Securing and Suctioning

Endotracheal Tube

Artificial Airways
Artificial

airways may be used for clients with

significant airway obstruction that cannot be

relieved by more conservative means or who
require mechanical ventilatory support.

Endotracheal Tube
Endotracheal

tubes bypass the upper airway

structures altogether; they may be inserted via
the nose or mouth and are passed beyond the
vocal cords into the trachea.

Endotracheal suctioning
Endotracheal

suctioning is a component of
bronchial hygiene therapy and mechanical
ventilation and involves the mechanical aspiration
of pulmonary secretions from a patient with an
artificial airway in place.

Indications

Coarse breath sounds by auscultation of lungs or noisy

breathing

Increase peak inspiratory pressures during volume

controlled mechanical ventilation or decreased tidal
volume during pressure-controlled ventilation

Patients inability to generate an effective spontaneous

cough

Visible secretions in the airway

Changes in monitors flow and pressure graphics

Deterioration of arterial blood gas values

Suspected aspiration of gastric or upper airway secretions

Clinically apparent increased workload of breathing

Suction Pressure

For wall unit

Adult:

100-150 mm Hg

Neonates:

60-80 mm Hg

Infants: 80-100 mm Hg
Children:

100-120 mm Hg

Portable Unit
Adult:

10-15 cm Hg

Neonates:

6-8 cm Hg

Infants: 8-10 cm Hg
Children:

1-12 cm Hg

Rules:

Do not suction for more than 10-15 seconds at a time

Allow at least 30 sec. to 1 minute interval if additional suctioning is necessary

Ni more than three suction passes should be made per suctioning episode

Suctioning the Oropharyngeal and

nasopharyngeal Airways

Nasopharyngeal Suctioning

Nasopharyngeal suctioning help to maintain a patent airway by removing

secretions from the nares and pharynx

This type of suctioning is used when oral suctioning is ineffective or

inappropriate or when the lower airway requires removal of secretion

It involves inserting a small rubber or soft plastic tube into the nares to the
pharynx or trachea and applying negative pressure to withdraw mucus

Procedures and rationale

Assess

the clients need for suctioning: inability to

effectively clear the airway by coughing and
expectoration; coarse bubbling or gurgling noises
with respiration.

Rationale:
Suctioning is an uncomfortable and traumatic
procedure and should be used only when needed.

Choose the most appropriate route (nasopharyngeal or oropharyngeal) for

your client. If nasopharyngeal approach is considered, inspect the nares

with a penlight to determine patency. Alternatively, you may assess patency by
occluding each nare in turn with finger pressure while asking the client to
breathe through the remaining nare.
Rationale:
The oropharyngeal approach is easier but requires that the client cooperate; it
may also produce gagging more readily in some persons. The nasopharyngeal route
is more effective for reaching the posterior oropharynx but is con-traindicated in
clients with a deviated nasal septum, nasal polyps, or any tendency toward
excessive bleeding (low platelet count, use of anticoagulants, recent history of
epistaxis or nasal trauma).

Explain the procedure to the client. Advise that suctioning may cause
coughing or gagging but emphasize the importance of clearing the airway.
Rationale: Promotes cooperation and reduces anxiety.
Wash your hands.
Rationale: Reduces the transmission of pathogens.
Position the client in a high Fowlers or semi- Fowlers position.
Rationale: Maximizes lung expansion and effective coughing

If the client is unconscious or otherwise unable to protect

his or her airway, place in a side-lying position.

Rationale: Protects the client from aspiration in the event of

vomiting
Connect extension tubing to suction device if not already in
place, and adjust suction control to between 110 and 120
mm Hg.
Rationale: Excessive negative pressure can cause tissue
trauma, whereas insufficient pressure will be ineffective.

Using sterile technique open the suction kit. Consider the inside wrapper of the kit to be
sterile, and spread the wrapper out carefully to create a small sterile field.

Rationale: Produces an area in which to place sterile items without contaminating them.
Open a packet of sterile water-soluble lubricant and squeeze out the contents of the packet
onto the sterile field.
Rationale: Lubricant will be used to further lubricate the catheter tip if the nasopharyngeal
route is used.
If sterile solution (water or saline) is not included in the kit, pour about 100 ml of solu- tion
into the sterile container provided in the kit.
Rationale: This solution will be used to lubricate the catheter and to rinse the inside of the
catheter to clear secretions.

