1. Oral suction training for parents and carers
Carer skills passport
Oral suction training for parents and carers
Leanne Turner Physiotherapist
Jenny Bayliss Specialist Nurse

2. Aims To understand what oral suction is
To understand why, when and how oral suction is carried out
To know how to use a suction machine
To know how to look after and clean a suction machine

3. What is suction?
‘Suction’ is the term used for removing secretions from a child’s airway using negative pressure (or vacuum)
It is like a hoover but you can set the pressure yourself

4. Why suction? When children have problems clearing their own secretions
To remove the secretions in the oral space (mouth) that can block the airway
To help the child breath more easily
It can sometimes help to promote a cough
Comfort

5. When to suction? Child will tell you by:
Being distressed/upset/ coughing/ work of breathing
Looks like something in their mouth
Vomiting
Change in colour
Change in saturations

6. Suction plan When do I need suction?
When you can hear and feel secretions and I’m distressed by them
When my saturations are low
When I’m working harder with my breathing
When I’m coughing but not clearing secretions
How can you make suctioning easier for me?
Explain to me what you are doing
Talk to me as you do it so I know it is nearly over
How do I get suctioned?
Suction pressure– 150mmHg/ 20KPa
I am suctioned via my tracheostomy. I use size 10 suction catheters down to a depth of 7.5. I sometimes require suction in my nose or mouth
How often do I get suctioned when I’m well?
This is vary variable as every day is different but if I’m unwell my secretions change in colour and are thicker
What are my secretions like when I’m well?
Loose white/clear secretions
What machines can be used and where are they stored?
Sam 12 - at home
De Vilbiss - portable
Contacts for suctioning
BME Alder Hey– Machine maintenance
Telephone–
Community nurses– Consumables/Training
Telephone–
Community respiratory Physiotherapist
Telephone–
Suction plan

7. Will it hurt? NO as long as it is done properly by a trained person
Suctioning is an invasive procedure that can have side effects and dangers
IT MUST ONLY BE DONE BY TRAINED PEOPLE!
If done properly then side effects are rare

8. Side effects and Dangers
Trauma
Pain
Vomiting
Gagging
Loosen teeth
Distress
Infection
All of these can be avoided if the right procedure is used

9. How to suction orally ?
Suction in the mouth area from the back teeth forward
NO further than the back teeth or end of the buccal space in babies with no teeth

10. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

11. What to use to suction?
Usually decided by the hospital or physiotherapist
Yankeur Suction catheter

12. Things to know
Yankauers are wider and are firmer so a risk of trauma to the mouth
Small Yankauers have holes and large ones don’t
Temptation to go further with a suction catheter than you will be competent to do
Yankauers need a cover on them whenever they are not being used

13. Typical suction machine

14. Checking the suction machine
This is a very important part of your care
Failure to check the machine correctly means you are putting the child/young person at risk
You will be working out of your competency and will carry the responsibility yourself

15. Suction machine checks
Charge Level
Charger present
Pressure is Correct
Adequate supply of suction catheters / yankauers
Suction Circuit is intact
Lid of bottle
Connector on top
Tubing
Supply of clean water for flushing of tube
Suction machine and all components clean and appropriate for use
Disposal bags
Hand cleaning gel
Gloves
Bag is safe to use

16. Lights on machine External charge (plugged in) Charged light
Warning light – flashes and then stays on - approx 30 minute charge

17. Cleaning and caring for the suction machine
Wipe down suction machine weekly
Suction bags machine wash at 40 degrees
Consumables
Yankaeur change daily (more often if blocked)
Suction tubing change weekly
Filter, Pot and Lid change 3 monthly

18. Care & Cleaning continued
Flush the suction tubing after every use
Empty the pot when half full
Charge overnight
Serviced by manufacturer
Report any problems

19. Troubleshooting
Cracks
Seal
Battery
Wet filter

20. Suction pressures The pressure for suction is always 150Hg or 20KPa
Check your pressures each time you are preparing to suction
Older machines pressure valve can easily be pushed and put pressure up!!

21. Check your child - before, during and after
Responsive
Colour
Respiratory rate
Increased work of breathing
Sound of breathing
Chest movement
Saturations

22. Holistic approach How does she look? Does she need a position change?
Is she trying to tell you something? What is her environment like?
Is she too hot or too cold?
Are her clothes rubbing her?
Is she uncomfortable?
Is she bored?
Is it too noisy?
Is she unwell?

23. How is suction done?
Wash your hands or alcogel before you suction, except in an emergency
Put on gloves
Have all equipment together and ready to use
The suction machine should be set at a pressure of less than 20kpa/150mmHg. Check the machine to make sure it is adjusted correctly
Attach the catheter to the tubing

24. How is suction done?
Remove the catheter with the gloved hand (clean hand/dirty hand)
Insert the yankauer no further than the hard pallet (back teeth)
Suction by blocking the finger hole (if small one) - side to side and out - moving the catheter slowly.
Allow the child to take at least three breaths if you need to repeat the procedure.
Stop suctioning when mucus cannot be seen or heard.

25. How is suction done?
Remove the glove by pulling the glove inside out. Throw in the bin
Rinse the yankauer and tubing in sterile water by suctioning a small amount through the catheter
Turn the suction machine off and make sure new supplies are ready for the next time (don’t open catheters)
Wash hands

26. What if it doesn’t work and the child is struggling to breathe?
SHOUT FOR HELP!
Consider giving the child oxygen if colour has changed
Consider re-suctioning or repositioning
Try to reassure the child
Dial 999 and follow resus protocol

27. Practical Putting the suction machine together Setting pressures
Attaching the yankeur and suction catheter
What parts to clean
Common trouble shooting areas
Practice oral suction technique

28. Any questions?