OROPHARYNGEAL AND NASOTRACHEAL SUCTIONING

1. Explain procedure and rationale to patient/family regardless of patients level of consciousness. 2. Identify patient by armband and patient stating name if able to do so. 3. Wash hands. Don clean gloves. 4. Position a conscious person who has a functional gag reflex in the semi-Fowlers position, with head turned to one side for oral suctioning or with neck hyperextended for nasal suctioning. Position an unconscious patient in the lateral position, facing you. 5. For oral and oropharyngeal suction: Moisten the tip of the Yankauer suction catheter with the sterile water or saline. Pull tongue forward, if necessary, using gauze. Do not apply suction (leave your finger off the port) during the insertion. Advance the catheter about 1015 cm (46 inches) along one side of the mouth into the oropharynx. It may be necessary during oropharyngeal suctioning to apply suction to secretions that collect in the vestibule of the mouth and beneath the tongue. 6. For nasopharyngeal and nasotracheal suction: Open the lubricant, if performing nasopharyngeal/nasotracheal suctioning. Open the sterile suction package. Set up the cup or container, touching only the outside. Pour sterile water or saline into the container. Don sterile gloves. With your sterile-gloved hand, pick up the catheter, and attach it to the suction unit.

7. Make an approximate measure of the depth for the insertion of the catheter, and test the equipment. Measure the distance between the tip of the patients nose and the earlobe. Mark the position on the tube with the fingers of the sterile-gloved hand. 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 (the suction control) to create suction. If needed, increase supplemental oxygen. 8. Lubricate and introduce the catheter. Lubricate the catheter tip with sterile water, saline, or water-soluble lubricant. Remove oxygen with your nondominant hand, if appropriate. Without applying suction, insert the premeasured or recommended distance of the catheter into either naris, and advance it along the floor of the nasal cavity. Never force the catheter against the obstruction. If one nostril is obstructed, try the other. 9. Perform suctioning. Apply your finger to the suction control port to start suction, and gently rotate the catheter. Apply suction for 510 seconds while slowly withdrawing the catheter, then remove your finger from the control and remove the catheter. A suction attempt should last only 1015 seconds. During this time, the catheter is inserted, the suction applied and discontinued, and the catheter removed. 10. 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, and limit suctioning to 5 minutes in total. Encourage the patient to breathe deeply and to cough between suctions. 11. Obtain a specimen, if required. Use a sputum trap as follows: Attach the suction catheter to the tubing of the sputum trap. Attach the suction tubing to the sputum trap air vent. Suction the patient. The sputum trap will collect the mucus during suctioning. Remove the catheter from the patient. Disconnect the sputum trap tubing from the suction catheter. Remove the suction tubing from the trap air vent. Connect the tubing of the sputum trap to the air vent.

 Flush the catheter to remove secretions from the tubing. 11. Promote patient comfort. Offer to assist the patient with oral or nasal hygiene. Assist the patient to a position that facilitates breathing. 12. Dispose of equipment and ensure availability for the next suction. Dispose of the catheter, gloves, water, and waste container. Wrap the catheter around your sterile-gloved hand and hold the catheter as the glove is removed over it for disposal. Rinse the suction tubing as needed by inserting the end of the tubing into the used water container. Empty and rinse the suction collection container as needed or indicated by protocol. Change the suction tubing and container daily. Ensure that supplies are available for the next suctioning. 13. Assess the effectiveness of suctioning. Auscultate the patients breath sounds to ensure they are clear of secretions. Observe skin color, dyspnea, level of anxiety, and oxygen saturation levels.

Oxygen Delivery Systems 1. Nasal Cannula

ventilation, at liter flows of 10 to 15 liters per minute.

4.

Also called nasal prongs. Is the most common inexpensive device It is easy to apply and does not interfere It delivers a relatively low concentration of

Venturi Mask Delivers oxygen

concentrations varying from 24% to 40% or 50% at liter flows of 4 to 10 liters per minute. 3. Face Tent

used to administer oxygen. with the clients ability to eat or talk. oxygen which is 24% to 45% at flow rates of 2 to 6 liters per minute. 2. Face Mask

It can replace oxygen masks when masks It provide varying concentrations of

are poorly tolerated by clients. oxygen such as 30% to 50% concentration of oxygen at 4 to 8 liters per minute. 4. Transtracheal Oxygen Delivery

It cover the clients nose and mouth may Exhalation ports on the sides of the mask

be used for oxygen inhalation. allow exhaled carbon dioxide to escape. Types of Face Masks:
1.

It may be used for oxygen-dependent

clients.

Simple Face Mask - Delivers The client requires less oxygen (0.5 to 2 liters per minute) because all of the low delivered enters the lungs.

oxygen concentrations from 40% to 60% at liter flows of 5 to 8 liters per minute, respectively.
2.

Partial Rebreather Mask

Delivers oxygen concentration of 60% to 90% at liter flows of 6 to 10 liters per minute, respectively.
3.

Non Rebreather Mask Delivers

the highest oxygen concentration possible 95% to 100% by means other than intubation or mechanical