ORAL OROPHARYNGEAL Nasopharyngeal Catheter Nasopharyngeal Catheter Nasopharyngeal Catheter 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 ASSESSMENT Assess for clinical signs indicating the need for suctioning: Restlessness Gurgling sounds during respirations Adeventitious sounds when the chest is being auscultated Change in mental status Skin color Rate and pattern of respirations Pulse rate and rhythm Decreased oxygen saturation PLANNING Delegation Oral suctioning using the yankuer suction tube and oropharyngeal suctioning using a suction catheter can be deligated to UAP and to the client or family, if appropriate, since this is not a sterile. The nurse needs to review the procedure and important points such as not applying suction during insertion of the tube to avoid trauma to the mucous membranes. In contrast, nasopharyngeal and nasotracheal suctioning uses sterile technique and requires application of knowledge and problem solving and should be performed by the nurse or respiratory therapist. EQUIPMENT Oral and Nasopharyngeal/Nasotracheal Suctioning Towel or moisture resistant pad Portable or wall suction machine with tubing, collection receptacle, and suction pressure gauge Sterile disposable container for fluids Sterile normal saline or water Goggles or face shield, if approoriate Moisture-resistant disposable bag Sputum trap, if specimen is to be collected EQUIPMENT Oral and Oropharyngeal Suctioning Yankauer suction catheter or suction catheter kit Clean gloves
Nasopharyngeal or Nasotracheal Suctioning
Sterile gloves Sterile suctrion catheter kit (# 12 to # 18 Fr. For adults, # 8 to # 10 Fr. For children, and # 5 to # 8 for infants) Water soluble lubricant Y- connector IMPLEMENTATION Performance 1. Prior to performing the procedure, introduce self and verify the clients identity using agency protocol. Explain to the client what you are going to do, why it is necessary, and how he or she can cooperate. Inform the client that suctioning will relieve breathing difficulty and that the procedure is painless but may be uncomfortable and stimulate the cough, gag, or sneeze reflex. RATIONALE: Knowing that the procedure will relieve breathing problems is often reassuring and enlists the clients cooperation. 2. Perform hand hygiene and observe other appropriate infection control procedures. 3. Provide for client privacy Yankauer suction catheter IMPLEMENTATION 4. Prepare the client Position a conscious person who has a functional gag reflex in semi Fowlers position with the head turned to one side for oral suctioning or with the neck hyper extended for nasal suctioning. RATIONALE: These positions facilitate the insertion of catheter and help prevent aspiration of the secretions Position an unconscious client in the lateral position, facing you. RATIONALE: This position allows the tongue to fall forward, so that it will not obstruct the catheter on insertion. The lateral position also facilitates drainage of secretions from the pharynx and prevents the possibility of aspiration. Place the towel or moisture resistant pad over the pillow or under the chin IMPLEMENTATION 5. Prepare the equipment. Set the pressure on the suction gauge, and turn on the suction. Many suction devices are calibrated to three pressure ranges. Wall unit: Adult: 100 to 120 mm.Hg. Child: 95 to 110 mm.Hg. Infant: 50 to 95 mm.Hg. Portable unit: Adult: 10 to 15 mm. Hg. Child: 5 to 10 mm. Hg. Infant: 2 to 5 mm. Hg. IMPLEMENTATION For Oral and Oropharyngeal Suction Moisten the tip of the Yankauer or suction catheter with sterile saline water or saline. RATIONALE: This reduces friction and eases insertion. Pull the tongue forward, if necessary, using gauze. Do not apply suction. RATIONALE: Applying suction during insertion causes trauma to th emucous membrane. Advance the catheter about 10 to 15 cm. ( 4 to 6 in.) along one side of the mouth into the oropharynx. RATIONALE: Directing the catheter along the sides prevents gagging. It maybe necessary during the oropharyngeal suctioning to apply suction to secretions that collect in the vestibule of the mouth and beneath the tongue. IMPLEMENTATION For Nasopharyngeal and Nasotracheal Suction Open the lubricant if performing nasopharyngeal/nasotrecheal suctioning Open the sterile suction package a. Set up the container, touching only the outside. b. Pour sterile water or saline into the container. c. Put on sterile gloves, or put on a non sterile gloves on the non dominant hand. RATIONALE: The sterile glove hand maintains the sterility of the suction catheter, and the un sterile gloves prevents the transmission of microorganism to the nurse. With your sterile gloved hand, pick up the catheter and attach it to the suction unit. 6. Make an approximate depth of insertion of the catheter and test the equipment. Measure the distance betwteen the tip of the clients nose and the earlobe, or about 13 cm ( 5 in.) for an adult. Mark the position on the tube with the fingers of the sterile gloved hand. IMPLEMENTATION Test the pressure of the suction and the patency of the catheter by applying your sterile gloved finger or thumb to the port or open branch of the Y- connector to create suction. 7. Lubricate and introduce the catheter. Lubricate the catheter tip with saline water, or sterile water or water soluble lubricant. RATIONALE: This reduces friction and eases insertion. Remove oxygen with the non dominant hand, and if appropriate. Without applying suction, inset the catheter the pre measured or recommend distance into their naris and advance it along the floor of the nasal cavity. RATIONALE: This avoids the nasal turbinates. 8. Perform suctioning. Apply your finger to the suction control port to start suction, and gently rotate the catheter. RATIONALE: Gentle rotation of the catheter ensures that all surfaces are reached and prevents trauma to any one area of the respiratory mucosa due to prolonged suction. Apply suction for 5 to 10 seconds while slowly withdrawing the catheter , then remove the finger from the control and remove the catheter . IMPLEMENTATION 9. Rinse the catheter and repeat suctioning as above. Rinse and flush the catheter and tubing with sterile water or saline. Relubricate the catheter, and repeat suctioning until the air passage is clear. Allow sufficient time between each suction THE END