Suctioning

– A method of removing excessive secretions from the airways. It may be applied

to the oral, nasal or tracheal passages, using a sterile catheter

Purpose:
1. Maintain patent airway through removal of secretions
2. Promote adequate exchange of oxygen and carbon dioxide
3. Substitute for effective coughing
4. Obtain specimen for analysis

Indication:
1. When secretion can be seen or sounds resulting from secretion are heard
with or without use of stethoscope (i.e moist, noisy, respiration)
2. Following postural drainage or chest physiotherapy
3. Following respiratory treatment, aimed at liquefying secretion
4. Following a sudden rise of the peak airway pressure in mechanically
ventilated patients that is not due to:
a. Kinking of the artificial airways
b. Biting of the tube
c. Patient coughing or struggling against ventilator
d. Pneumothorax
Equipment:

Suctioning equipment padded tongue depressor

Working suction apparatus sterile gloves
Connections tube tissue papers
Sterile catheter acetic acid
Adult - fr: 14-16 source of oxygen support ready to use
Pedia – fr: 8-10 pick-up forces
Sterile NSS for instilling
Sterile water for rinsing
Soluble lubricated jelly pm

Process:

RATIONALE
1. Assess the need for suctioning
planning
2. Explain procedure to patient and Cooperation and reassurance
SO
3. Assemble sunctioning equipment, Workability and safely
turn vacuum on, test suction system
and regulate pressure if indicated
implementation Recommended pressure established
4. Positioning patient properly Appropriate position observed
a. Conscious – semi-fowler’s
b. Unconscious – supine
1. Auscultate for crackles, do Need for suctioning established phlegm
chest/back tapping before loosened
suctioning
2. Carefully remove the catheter from
its package using the dominant
 hand, hold it near the vent and
operate suction machine with the
free hand. Put on gloves
3. Dip catheter tip to sterile water Tip lubrication ; patency of system tested
4. Intended for rising and allow some Safety from accidental loss of needle into
airway if secretions are tenacious: trachea and from aspiration
a. Have NSS in syringe ready for
instillation at all times
b. Remove needle from syringe
with NSS and inject content to
airway

NASAL ROUTE:

RATIONALE
1. Steps 2-7
2. Measure with catheter the distance Proper distance for catheter insertion
from tip of nose to tragus of ear determined tip lubricated properly
without touching the skin; apply
lubricant jelly to tip if necessary
3. Elevate tip of nose, and while
leaving the vent open, introduce the
catheter along the floor of nares
until the marked area is reached
4. Rotate catheter while in the nose. If Any obstruction determined.
obstruction is encountered do not
force but remove/ insert at another Injury to mucus prevented
angel or try other nostrils
5. Occlude vent with thumb and slowly
withdraw catheter while rotating it in
between the thumb and finger.
Apply intermittent suction. If
catheter grabs, release vent to stop
suction
 6. DO NOT SUCTION longer than 15
seconds at a time and allow 1-3
mins. rest in between each period
unless abundance of secretions
make this impossible
7. Administer oxygen PRN in between Patient ventilated
aspiration
8. Dip catheter in and out of sterile Secretions removed from catheter tubings
water reservoir, drawing some
water through it, then re-insert as
needed
9. Wipe nose, keep patient dry and Patient’s comfort
comfortable
10. Assess effectiveness by observing Re-evaluation
respiration and auscultating the
lunhs
11. Record significant observations Proper documentation

ORAL ROUTE:

RATIONALE
1. Step 2-7
2. Instruct patient to protrude tongue Catheter insertion facilitated
and guide catheter to oropharynx;
of necessary, keep tongue out of
the way by padded tongue
depressor
• Introduce catheter during Over stimulation of gag reflex facilitated
inspiration
1. If necessary use padded tongue Biting of catheter prevented
depressor to separate upper from
 lower teeth
2. Proceed with steps 5-8 in nasal
route
3. Give mouth care; make patient Hygiene and comfort
comfortable
4. Proceed with steps 10-11 in nasal
catheter

DOCUMENTATION:

• Date and time of procedure

• Reason for suctioning
• Amount, color, consistency and odor of secretion
• Complication & action taken
• Patient’s tolerance of procedure

COMPLICATIONS OF TRACHEAL SUCTIONING:

• Hypoxemia and dyspnea from removal of oxygen along with secretion

• Altered respiratory pattern from anxiety
• Tracheal or bronchial trauma, from prolonged suctioning
• Bleeding in patients with history of nanopharyngeal bleeding
• Further rise in intracranial pressure, in patients with increased ICP