Performing Upper Airway Suctioning

Performing Upper Airway Suctioning

Equipment
■ Portable or wall suction device with connection tubing and a collection canister.
■ Linen-saver pad or towel.
■ Yankauer device (can be used for oropharyngeal suction).
■ Pour-bottle of sterile normal saline solution.
■ Sterile basin or other container for fluids.
■ Face shield or goggles and gown.
■ Procedure gloves.
■ Water-soluble lubricant for nasopharyngeal suctioning.
■ Sputum trap, if a specimen is needed.
■ Biohazard bag.
■ Sterile suction catheter kit (12 to 18 Fr for adults, 8 to 10 Fr for children, and 5 to 8 Fr for infants).
■ If a kit isn’t available, collect the following: sterile suction catheter of the appropriate size, and a sterile container.
■ If you plan to suction both the oropharynx and the nasopharynx, you need a separate sterile catheter for each.

Assessment
■ Assess:
■ Respiratory status, including respiratory rate, depth, and rhythm.
■ Breath sounds.
■ Color.
■ Pulse oximetry results.
■ Note signs that indicate the need for suctioning:
■ Restlessness.
■ Cyanosis.
■ Labored respirations.
■ Decreased oxygen saturation.
■ Increased heart and respiratory rates.
■ Visible secretions in the airway.
■ Presence of adventitious breath sounds during auscultation.
■ Be Safe! You must be certain the patient requires suctioning. Suctioning should be performed only when necessary to prevent unnecessary oxygen desaturation and tissue trauma.

Post-Procedure Reassessment
■ Assess the color, consistency, and amount of secretions.
■ Evaluate the patient’s tolerance of the procedure.
■ Note whether there were signs of respiratory distress during the procedure.
■ Evaluate the effectiveness of the procedure by comparing breath sounds, VS, and pulse oximetry before and after the procedure.

Key Points
■ Position the patient in semi-Fowler’s position.
■ Oropharyngeal: Patient’s face turned toward you.
■ Nasopharyngeal: Neck hyperextended.
■ Adjust the suction regulator according to agency policy (typically 100 to 120 mm Hg for adults, 95 to 110 mm Hg for children, and 50 to 95 mm Hg for infants).
■ If using the nasal approach, open the water-soluble lubricant.
■ Don procedure gloves.
■ Using your dominant hand, attach the suction catheter to the connection tubing.
■ Approximate the depth the suction catheter should be inserted.
■ Remove the oxygen delivery device, if necessary.
■ If the oxygen saturation is less than 94%, or if patient is in distress, administer supplemental oxygen before, during, and after suctioning.
■ Lubricate and insert the suction catheter.
■ Gently advance the catheter the premeasured distance into the pharynx.
■ Engage the suction and apply it while you withdraw the catheter, using a continuous rotating motion.
■ Clear the catheter with sterile saline.
■ Lubricate the catheter, and repeat suctioning as needed, allowing 20-second intervals between suctioning.
■ Be Smart! Upper airway suctioning may be done via the oropharyngeal or nasopharyngeal route. However, nasal suction is usually required to improve oxygenation only in infants because most adult airway obstruction occurs in the mouth and oropharynx.
■ Be Safe! Vigorous nasal suction can induce epistaxis (nosebleed) and further complicate an already difficult airway.

Documentation
■ Record:
■ Date, time, and reason you performed suctioning.
■ Suction technique you used.
■ Catheter size.
■ Note:
■ Color, consistency, and odor of secretions.
■ Patient’s respiratory status before and after the procedure.
■ Patient’s tolerance of the procedure.
■ Any complications that occurred as a result of the procedure.
■ Resulting interventions.

Oropharyngeal suctioning

Nasopharyngeal suctioning