Oropharyngeal , nasopharyngeal and naso tracheal suctioning

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OROPHARYNGEAL , OROPHARYNGEAL , NASOPHARYNGEAL AND NASO NASOPHARYNGEAL AND NASO TRACHEAL SUCTIONING TRACHEAL SUCTIONING PREPARED BY: JESSICA M. SALDANA, RN., MAN PREPARED BY: JESSICA M. SALDANA, RN., MAN

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Step by step procedure by Kozier Oropharyngeal, nasopharyngeal and nasotracheal suctioning

Transcript of Oropharyngeal , nasopharyngeal and naso tracheal suctioning

Page 1: Oropharyngeal , nasopharyngeal and naso tracheal suctioning

OROPHARYNGEAL , OROPHARYNGEAL , NASOPHARYNGEAL AND NASOPHARYNGEAL AND

NASO TRACHEAL NASO TRACHEAL SUCTIONINGSUCTIONING

PREPARED BY: JESSICA M. SALDANA, RN., MANPREPARED BY: JESSICA M. SALDANA, RN., MAN

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ORAL OROPHARYNGEALORAL OROPHARYNGEAL

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Nasopharyngeal CatheterNasopharyngeal Catheter

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Nasopharyngeal CatheterNasopharyngeal Catheter

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Nasopharyngeal CatheterNasopharyngeal Catheter

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PURPOSESPURPOSES

• To remove secretions that obstruct To remove secretions that obstruct the airwaythe airway

• To facilitate ventilationTo facilitate ventilation• To obtain secretions for diagnostic To obtain secretions for diagnostic

purposespurposes• To prevent infection that may result To prevent infection that may result

from accumulated secretionsfrom accumulated secretions

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ASSESSMENTASSESSMENT

Assess for clinical signs indicating the need Assess for clinical signs indicating the need for suctioning:for suctioning:

• RestlessnessRestlessness• Gurgling sounds during respirationsGurgling sounds during respirations• Adeventitious sounds when the chest is Adeventitious sounds when the chest is

being auscultatedbeing auscultated• Change in mental statusChange in mental status• Skin colorSkin color• Rate and pattern of respirationsRate and pattern of respirations• Pulse rate and rhythmPulse rate and rhythm• Decreased oxygen saturationDecreased oxygen saturation

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PLANNINGPLANNING

DelegationDelegationOral suctioning using the yankuer suction tube Oral suctioning using the yankuer suction tube

and oropharyngeal suctioning using a suction and oropharyngeal suctioning using a suction catheter can be deligated to UAP and to the catheter can be deligated to UAP and to the client or family, if appropriate, since this is not client or family, if appropriate, since this is not a sterile. The nurse needs to review the a sterile. The nurse needs to review the procedure and important points such as not procedure and important points such as not applying suction during insertion of the tube to applying suction during insertion of the tube to avoid trauma to the mucous membranes. In avoid trauma to the mucous membranes. In contrast, nasopharyngeal and nasotracheal contrast, nasopharyngeal and nasotracheal suctioning uses sterile technique and requires suctioning uses sterile technique and requires application of knowledge and problem solving application of knowledge and problem solving and should be performed by the nurse or and should be performed by the nurse or respiratory therapist.respiratory therapist.

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EQUIPMENTEQUIPMENT

Oral and Nasopharyngeal/Nasotracheal Oral and Nasopharyngeal/Nasotracheal SuctioningSuctioning

• Towel or moisture resistant padTowel or moisture resistant pad• Portable or wall suction machine with tubing, Portable or wall suction machine with tubing,

collection receptacle, and suction pressure collection receptacle, and suction pressure gaugegauge

• Sterile disposable container for fluidsSterile disposable container for fluids• Sterile normal saline or waterSterile normal saline or water• Goggles or face shield, if approoriateGoggles or face shield, if approoriate• Moisture-resistant disposable bagMoisture-resistant disposable bag• Sputum trap, if specimen is to be collectedSputum trap, if specimen is to be collected

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EQUIPMENTEQUIPMENT

Oral and Oropharyngeal SuctioningOral and Oropharyngeal Suctioning• Yankauer suction catheter or suction catheter kitYankauer suction catheter or suction catheter kit• Clean glovesClean gloves

Nasopharyngeal or Nasotracheal SuctioningNasopharyngeal or Nasotracheal Suctioning• Sterile glovesSterile gloves• Sterile suctrion catheter kit (# 12 to # 18 Fr. For Sterile suctrion catheter kit (# 12 to # 18 Fr. For

adults, # 8 to # 10 Fr. For children, and # 5 to # adults, # 8 to # 10 Fr. For children, and # 5 to # 8 for infants)8 for infants)

