Oropharyngeal and Nasopharyngeal Suctioning Study Notes

## Introduction

Suctioning via the oropharyngeal (mouth) and nasopharyngeal (nasal) routes is a clinical procedure performed to remove accumulated materials that inhibit breathing.
It is essential for individuals unable to cough or clear secretions effectively.
Indications for suctioning include the presence of visible secretions, abnormal lung sounds, oxygen saturation issues, and increased work of breathing.

Evidence for Need:
- Visible secretions in the airway.
- Chest auscultation shows:
- Coarse, gurgling breath sounds.
- Rhonchi or diminished breath sounds.
- Patient reports feeling of secretions in the chest.
- Suspected aspiration of gastric or upper airway secretions.
- Clinically apparent increased work of breathing, such as:
- Restlessness.
- Unrelieved coughing.
Emergent Situations:
- No provider order is needed for suctioning to maintain an airway.
- Routine suctioning requires a provider order.

Device Used: Yankauer suction tip.
- Rigid with multiple holes for suctioning thick secretions.
- Delegation to trained assistive personnel is permissible if the patient is stable.
Safety Note: Care should be taken to protect the patient’s soft mucous membranes during suctioning to avoid trauma.

Involves using a soft, flexible suction catheter through the nares to remove secretions.
Indicated when Yankauer suctioning is ineffective.
Equipment: Suction catheter and connection to suction canister.

Follow agency policy for suction pressure settings:
- Maximum pressures to avoid complications:
- Neonates: 60-80 mm Hg
- Infants: 80-100 mm Hg
- Children: 100-120 mm Hg
- Adults: 100-150 mm Hg
Portable Unit Pressures:
- Adults: 10-15 cm Hg
- Adolescents: 8-15 cm Hg
- Children: 8-10 cm Hg
- Infants: 8-10 cm Hg
- Neonates: 6-8 cm Hg
Caution: Suctioning should last no more than 15 seconds at a time to reduce respiratory complications.

Hyperoxygenation/Hypoventilation:
- Important to hyperoxygenate the patient before the procedure to mitigate risks like hypoxemia and arrhythmias.
- Techniques include increasing O2 levels and encouraging deep breathing prior to suctioning.
Patient Positioning:
- For nasal suctioning, position patient with head leaning back to facilitate catheter insertion toward trachea.

Gather Supplies: Yankauer/suction catheter, suction machine, canister, connecting tubing, PPE, lubricant, saline or water.
Safety Steps:
- Perform hand hygiene.
- Confirm patient identity with two identifiers.
- Explain the procedure to the patient.
- Assess ABCs (Airway, Breathing, Circulation).
Patient Positioning:
- Semi-Fowler’s for conscious patients.
- Lateral position for unconscious patients.
Equipment Setup:
- Adjust suction to appropriate pressure settings accordingly.
- Perform checks for correct suction pressure.
Sterile Technique Initiation:
- Open sterile packages while maintaining aseptic technique and set up the sterile field.
Catheter Preparation:
- Moisten catheter with saline and lubricate its tip.
Suctioning Procedure:
- Insert catheter while occluding suction valve intermittently.
- Suction only on withdrawal and limit duration.
Post-Procedure Steps:
- Conduct necessary follow-ups such as reoxygenation, assess lung sounds, and documentation.

Expected Findings:
- Patient complaints of secretion difficulty, suction conducted, and improvements noted in vital signs and lung sounds.
- Example Values:
  - Pre-procedure: HR 88, RR 28, O2 Sat 88%.
  - Post-procedure: HR 78, RR 18, O2 Sat 94%.
Unexpected Findings:
- Signs of crisis during procedure, such as uncontrollable coughing requiring emergency intervention.

Ensure Call light is within reach, bed lowered and locked, side rails secured, and room is free of hazards when leaving.

Essential to perform thorough hand hygiene post-procedure and document all findings as per agency policy.