIRWAYS.
TRACHEOSTOMY

2.  APLLICABLE EQUIPMENT
Suction machine.
 Suction connecting tubing (6ft) and collection bottle.
 Appropriate size suction catheter.
 Y adapter.
 AMBU bag with mask and reservoir.
 One sterile& one clean glove.
 Sterile Normal saline.
 Oxygen source and stethoscope.
 Kidney tray.
 Water soluble lubricant.
 Face mask.
 Clean towel or sterile drape.
 100ml NS (Single use).

3.  PRE-PROCEDURE
 Identify the patient, check the doctor’s order.
Explain the procedure to patient to gain confidence and cooperation from the patient.
 Wash hands.
 Collect all the required equipment & keep the equipment at the patient’s bed side.
 Apply face mask.
 Position the patient to semi-Fowler or sitting upright position if not contraindicated.
 An unconscious patient should be placed in the lateral position facing you.
 Place towel across patient’s chest.
 Place pulse oxy-meter on patient’s finger. Take oxygen saturation reading and leave pulse oxy-
meter in place.
 Apply sterile glove to dominant hand and clean glove to non dominant hand.
 Pick up suction catheter with dominant hand without touching unsterile surfaces.
 Attach the catheter to one opening of Y adapter which is attached to suction
connecting tube, ensuring a tight fit.
 Switch on the suction machine and set suction.

4.  Intra Procedure:
 Remove oxygen delivery device with non dominant hand.
 Hyper oxygenate the patient using manual resuscitation bag connected to oxygen source
Then remove oxygen delivery device with non dominant hand.
 Without applying suction, gently but quickly insert catheter, until resistance is met or patient
coughs.
 Apply intermittent suction by placing and releasing non dominant thumb over vent of
catheter.
 Slowly withdraw catheter while rotating it back and forth between dominant thumb and
forefinger.
 100ml normal saline should be used for cleaning the suction catheter intermittently.
 Oxygenate the patient by manual resuscitation bag in between the suction to prevent
hypoxia.
 Assess patient’s cardiopulmonary status for secretion clearance and complication.
 Repeat suction after 1 minute.
 Perform nasopharyngeal and oro-pharyngeal suctioning.
 Now catheter is contaminated so do not reinsert into tracheotomy tube.
 Clean the catheter and suction tubing by suctioning normal saline from bottle.

5.  ProPostcedure
Follow up care:
 Reposition the patient and see that patient is comfortable.
 Compare patient’s vital signs and O2 saturation before and after the procedure.
 Documentation
 Document the quantity, color, consistency and odour of secretions.
 Document the patient’s response to the procedure.
 Care of equipments.
 Disconnect catheter from connecting tubing. Roll catheter around fingers of dominant hand. Pull glove off
inside out so that catheter remains in glove.
 Then dispose in the appropriate bag.
 Turn off suction.
 Wash hands and replace used articles.
 ENDOTRACHEAL TUBE
Applicable Equipments
 Suction machine with tubing
 Wall mounted suction apparatus
 Appropriate size suction catheter & Y adapter
 One sterile& clean pair of gloves
 Oxygen source and stethoscope
 Kidney tray Water soluble lubricant & Face mask

6.  Instructions Pre Procedure:
 Identify the patient, check the doctor’s order
 Explain the procedure to patient to gain confidence and cooperation from the patient.(If conscious)
 Observe the patient for any respiratory difficulties.
 Wash hands. & Collect all the required equipment & keep the equipment at the patient’s bed side.
 Apply face mask. Position the patient to semi-Fowler or sitting upright if not contraindicated.
 An unconscious patient should be placed in the lateral position facing you.
 Place towel across patient’s chest.
 Open sterile normal saline bottle and keep.
 Check the equipment is functioning properly by suctioning small amount of saline from saline bottle. Connect a Y
adapter to suction connecting tube.
 Place pulse oxymeter on patient’s finger. Take oxygen saturation reading and leave pulse oxymeter in place.
 Apply sterile glove to dominant hand and clean glove to non dominant hand.
 Pick up suction catheter with dominant hand without touching unsterile surfaces.
 Attach the catheter to one opening of Y adapter which is attached to suction connecting tube, ensuring a tight fit.
 Switch on the suction machine and set suction.

