Oral Suctioning

Suction is used in patients who are unable to clear retained or excessive lower respiratory tract secretions on their own. This could be due to the presence of an artificial airway, such as an endotracheal or tracheostomy tube, or it could be due to patients having a poor cough for a variety of reasons, such as excessive sedation or neurological involvement.

Procedure

1. Confirm the client's ID using two client identifiers according to your facility's policy.

Rationale:Checking identification ensures client safety through a concept of correct procedure for correct client.

1. Explain the procedure to the client even if the client is unresponsive. Inform the client that suctioning may stimulate transient coughing or gagging, but explain that coughing helps to mobilize secretions. If the client has been suctioned before, just summarize the reasons for the procedure. Reassure the client throughout the procedure.

Rationale:Explanation minimizes anxiety and fear, which can increase oxygen consumption.

1. Wash your hands.

Rationale:Handwashing reduces the transfer of microorganisms.

1. Gather and place the suction equipment on the client's overbed table or bedside stand. Position the table or stand on your preferred side of the bed to facilitate suctioning. Connect the tubing to the suctioning unit. Date and open the bottle of normal saline solution. Open the waterproof trash bag.
2. Don personal protective equipment, as appropriate.

Rationale: Protective equipment protects you from contact with secretions.

1. Turn on the suction from the wall or portable unit and set the pressure according to your facility's policy. The pressure may be set between 100 and 150 mm Hg. Occlude the end of the connecting tubing to check suction pressure.

Rationale:Tube occlusion tests suction apparatus; higher pressures cause excessive trauma without enhancing secretion removal.

1. Place the client in semi-Fowler's or high-Fowler's position, if tolerated, to promote lung expansion and effective coughing. If the client is unconscious, position the client on his side facing you to help promote drainage of secretions.

Rationale:Side position promotes forward drainage of secretions.

1. Place a towel across the client's chest.

Rationale:Towel prevents contact with secretions.

1. Using strict aseptic technique, open the suction catheter kit or the packages containing the sterile catheter, container, and gloves. Don the gloves; consider your dominant hand sterile and your nondominant hand nonsterile. Using your nondominant hand, pour the saline solution into the sterile container.
2. Pick up the catheter with your dominant (sterile) hand and attach it to the connecting tubing. Use your nondominant hand to control the suction valve while your dominant hand manipulates the catheter.
3. Lubricate 3" to 4" of the catheter tip with an irrigating solution.

Rationale:Lubrication prevents mucosal trauma when a catheter is inserted.

1. Instruct the client to a cough and breathe slowly and deeply several times before beginning suction. (SeeTips on Airway Clearance.)

Rationale:Coughing helps loosen secretions and may decrease an amount of suction necessary, while deep breathing helps minimize or prevent hypoxia.

1. Without applying suction, gently insert the catheter into the client's mouth. Advance it 3_ to 4_ (7.5 to 10 cm) along the side of the client's mouth until you reach the pool of secretions or the client begins to cough.
2. Using intermittent suction, withdraw the catheter from the mouth with a continuous rotating motion to minimize invagination of the mucosa into the catheter's tip and side ports.

Rationale:Apply suction for only 10 to 15 seconds at a time to minimize tissue trauma.

1. When removing the catheter, wrap it around your dominant (sterile) hand to prevent contamination.
2. Suction both sides of the client's mouth and pharyngeal area. If secretions are thick, clear the lumen of the catheter by dipping it in water and applying suction.

Rationale:Dipping in water clears secretions from tubing.

1. Repeat the procedure, up to 3 times, until gurgling or bubbling sounds stop and respirations are quiet. Allow 30 seconds to 1 minute between repetitions.

Rationale:Time between each suctioning allows for reoxygenation and ventilation.

1. After suctioning is complete, pull your sterile glove off over the coiled catheter and discard it, the nonsterile glove, and the container of water.

Rationale:Glove removal reduces the transfer of microorganisms.

1. Flush the connecting tubing with normal saline solution. Discard the used items and replace with new supplies so they are ready for the next suctioning.

Rationale:Apply suction for only 10 to 15 seconds at a time to minimize tissue trauma.

1. Remove personal protective equipment and wash your hands.

Rationale:Handwashing reduces the transfer of microorganisms.

1. Let the client rest after the suctioning while you continue to observe him. The frequency and duration of suctioning depend on the client's tolerance for the procedure and on any complications.
2. Record the date, time, reason for suctioning, and technique used; amount, color, consistency, and odor (if any) of the secretions; the client's respiratory status before and after the procedure; any complications and the nursing action taken; and the client's tolerance for the procedure.