Prepared by : Dr. Irene Roco Suctioning Prepared by : Dr. Irene Roco

Outline 1- Definition of suctioning . 2- Sites for suctioning . 3- Purposes 4- Indications 5- Choosing the right size catheter. 6 -Complications of suctioning . 7- Techniques to minimize or decrease the complications .

Definition Aspirating secretion through a catheter connected to a suction machine or wall suction outlet.

Sites for Suctioning Endotracheal/Tracheostomy suctioning Oropharyngeal /Nasopharyngeal suctioning Remove secretion from the trachea and bronchi or the lower respiratory tract . Remove secretion from the upper respiratory tract .

PURPOSES To remove secretions that obstruct the airway To facilitate ventilation To obtain secretions for diagnostic purposes To prevent infection that may result from accumulated secretions

Indications Oropharyngeal and Nasopharyngeal suctioning are required for: 1- Patient who has undergone head and neck surgery. 2- Signs of respiratory distress . 3- Evidence of unable to cough up and expectorate secretions . 4- Obtain sample of secretion for diagnostic purposes 5- Prevent infection.

Indications Tracheal suctioning is required for : 1- Patients who are unable to clear their secretions themselves. 2- patients with mechanical ventilation.

Choosing the Right Size Catheter #12 to #18 Adult #8 to # 10 Children # 5 to #8 Infant Half the diameter (or less) of the tracheal tube.

whistle – tipped catheter Less irritate the airway Two types of suction catheter 1- Whistle – tipped catheter . 2- Open – tipped catheter . open – tipped catheter whistle – tipped catheter More effective for removing thick mucus plugs . Less irritate the airway

E Q U I P M N T Towel or moisture – resistant pad Portable or wall suctioning machine with tubing and collection receptor. sterile deposable container for fluids . Sterile normal saline or water.

E Q U I P M N T Sterile gloves . Goggles or face shield . Sterile Suction Catheter kit . Water – soluble lubricant . sterile gauzes. Moisture resistant disposable bag. Sputum trap .

Clinical Signs indicating the need for Suctioning Restlessness Gurgling sounds during respiration Adventitious breath sounds when the chest is auscultated Change in mental status Skin color Rate and pattern of respiration Pulse rate and rhythm Decreased oxygen saturation

Position of the patient Unconscious patient Conscious patient Lateral position and the patient facing you . Semi – Fowler’s position with: head turned to one side for oral suctioning . For nasal suctioning with the neck hyperextended.

For Oropharyngeal suctioning : Pull the tongue forward . Do not apply suction during insertion . Advance the catheter about 10 to 15 cm along on side of the mouth into oropharynx.

For Nasopharyngeal suctioning Advance the catheter along the nasal cavity with out suctioning. Never force the catheter against an obstruction .

Suctioning Apply suction 5-10 seconds while slowly withdrawing the catheter Allow 20 t0 30 second intervals between each suction Limit suctioning to 5 minutes in total . A suction attempt should only lasts for 10 – 15 seconds Alternate nares for repeat suctioning. Encourage the client to breath deeply and to cough between suctioning .

Hypoxemia Trauma to the airway Complications Nosocomial infection Cardiac dysrhythmia

Techniques to Minimize or Decrease the Complications 1- Suction only as needed . 2- sterile technique . 3- Hyperinflation - 3-5 breaths before and after each pass of suction catheter 4- Hyperoxygenation - manual resuscitation bag or ventilator by increasing the O2 flow 5- safe catheter size . 6- No saline instillation. REF: Kozier & Erbs fundamentals of Nursing. Eighth ed