Suctioning

Define suctioning

Mechanical aspiration of secretions from patient

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Outline the indications for suctioning

-Crackles in upper airway on auscultation
-Audible crackles or tactile fremitus
-Patient is unable to clear secretions
-Hypoxia/hypoxaemia
-Increased work of breathing
-Decreased tidal volume in ventilated patient

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Outline the absolute contraindications

-Stridor
-Basal skull fracture when risk of CSF into nasal passages

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Outline the relative contraindications

-Severe bronchospasm
-Unstable CV system
-Haemoptysis
-Acute face/neck injury
-Clotting disorders
-Esophagectomy with high anastomosis
-Recent pneumonectomy

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Outline complications

-Discomfort/pain
-Gagging/vomiting
-Mucosal damage
-Infection
-Atelectasis
-Hypoxia/hypoxemia
-Broncospasm
-Cardiac arrhythmias
-Vasovagal response
-Raises intracranial pressure

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What are the names of the two types of suction

-Nasopharyngeal (nasal)
-Oropharyngeal (mouth)

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Nasopharyngeal: how would you measure the tube size and which nostril is preferable?

-Measure from patient's nostril to ear lobe
-Normally 6mm for female, 7 mm for male
-Right nostril is favoured due to its anatomical structure

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Describe the first 4 stages of nasopharyngeal suction technique

1. Ensure you know pt's resus
2. Explain the procedure to the pt
3. Select a size 10/12 catheter
4. Ensure pt is upright/side lying in case of vomit

8 of 16

Describe stages 5-8

5. Head and neck extended to avoid tongue obs. oropharynx
6. Place pt on pulse oximetry monitor
7. Pre oxygenate (if safe) pre suction for 2 mins, keep mask close to pt's face through-out suctioning
8. Set suction pressure to -20 kPa

9 of 16

Describe stages 9-12

9.Put gloves on
10. Partially unpeel catheter pack so top part (suction port) is exposed
11. Attach this to suction tube whilst keeping rest of catheter in pack
12. Place catheter in pack in non-dominant hand

10 of 16

Describe stages 13-16

13. Put sterile glove on dominant hand
14. Pull catheter from pack using dominant hand (only touches sterile catheter)
15. Hold suctioning tube beneath catheter with non-dominant hand
16. Lubricate catheter with jelly

11 of 16

Describe stages 17-20

17. With suction port open insert catheter into nostril
18. Directing in parallel to the floor of the nose. Once past top of nose aim catheter towards occiput
19. Pass until cough induced or resistance felt
20. Cough may be stimulated at pharynx or tra

12 of 16

Describe stages 21-24

21. If hit resistance pull back slightly before applying suction
22. Apply suction and slowly remove catheter. Max time = 10-15 s. Don't rotate catheter on removal
23. Wrap catheter around gloved hand and remove glove
24. Dispose of contents in clinica

13 of 16

Discuss some clinical tips for this suction technique

1. Resistance felt at pharynx?
Rotate catheter slightly
2. Pt swallowing?
Insert catheter on inspiration only
Place head into extension
If gone into oesophagus, pull catheter back slightly and try above

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Oropharyngeal: outline the stages

1. Measure distance from front teeth to earlobe
2. Open mouth
3. Lubricate Guedel airway if mouth is excessively dry
4. On inspiration rotate Guedel airway and pass it backwards to throat
5. Try place pressure downwards towards tongue to minimise gaggin

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Discuss some clincial tips for the technique

-Technique is same as Nasopharyngeal
-Lubrication often not needed
-If suctioning via ET tube or trachy, catheter should not exceed more than 1/2 of airway tubing
-Calculation used for ET tube + trachy:
-2*2= max size

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Get Revising

Suctioning

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Card 3

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Card 4

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Card 5

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Other cards in this set

Card 2

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Card 3

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Card 4

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Card 5

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Back

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