7. Intra Procedure:
 Open suctioning:
 Ask the assistant to Remove oxygen delivery device & hyper inflate and hyper oxygenate the patient by manual
resuscitation bag connected to oxygen.
 Without applying suction, gently but quickly insert catheter, until resistance is met.
 Apply intermittent suction by occluding Y port with thumb of unsterile gloved non dominant hand.
 Slowly withdraw catheter while rotating it back and forth between dominant thumb and forefinger.
 Hyperventilate the patient, 3 to 5 times between suctioning by manual resuscitation bag.
 Assess patient’s cardiopulmonary status for secretion clearance and complication.
 Do not allow suctioning to continue to more than 10secs.
 Repeat after1iminute if needed.
 Perform nasopharyngeal and oropharyngeal suctioning.
 Now catheter is contaminated so do not reinsert into Endo tracheal tube.
 Closed suctioning:
 Wash hands
 Wear clean gloves
 Connect tubing to closed suction port

8.  Pre-oxygenation the patient with 100 O2
 Gently insert catheter tip into artificial airway without applying suction, stop if you met resistance or when patient
starts coughing and pull back 1cm out
 Place the dominant thumb over the control vent of the suction port, applying continuous or intermittent suction for
no more than 10 sec as you withdraw the catheter into the sterile sleeve of the closed suction device
 Repeat steps above if needed
 Clean suction catheter with sterile saline until clear; being careful not to instill solution into the ETtube
 Suction oropharynx above the artificial airway
 Wash hands
 Post procedure
 patient should be hyper-oxygenated by delivery of 100% oxygen > 1 =1 minute
 The patient should be monitored for adverse reactions.
 Documentation
 Document the quantity, color, consistency and odour of secretions
 Document the patient’s response to the procedure.
 Maintain ventilator bundle checklist.

9.  CARE OF EQIUPMENT
 Disconnect catheter from connecting tubing. Roll catheter around fingers of dominant hand.
 Pull glove off inside out so that catheter remains in glove and then dispose.
 Wash hands and dispose used articles according to the hospital policy.
 Turn of suction.
 SUCTIONING (ORAL)
 Applicable eqiupment:
 Suction machine with tubing /Wall mounted suction apparatus
 Oral suction catheter (e.g.Yankuer’sucker) or Suction catheter 8 to16 gauge
 Sterile distilled water in bowl
 Towel to protect patient’s clothes and bed linen
 Face mask, Eye shield, Gloves

10.  INSTRUCTIONS:
 Pre Procedure:
 Obtain physician’s order.
 Perform hand hygiene.
 Assemble equipment
 Attach oral sucker /suction catheter to suction tubing, ensuring a tight fit.
 Explain the procedure to patient.
 Position the patient.
 If conscious place the patient in semi-fowlers position
 If unconscious place in lateral position facing you.
 Place pulse oxymeter on patient’s finger if needed.
 Place towel across patient’s chest.
 Open fresh saline bottle (100ml) for moistening & cleaning catheter.
 Intra Procedure:
 Put on glove. Eye shield and mask
 Switch on the suction machine and set suction at low level.
 Pickup the sterile catheter with glove hand and connect to suction tubing.

11. continue
 Remove O2 mask of patient if present
 Moisten the catheter by dipping it into the sterile saline bottle.
 Insert catheter into patient’s mouth
 Apply suction and move catheter around mouth, including pharynx and gum line, until secretion is cleared.
 Observe that patient is comfortable.
 Do not force the sucker between the teeth or touch the posterior pharyngeal wall of the soft palate as it can
make the patient choke or vomit
 Release the suction and remove oral sucker from patient mouth.
 Encourage client to cough and repeat suction if needed.
 Oral suction should not be prolonged for more than 10 to 15 sec at a time.
 Repeat suction at least after 20-30 seconds if needed.
 Post Procedure:
 Documentation
 Document the time of suction, patient’s response during suction.
 Document the quantity, colour, consistency and odour of secretions.
 Care of equipments
 Clean the sucker and tubing by suctioning through sterile water until all debris has been cleared.
 Wash hands and dispose used articles.