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Suctioning Procedure

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Suctioning Procedure

  1. 1. Suctioning Procedure <ul><li>Oropharyngeal </li></ul><ul><li>Nasopharyngeal </li></ul>
  2. 2. STEPS <ul><li>Assign signs and symptoms of upper and lower airway obstruction requiring nasotracheal or orotracheal suctioning, including RR or adventitious sounds, nasal secretions, drooling, gastric secretions, or vomitus in mouth </li></ul><ul><li>Rationale </li></ul><ul><ul><li>Physical signs and symptoms result from pooling of secretions in upper and lower airways. </li></ul></ul>
  3. 3. <ul><li>Assess signs and symptoms associated with hypoxia and hypercapnia. </li></ul><ul><ul><li>Rationale </li></ul></ul><ul><ul><ul><li>Physical signs and symptoms resulting from decreased oxygen to tissues indicate need for suctioning. </li></ul></ul></ul>Step 2
  4. 4. Step 3 <ul><li>Determine factors that normally influence upper or lower airway functioning </li></ul><ul><ul><li>Fluid Status </li></ul></ul><ul><ul><li>Lack of Humidity </li></ul></ul><ul><ul><li>Infection </li></ul></ul><ul><ul><li>Anatomy </li></ul></ul><ul><li>Rationale </li></ul><ul><li>Fluid overload may increase amount of secretions. Dehydration promotes thicker secretions </li></ul><ul><li>The environment influences secretion formation and gas exchange, necessitation airway suctioning when cannot clear secretions effectively . </li></ul><ul><li>Clients with respiratory infections are prone to increased secretions that are thicker and sometimes more difficult to expectorate </li></ul><ul><li>Abnormal anatomy can impair normal drainage or secretions. </li></ul>
  5. 5. Step 4 <ul><li>Assess client’s understanding of procedure (when applicable) </li></ul><ul><ul><li>Rationale: </li></ul></ul><ul><ul><ul><li>Reveals need for client instruction and also encourages cooperation. </li></ul></ul></ul>Step 5 <ul><li>Obtain physicians order if indicated by agency policy. </li></ul><ul><ul><li>Rationale </li></ul></ul><ul><ul><ul><li>Some institutions require a physicians order for tracheal suctioning </li></ul></ul></ul>
  6. 6. Step 6 <ul><li>Help client assume position comfortable for nurse and client (usually semi-Fowler’s or sitting upright with head hyperextended, unless contraindicated). </li></ul><ul><ul><li>Rationale </li></ul></ul><ul><ul><ul><li>Reduces stimulation of gag reflex, promotes client comfort and secretion drainage, and prevents aspiration. </li></ul></ul></ul><ul><ul><ul><li>Lessens strain on nurses’ back. </li></ul></ul></ul><ul><ul><ul><li>Hyperextension fascilitates insertion of catheter into trachea. </li></ul></ul></ul>
  7. 7. Step 7 <ul><li>Place pulse oximeter on client’s finger. Take reading and leave pulse oximeter in place. </li></ul><ul><ul><li>Rationale </li></ul></ul><ul><ul><ul><li>Provides baseline SpO 2 to determine client’s response to suctioning. </li></ul></ul></ul>Step 8 <ul><li>Place tower across client’s chest. </li></ul><ul><ul><li>Rationale </li></ul></ul><ul><ul><ul><li>Reduces transmission of microorganisms by protecting gown from secretions. </li></ul></ul></ul>
  8. 8. Step 9 <ul><li>Perform hand hygiene. </li></ul><ul><ul><li>Rationale </li></ul></ul><ul><ul><ul><li>Reduces transmission of microorganisms. </li></ul></ul></ul>
  9. 9. Step 10 <ul><li>Preparation for all types of suctioning </li></ul><ul><li>Open suction kit or catheter with use of aseptic technique. Do not allow the suction catheter to touch any unsterile surfaces. </li></ul><ul><li>Unwrap or open sterile basin and place on bedside table. Fill basin with approx 100ml of sterile normal saline solution or water. </li></ul><ul><li>Rationale </li></ul><ul><li>Prepares catheter and prevents transmission of microorganisms. </li></ul>
  10. 10. Step 10 continued… <ul><li>Preparation for all types of suctioning </li></ul><ul><li>Connect one end of connecting tubing to suction machine. Place other end in convenient location near client. Check that equipment is functioning properly by suctioning a small amount of water from basin. </li></ul><ul><li>Rationale </li></ul><ul><li>Equipment must be in proper working order to prevent delay in the procedure. </li></ul>
  11. 11. Step 10 continued… <ul><li>Preparation for all types of suctioning </li></ul><ul><li>Turn on suction device. Set regulator to appropriate negative pressure: wall suction, 80 – 120mmHg; portable suction, 7 – 15 mmHg for adults. </li></ul><ul><li>Rationale </li></ul><ul><li>Elevated pressure settings increase risk of trauma to mucosa and can induce greater hypoxia. </li></ul>