• Water soluble lubricantWater soluble lubricant• Y- connectorY- connector

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IMPLEMENTATIONIMPLEMENTATIONPerformancePerformance1.1. Prior to performing the procedure, introduce self Prior to performing the procedure, introduce self

and verify the client’s identity using agency and verify the client’s identity using agency protocol. Explain to the client what you are going protocol. Explain to the client what you are going to do, why it is necessary, and how he or she can to do, why it is necessary, and how he or she can cooperate. Inform the client that suctioning will cooperate. Inform the client that suctioning will relieve breathing difficulty and that the procedure relieve breathing difficulty and that the procedure is painless but may be uncomfortable and stimulate is painless but may be uncomfortable and stimulate the cough, gag, or sneeze reflex. the cough, gag, or sneeze reflex. RATIONALERATIONALE: : Knowing that the procedure will relieve Knowing that the procedure will relieve breathing problems is often reassuring and breathing problems is often reassuring and enlists the client’s cooperation.enlists the client’s cooperation.

2.2. Perform hand hygiene and observe other Perform hand hygiene and observe other appropriate infection control procedures.appropriate infection control procedures.

3.3. Provide for client privacyProvide for client privacy

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Yankauer suction Yankauer suction cathetercatheter

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IMPLEMENTATIONIMPLEMENTATION4.4. Prepare the clientPrepare the client• Position a conscious person who has a functional gag Position a conscious person who has a functional gag

reflex in semi Fowler’s position with the head turned to reflex in semi Fowler’s position with the head turned to one side for oral suctioning or with the neck hyper one side for oral suctioning or with the neck hyper extended for nasal suctioning. extended for nasal suctioning. RATIONALE: RATIONALE: These These positions facilitate the insertion of catheter and positions facilitate the insertion of catheter and help prevent aspiration of the secretionshelp prevent aspiration of the secretions

• Position an unconscious client in the lateral position, Position an unconscious client in the lateral position, facing you. facing you. RATIONALE: RATIONALE: This position allows the This position allows the tongue to fall forward, so that it will not obstruct tongue to fall forward, so that it will not obstruct the catheter on insertion. The lateral position also the catheter on insertion. The lateral position also facilitates drainage of secretions from the pharynx facilitates drainage of secretions from the pharynx and prevents the possibility of aspiration.and prevents the possibility of aspiration.

• Place the towel or moisture resistant pad over the pillow Place the towel or moisture resistant pad over the pillow or under the chinor under the chin

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IMPLEMENTATIONIMPLEMENTATION

5.5. Prepare the equipment.Prepare the equipment.• Set the pressure on the suction gauge, and turn Set the pressure on the suction gauge, and turn

on the suction. Many suction devices are on the suction. Many suction devices are calibrated to three pressure ranges.calibrated to three pressure ranges.

• Wall unit:Wall unit:Adult: 100 to 120 mm.Hg.Adult: 100 to 120 mm.Hg.Child: 95 to 110 mm.Hg.Child: 95 to 110 mm.Hg.Infant: 50 to 95 mm.Hg.Infant: 50 to 95 mm.Hg.

• Portable unit:Portable unit:Adult: 10 to 15 mm. Hg.Adult: 10 to 15 mm. Hg.Child: 5 to 10 mm. Hg.Child: 5 to 10 mm. Hg.Infant: 2 to 5 mm. Hg.Infant: 2 to 5 mm. Hg.

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IMPLEMENTATIONIMPLEMENTATIONFor Oral and Oropharyngeal SuctionFor Oral and Oropharyngeal Suction• Moisten the tip of the Yankauer or suction catheter Moisten the tip of the Yankauer or suction catheter

with sterile saline water or saline. RATIONALE: This with sterile saline water or saline. RATIONALE: This reduces friction and eases insertion.reduces friction and eases insertion.

• Pull the tongue forward, if necessary, using gauze.Pull the tongue forward, if necessary, using gauze.• Do not apply suction. RATIONALE: Applying suction Do not apply suction. RATIONALE: Applying suction

during insertion causes trauma to th emucous during insertion causes trauma to th emucous membrane.membrane.