Carefully lift the wrapped gloves from the kit without touching the
inside of the kit or the gloves themselves. Lay the wrapped gloves
down next to the suction kit, and open the wrapper. Put on the gloves
using sterile gloving technique
Rationale: The gloves should be kept sterile for handling the sterile
suction catheter to avoid introducing pathogens into the clients
airway.
If a cup of sterile solution is included in the suc- tion kit, open it.
Rationale: This solution will be used to lubricate the catheter and to
rinse the inside of the catheter to clear secretions.

Designate one hand as sterile (able to touch only sterile items) and the
other as clean (able to touch only nonsterile items).

Rationale: Usually, the dominant hand is the sterile hand, while the
nondominant hand is clean. This pre- vents contamination of sterile
supplies while allowing you to handle unsterile items.

Using your sterile hand, pick up the suction catheter. Grasp the plastic
connector end between your thumb and forefinger and coil the tip around
your remaining fingers.
Rationale: Prevents accidental contamination of the catheter tip.

Pick up the extension tubing with your clean hand. Connect the suction catheter to
the extension tubing, taking care not to contaminate the catheter

Rationale: The extension tubing is not sterile.

Position your clean hand with the thumb over the catheters suction port.
Rationale: Suction is activated by occluding this port with the thumb. Releasing the
port deactivates the suction.
Dip the catheter tip into the sterile solution, and activate the suction. Observe as the
solution is drawn into the catheter
Rationale: Tests the suction device as well as lubricates the interior of the catheter to
enhance clearance of secretions.

For oropharyngeal suctioning, ask the client to open his or her mouth.
Without activating the suction, gently insert the catheter and advance it
until you reach the pool of secretions or until the client coughs.

Rationale: To minimize trauma, do not apply suction while the catheter is

being advanced.
For nasopharyngeal suctioning, estimate the dis- tance from the tip of the
clients nose to the earlobe and grasp the catheter between your thumb
and forefinger at a point equal to this distance from the catheters tip.
Rationale: Ensures placement of the catheter tip in the oropharynx and
not in the trachea.

Dip the tip of the suction catheter into the water- soluble lubricant to
coat catheter tip liberally.

Rationale: Promotes the clients comfort and minimizes trauma to nasal

mucosa.
Insert the catheter tip into the nare with the suction control port
uncovered. Advance the catheter gently with a slight downward slant.
Slight rotation of the catheter may be used to ease insertion. Advance the
catheter to the point marked by your thumb and forefinger
Rationale; Guides the catheter toward the posterior oropharynx along the
floor of the nasal cavity

If resistance is met, do not force the catheter. Withdraw it and attempt

insertion via the opposite nare.

Rationale: Forceful insertion may cause tissue damage and bleeding.

Apply suction intermittently by occluding the suction control port with your
thumb; at the same time, slowly rotate the catheter by rolling it between
your thumb and fingers while slowly withdrawing it. Apply suction for no
longer than 15 seconds at a time.
Rationale: Prolonged suction applied to a single area of tis- sue can cause
tissue damage.

Repeat step 24 until all secretions have been cleared, allowing brief rest
periods between suc- tioning episodes.

Rationale: Promotes complete clearance of the airway.

Withdraw the catheter by looping it around your fingers as you pull it out.
Rationale: Allows you to maintain control over the catheter tip as it is
withdrawn.

Dip the catheter tip into the sterile solution and apply suction

Rationale: Clears the extension tubing of secretions that would promote

bacterial growth.
Disconnect the catheter from the extension tub- ing. Holding the coiled
catheter in your gloved hand, remove the glove by pulling it over the
catheter. Discard catheter and gloves in an appropriate container.
Rationale: Contains the catheter and secretions in the glove for disposal.

Discard remaining supplies in the appropriate container.

Rationale: Follow institutional policy regarding the dis- posal of patient

care supplies.
Wash your hands
Provide the client with oral hygiene if indicated or desired.
Rationale: Suctioning and coughing may produce an unpleasant taste.
Document the procedure, noting the amount, color, and odor of
secretions and the clients response to the procedure

Using Bag and mask ( Handled

Resuscitation Bag)