  12. 12. Step 11 – Oropharyngeal Suctioning <ul><li>Apply clean disposable glove to dominant hand. </li></ul><ul><li>Consider applying mask or face shield. </li></ul><ul><li>Attach suction catheter to connecting tube. Remove oxygen mask if present. </li></ul><ul><li>Insert catheter into client’s mouth. With suction applied, move catheter around mouth, including pharynx and gum line, until secretions are cleared. </li></ul><ul><li>Suction of oral cavity does not require sterile glove use. </li></ul><ul><li>Suction may cause splashing of body fluids. </li></ul><ul><li>If catheter does not have a suction ctrl, apply intermittent suction, take care not to allow suction tip to invaginate oral mucosal surfaces with continuous suction. </li></ul>
  13. 13. Step 11 – Oropharyngeal Suctioning cont’d… <ul><li>Encourage client to cough, and repeat suctioning if needed. Replace oxygen mask if used </li></ul><ul><li>Suction water from basin through catheter until clear from secretions </li></ul><ul><li>Place catheter in a clean dry area for reuse with suction turned off or within client’s reach, with suction on, if client is capable of suctioning self. </li></ul><ul><li>Coughing moves secretions from lower to upper airways into the mouth. </li></ul><ul><li>Clearing secretions before they dry reduces probability of transmission of microorganisms and enhances delivery of preset suction pressures . </li></ul><ul><li>Facilitates prompt removal of secretions when needed in the future. </li></ul>
  14. 14. Nasopharyngeal Suctioning <ul><li>If indicated, increase supplemental oxygen therapy to 100% or as ordered by physician. Encourage client’s deep breathing. </li></ul><ul><li>Preoxygenation and deep breathing assist in reducing suction-induced hypoxemia. Preoxygenation should be used with caution in oxygen sensitive clients such as those with chronic heart and lung conditions and those with pneumonia. </li></ul>
  15. 15. Nasopharyngeal Suctioning… <ul><li>Open lubricant. Squeeze small amount onto open sterile catheter package without touching package. </li></ul><ul><li>Apply sterile glove to each hand </li></ul><ul><li>Prepares lubricant while maintaining sterility. Water soluble lubricant is used to avoid lipoid aspiration pneumonia. Excessive lubricant can occlude catheter. </li></ul><ul><li>Reduces transmission of microorganisms and allows nurse to maintain sterility of suction catheter. </li></ul>
  16. 16. Nasopharyngeal Suctioning… <ul><li>Pickup suction catheter with dominant hand without touching nonsterile surfaces. Pick up connecting tubing with nondominant hand. Secure catheter to tubing. </li></ul><ul><li>Lightly coat distal 6 to 8 cm (2-3in) of catheter with water-soluble lubricant. </li></ul><ul><li>Maintains catheter sterility. Connects catheter to suction. </li></ul><ul><li>Lubricates catheter for easier insertion. </li></ul>
  17. 17. Nasopharyngeal Suctioning… <ul><li>Measure the distance from the tip of the nose to the tip of the earlobe 13 cm (5in) </li></ul><ul><li>Follow natural course of naris; slightly slant catheter downward and advance to back of pharynx. </li></ul><ul><li>When pulling back the catheter, slightly roll the tube between the thumb and index finger. </li></ul><ul><li>Proper placement ensures removal of pharyngeal secretions. </li></ul><ul><li>Rolling the tube back and forth ensures suctioning in all areas. </li></ul>
  18. 18. Nasopharyngeal Suctioning… <ul><li>Encourage client to cough. </li></ul><ul><li>Allow for rest periods and repeat this procedure until airway is cleared. Limit suction time to 3-5 mins. </li></ul><ul><li>Reapply oxygen as needed. </li></ul><ul><li>Coughing facilitates removal of secretions </li></ul><ul><li>Rest periods allow for rest and reoxygenation </li></ul><ul><li>Repeated passes with the suction catheter assist in clearing the airway of excessive secretions and promotes oxygenation. </li></ul>
  19. 19. Nasopharyngeal Suctioning… <ul><li>Rinse catheter and connecting tubing with normal saline or water until cleared. </li></ul><ul><li>Reassess client’s respiratory status. </li></ul><ul><li>Clearing secretions before they dry reduces probability of transmission of microorganisms and enhances delivery of preset suction pressures. </li></ul>

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