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

2. 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 .

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

4. 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 .

5. 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

6. 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.

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

8. 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.

9. 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

10. 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.

11. 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 .

12. 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

13. 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.

14. 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.

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

16. 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 .

17. Hypoxemia
Trauma to the airway
Complications
Nosocomial infection
Cardiac dysrhythmia

18. Techniques to Minimize or Decrease the Complications
1- Suction only as needed .
2- sterile technique .
3- Hyperinflation 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