Division of Health Sciences, Departent of Nursing S! "0#0$"0## SUCTIONING Purpose Reove respirator% secretions &hen patient is una'le to (o so &ith coughing an($or e)pectoration. Types *rophar%ngeal *rotracheal Nasotracheal Suctioning of artificial air&a% When to Perform +hen secretions are i(entifie( (uring assessent an( the patient is una'le to clear secretions on his$her o&n. Common Conditions which often result in Increased Secretions or Problems with Cough!"pectoration ,lui( status o ,lui( overloa( -increase(. o Deh%(ration -thic/. 0ac/ of hui(it% !nfections -pneuonia etc.. 1nato% changes -a'noralities, e(ea, tuors etc.. Misc. con(itions -neurological 2stro/e etc3, paral%sis etc.. #elegation Ma% 'e (elegate( to 14 onl% in special situations such as sta'le patient &ith esta'lishe( tracheosto% or hoe ventilation Ma% onl% 'e (elegate( if allo&e( per agenc% polic%, inclu(e( in the 5o' (escription of the 14, an( the 14 has ha( appropriate training an( (eonstrate( copetence in perforing the s/ill RN ust follo& all the appropriate steps of the (elegation process, inclu(ing a/ing sure it is the right tas/, right circustance, right person, right counication$(irection, an( right supervision$evaluation $e%uired !%uipment Suction catheter -sallest (iaeter that &ill effectivel% reove secretions. *R 6an/auer catheter -for oral secretions. 7o&el or (rape Sterile or clean gloves -(epen(s on t%pe of suctioning. Suction e8uipent -&all or porta'le. 4ersonnel protective e8uipent for nurse -as/ 9 e%e protection or face shiel(. Sterile saline apoules -controversial: not al&a%s use(. Connecting tu'e Physical SignsSymptoms of Need to Suction Respirator% rate changes -usuall% increase(. 1(ventitious 'reath soun(s Nasal secretions ;urgling Drooling Restlessness ;astric secretion or voitus in outh Coughing &ithout clearing secretions Others &associated with hypo"ia or hypercapnia' Decrease( Sp*" 1pprehension, an)iet% Decrease( a'ilit% to concentrate 0etharg% Decrease( 0*C !ncrease( fatigue Di<<iness =ehavioral changes especiall% increase( irrita'ilit% !ncrease( HR, =4, RR Decrease( (epth of 'reathing Car(iac (%srh%thias 4allor C%anosis D%spnea Techni%ue O(er(iew +ill 'e either clean or sterile techni8ue (epen(ing on area suctione( o Clean > orophar%n) o Sterile > orotracheal, nasotracheal, suctioning of artificial air&a% Ma% re8uire pre?o)%genation an($or (eep 'reathing Re8uires 44@ -as/, face shiel(, goggles. )ey Steps 1ssess clientAs respirator% status ;ather supplies *and hygiene Identify client @)plain proce(ure 4osition client -H*= elevate( 'est. $emo(e salinewater basin without contaminating other materials 4our saline$&ater into 'asin +pply sterile glo(es, #ominant hand will remain sterile, +ttach suction catheter to suction tubing and turn on suction &while maintaining sterility of catheter,' 7est suction &ith saline$&ater. 0u'ricate catheter &ith saline$&ater or &ater solu'le lu'ricant. o ,or trach onl% use saline to lu'ricate Nares Insert catheter into nares to appropriate distance without applying suction, +pply suction to remo(e secretions &-. /-0 second ma"imum' +s suction catheter is remo(ed use twisting motion, 1ay also intermittently apply suction, 7racheosto% o Bpreo)%genateC 'efore suctioning o ,or patients that can cough onl% insert as far as o'turator o ,or patients &ho cannot cough a% nee( to insert (eeper 'ut N*7 as far as carinaDD #o NOT apply suction during insertion +pply suction to remo(e secretions &-. /-0 second ma"imum' +s suction catheter is remo(ed use twisting motion, Reassess clientAs respirator% status. 4rovi(e cofort care -&ipe outh, oral care prn. #isposes of materials without contamination, Perform hand hygiene, 2ea(e client in a safe and appropriate conditionposition, $ecording and $eporting 4resuction > patientAs car(iopulonar% status 1fter suction / 1ount, consistenc%, color, o(or, patient response, an( patientAs car(iopulonar% status Docuentation @)aple > (presuction) Diffuse inspiratory and expiratory wheezes all fields, frequent productive cough of thick yellow secretions, increased WOB, ! "#, !! $#, O% &"'( (after suction) )opious thick yellow secretions, no odor, client coughed vigorously with procedure, no *radycardia, decreased inspiratory wheezes all fields, respirations full and unla*ored, ! &#, !! %#, O% "+'( ,atient ver*alized, -.ow / can *reathe0( Une"pected Outcomes and Inter(entions +orsening respirator% con(ition o 0iit length of suctioning o Deterine nee( for ore fre8uent &ith shorter (uration o Notif% MD =loo(% secretions o Chec/ suction pressure o @valuate fre8uenc% o 4rovi(e ore fre8uent oral h%giene Una'le to pass catheter through # st nares o 7r% other naris or oral route o !nsert nasal air&a% o ;ui(e catheter along floor of naris o !f ucus o'struction suction ucus: if clot notif% MD o !ncrease lu'rication of catheter Cough spass o 1(inister o)%gen o 1llo& rest 'et&een passes o Consult MD for nee( for 'roncho(ilators or inhale( anesthetics No secretions o @valuate flui( status o 1ssess for infection o Deterine nee( for chest ph%siotherap% o 1ssess hui(ification on o)%gen (eliver% (evice