#9 from Cassie

Discuss the procedure for suctioning:
a) oral
b) nasopharygeal
c) orophayngeal
d) trachel/trachesotomy

pg. 1318-1324 fundamentals & pg.396-398 ATI

Oropharyngeal and nasopharyngeal suctioning are done to remove secretions form the upper respiratort tract when client can cough effectively, but is unable to expectorate or swallow them; to facilitate ventilation; obtain secretions for testing, to prevent infection.
1. Assess the need for suctioning: bubbling or rattling breath sounds, decreased breath sounds, dyspnea, restelesness, gurgling sounds during respiration, adventitious breath sounds when chest is ausculatated, change in mental status, skin color, pulse rate and rhythm
2. Delegate: oropharnygeal suctioning with a Yankauer suction tube can be done by UAP or client family b/c it is not a sterile procedure, but sterile oropharnygeal or nasopharyngeal suctioning must be performed by the nurse.
3. gather equpiment pg. 1319
wash hands and appropriate infection control procedure
4. provide for privacy
5. provide client safety and comfort:
- explain procedure and what client should expect to feel
- Oral: postion client in semi-fowler with head turned to one side, if conscious with functional gag reflex.
- Nasal: postion client in semi-fowler with neck hyperextended, if conscious with functional gag reflex.
- if unconscious, place in side-lying posistion facing the nurse
- place towel on pillow or under chin
- select proper suction pressure (for wall units, usually 110-150mm/Hg for adults)
- measure distance between client's ear lobe and tip of nose (about 5 in)
- test the pressure of the suction and patency of catheter by applying a sterile gloved finger to the port to create suction.
- Oral: mositen catheter tip with water; gently insert catheter into one side of mouth (reduces gag reflex) and glide into oropharynx, without applying suction (prevents damage to pharyngeal mucosa)
- Nasal: lubricate the catheter tip with water-soluble lubricant; gently insert catheter into one nostril and guide it along floor of the nasal cavity. Do not force; if one nostril isnot patent try the other.
- after catheter is posistioned, use nondominant hand to occlude the suction port and apply suction. gently rotate and withdraw catheter. suction intermittently as catheter is withdrawn.this should take no longer than 15 seconds.
- clear catheter by suctioning sterile water through it before reinserting it.
- ask client to breathe deep and cough between catheter insertions (help break up sputum/mucous)
- after suction is complete, suction secretions in mouth and under tongue.
-allow client to rest 20-30 seconds before reinserting catheter. replace nasal canula, if applicable during this time.

-evaluate effectiveness of suctiong by assessing and documenting pre and post suctioning respiratort status (skin color, lung sounds, dyspnea, anxiety); document amount, consistency, color, odor of sputum.

Suctioning a traceostomy is done to maintain a patent airway, prevent airway obstructions, to promote respiratory function (optimal gas exchange), to prevent pneumonia.
1.assess client for presence of congestion of the thorax by ausculataion.
2. delegate sterile, invasive procedure to nurse or respiratory therapist
3. gather equpiment.
4. explain procedure will make breathing easiert and that it will cause couhging.
- wash hand, gloves
- administer analgesia if necessary ( coughing causes pain for clients who have had thoracic surgery)
- place in semi-fowler unless contraindicated
- select proper suction pressure (for wall units usually 110-120 mm/Hg for adults)
- place catheter tip in sterile saline solution, occlude the thumb and suction a small amount of the sterile solution through the catheter.
- quickly and gently insert the catheter without applying suction
- insert catheter about 5 in. for adults or untill the client coughs or resistance is felt
- clear cather by suctiong sterile water through it before reinserting it
- ask client to breathe deep and cough between catheter insertion.
- after each withdrawl of the suction catheter, flush the catheter by suctiong sterile water through it.
- after suctioning is complete suction secretions in mouth, and under tongue.

evaluate effectiveness of suctioning (same as above) and also document amount of sterile solution instilled.

Key Procedure Points of All Suctioning:
- use sterile technique
- determine proper lenght of tube to insert
- hyperventilate or oxygentate the client before suctioning
-DONOT APPLY SUCTION WHILE INSERTING THE TUBE
- apply suction while rotating and withdrwaing the catheter.
- restrict suction time to 5-15 seconds to minimize oxygen loss.
- encourage client to cough and breather deep between suctions
-hyperventilate or oxygentate between suctions
-let client rest between scutions
- evaluate respiratory status before and after suctioning.
-protect against expousre to body fluids.