Suctioning oropharyngeal & nasopharyngeal cavities

Suctioning oropharyngeal & nasopharyngeal cavities

SUCTIONINGThe aspiration of secretions through a rubber or polyethylene catheter connected to a suction machine or wall outletSterile techniquePurposes of suctioningRemove secretionsFacilitate respiratory ventilationObtain secretionsPrevent infectionSuctioning may cause the occurrence of:HypoxemiaVagal nerve stimulationHypoxemia: tachycardia, high BP, bradycardia, hypotension, cyanosisVagal nerve stimulation: bradycardia4CATHETER Have a thumb port on the side has several openings along the sides

SUCTION APPARATUS INCLUDES:Collection bottleTubing system connected to suction catheterGauge that registers the degree of suctionEither portable or wall mounted1 - used to control the suction2 - to distribute the negative pressure of the suction over a wide area thus preventing excessive irritation of any one area of the respiratory mucous membrane5TYPES OF CATHETEROPEN-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

2 types of suctioning1. OROPHARYNGEAL/NASOPHARYNGEAL SUCTIONING removes secretions from the upper respiratory tract

ENDOTRACHEAL SUCTIONING deeper suctioning removes secretions from the trachea & bronchi

Indicated when the client is unable to cough or swallow and makes light bubbling or rattling breath sounds that signal the accumulation of secretionsDeep suctioning requires more skill & carried out by a critical care nursing specialist7EQUIPMENTPortable or wall sution machine with tubing & collection receptacleSterile suction catheterSterile glovesSterile disposable container for sterile fluidsWater soluble lubricantSterile NSS or waterY-connectorSterile gauzeTowel or padMoisture-resistant disposal bagSputum trap

procedureAssess the need for suctioning

2. Prepare the patient. Place the towel over the pillow or under the chinSuction only when necessaryEstablish baseline data - chest - mental status - RR, PRExplainPositioning - conscious: semi-fowlers with head turned to one side for oral suctioning - unconscious: lateral position, facing you

When secretions are audible during respiration or when adventious sounds are auscultated - auscultate the chest, assess clients mental status, observe the rate & pattern of RR, PR & rhythmExplain 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 cooperationPositioning conscious: has a functional gag reflex; neck hyperextended for nasal suctioning; these position faclitates the insertion of the catheter & help prevent aspiration of secretionsUnconscious: 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 aspiration93. Prepare the equipmentSet the pressure on the suction gauge & turn on the suctionOpen 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 suctioningMany suction devices are calibrated to 3 pressure gauges:Wall unit: adults: 100 to 120 mm Hg; child 95-110; infant 50-95Portable unit: adult: 10-15 mm Hg; child 5-10; infant 2-5104. Make an appropriate measure and depth for the insertion & test the equipmentMeasure distance between the tip of clients nose & the earlobeMark the position on the tube with the fingers of the sterile gloveTest the pressure of the suction & the patency of the catheter13 cm/ 5 inches for adultPressure: By applying your sterile gloved finger or thumb to the port or open branch of the y connector to create suction115. Lubricate and introduce the catheter- lubricate catheter tip with water soluble lubricant- pull the tongue forward, if necessary using gauze- do not apply suction during insertion- advance the catheter Moisten tip with sterile waterWithout applying suction, insert catheter into either the naris & advance it along the floor of the nasal cavityNever force the catheter against an obstructionNASOPHARYNGEAL SUCTIONOROPHARYNGEAL SUCTIONMoisten: reduces friction & eases insertionDo not apply suction: doing so causes trauma to the mucous membraneAdvance the catheter: 4 to 6 inches; directing the catheter along the side prevents gaggingIf one nostril is obstructed, try the other12

6. Perform suctioningApply your finger to the suction control port to start suction & gently rotate the catheterApply suction for 5 to 10 seconds, then remove your finger from the control and remove the catheter

Gentle rotation ensures that all surfaces are reached & prevents trauma to any one area of the respiratory mucosa due to prolonged suctionA suction attempt should lasts only 10 -15 seconds. During this time the cathetr is inserted, the suction applied & discontinued and the catheter removed147. Clean the catheter & repeat suctioning as aboveWipe off the catheter with sterile gauze if thickly coated with secretionsFlush the catheter with sterile water or salineRelubricate the catheter & repeat suctioning until the air passage passage is clearAllow 20-30 seconds intervals b/n each suction & limit suction to 5 minutes in totalAlternate nares for repeat suctioningApplying suction for too long may cause secretions to increase or decrease the oxygens supply15Encourage the client to breathe deeply & cough between suctionsObtain specimen if required- attach the suction catheter to the rubber tubing of the sputum trapPromote client comfortDispose of equipment & ensure availability for next suctionAssess the effectiveness of suctioningCoughing & deep breathing help carry secretions from the trachea & bronchi into the pharynx where they can be reached with the suction catheterOffer to assist with oral or nasal hygieneDispose catheter, gloves, water & water container. Wrap the catheter around your sterile glove & roll it inside the glove for disposalAuscultate the clients breathing sounds to ensure thay are clear of secretions16Document relevant data- record procedure

Oropharyngeal suctioning for 5 minutes. 35 ml thick, greenish sputum. Respirations 20/min, wet. Cyanotic. No response to painful stimuli. Positioned in left Sims.Record: amount, consistency, color, odor of sputum ( foamy, white mucus; thick, green-tinged mucus or blood-flecked mucus) & the clients breathing status before & after procedure17Suctioning aN endotracheal tube

Procedure1. 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.

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.

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.

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 noseThe 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.

22Procedure6. 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.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.

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