• Advance the catheter about 10 to 15 cm. ( 4 to 6 in.) Advance the catheter about 10 to 15 cm. ( 4 to 6 in.) along one side of the mouth into the oropharynx. along one side of the mouth into the oropharynx. RATIONALE: Directing the catheter along the sides RATIONALE: Directing the catheter along the sides prevents gagging.prevents gagging.

• It maybe necessary during the oropharyngeal It maybe necessary during the oropharyngeal suctioning to apply suction to secretions that collect suctioning to apply suction to secretions that collect in the vestibule of the mouth and beneath the tongue.in the vestibule of the mouth and beneath the tongue.

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IMPLEMENTATIONIMPLEMENTATIONFor Nasopharyngeal and Nasotracheal SuctionFor Nasopharyngeal and Nasotracheal Suction• Open the lubricant if performing nasopharyngeal/nasotrecheal Open the lubricant if performing nasopharyngeal/nasotrecheal

suctioningsuctioning• Open the sterile suction packageOpen the sterile suction package

a. Set up the container, touching only the outside.a. Set up the container, touching only the outside.b. Pour sterile water or saline into the container.b. Pour sterile water or saline into the container.c. Put on sterile gloves, or put on a non sterile gloves on the non c. Put on sterile gloves, or put on a non sterile gloves on the non dominant hand. RATIONALE: The sterile glove hand maintains the dominant hand. RATIONALE: The sterile glove hand maintains the sterility of the suction catheter, and the un sterile gloves prevents sterility of the suction catheter, and the un sterile gloves prevents the transmission of microorganism to the nurse.the transmission of microorganism to the nurse.

• With your sterile gloved hand, pick up the catheter and attach it to With your sterile gloved hand, pick up the catheter and attach it to the suction unit.the suction unit.

6.6. Make an approximate depth of insertion of the catheter and test Make an approximate depth of insertion of the catheter and test the equipment.the equipment.

• Measure the distance betwteen the tip of the client’s nose and the Measure the distance betwteen the tip of the client’s nose and the earlobe, or about 13 cm ( 5 in.) for an adult.earlobe, or about 13 cm ( 5 in.) for an adult.

• Mark the position on the tube with the fingers of the sterile gloved Mark the position on the tube with the fingers of the sterile gloved hand. hand.

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IMPLEMENTATIONIMPLEMENTATION• Test the pressure of the suction and the patency of the catheter by 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 applying your sterile gloved finger or thumb to the port or open branch of the Y- connector to create suction.branch of the Y- connector to create suction.

7.7. Lubricate and introduce the catheter.Lubricate and introduce the catheter.• Lubricate the catheter tip with saline water, or sterile water or Lubricate the catheter tip with saline water, or sterile water or

water soluble lubricant. RATIONALE: This reduces friction and water soluble lubricant. RATIONALE: This reduces friction and eases insertion.eases insertion.

• Remove oxygen with the non dominant hand, and if appropriate.Remove oxygen with the non dominant hand, and if appropriate.• Without applying suction, inset the catheter the pre measured or Without applying suction, inset the catheter the pre measured or

recommend distance into their naris and advance it along the floor recommend distance into their naris and advance it along the floor of the nasal cavity. RATIONALE: This avoids the nasal turbinates.of the nasal cavity. RATIONALE: This avoids the nasal turbinates.

8.8. Perform suctioning.Perform suctioning.• Apply your finger to the suction control port to start suction, and Apply your finger to the suction control port to start suction, and

gently rotate the catheter. RATIONALE: Gentle rotation of the gently rotate the catheter. RATIONALE: Gentle rotation of the catheter ensures that all surfaces are reached and prevents catheter ensures that all surfaces are reached and prevents trauma to any one area of the respiratory mucosa due to prolonged trauma to any one area of the respiratory mucosa due to prolonged suction.suction.

• Apply suction for 5 to 10 seconds while slowly withdrawing the Apply suction for 5 to 10 seconds while slowly withdrawing the catheter , then remove the finger from the control and remove the catheter , then remove the finger from the control and remove the catheter .catheter .

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IMPLEMENTATIONIMPLEMENTATION

9.9. Rinse the catheter and repeat Rinse the catheter and repeat suctioning as above.suctioning as above.

• Rinse and flush the catheter and Rinse and flush the catheter and tubing with sterile water or saline.tubing with sterile water or saline.

• Relubricate the catheter, and repeat Relubricate the catheter, and repeat suctioning until the air passage is suctioning until the air passage is clear.clear.

• Allow sufficient time between each Allow sufficient time between each suctionsuction

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• THE ENDTHE END