a. Oral/nasal suctioning is suctioning of the upper airway passages of the nose, mouth, and pharynx. This procedure is used to assist the patient in eliminating secretions before he has regained full consciousness and cannot spit out secretions. The catheter used should be soft and pliable. When you employ suctioning, you must make every effort to prevent the introduction of pathogens (disease causing microorganisms) into the lower airways. Normally, countless microorganisms are found in the upper respiratory tract and it is virtually impossible to maintain sterility when suctioning the nose or pharynx. Clean technique and thorough handwashing are essential for pharyngeal suctioning of the oral and nasal cavities, but aseptic technique is mandatory for deep suctioning in the tracheobronchial tree and for the intubated patient.
b. Administer an oral/nasal suctioning to the patient in the recovery room.
(1) Wash your hands and assemble all needed equipment as listed:
(a) Portable continuous suction machine or gauge to attach to the wall suction.
(b) Connecting tube.
(c) Sterile whistle-tip straight catheter (14 to 18 Fr) with a valve or Y-connector.
(d) Exam gloves.
(e) Disposable cup with tap water.
(f) Waste receptacle.
(2) Identify the patient. If the patient is conscious, explain the suctioning procedure to him and that it may stimulate the cough reflex.
(3) Provide for the patient's privacy.
(4) Observe the patient for evidence of airway obstruction due to secretions.
(5) Position the patient on one side in a semi-Fowler's position, if possible.
(a) This will facilitate airway patency and drainage of secretions.
(b) If unable to place the patient in a semi-Fowler's position, be sure the patient's head is turned to the side.
(6) Provide a clean working area. Oropharyngeal/nasopharyngeal suctioning is a clean procedure provided suctioning is limited to the oral, nasal, and/or pharyngeal areas.
(7) Wash your hands.
(8) Open the suction catheter package, attach the end to the connecting tubing from the suction machine, and place the catheter on a clean towel (see Figure 3-7).
(9) Put tap water in a clean paper cup.
(10) Turn on the suction unit, and set the desired pressure according to the equipment specification or the physician's order.
(11) Put on the exam gloves. Protective gloves should be worn during the procedure to prevent the transmission of infection.
(12) Moisten the suction catheter tip in the cup of water to reduce friction.
(13) Insert the catheter tip gently into the patient's nose or mouth.
(a) Do not apply suction during insertion.
(b) Do not force the catheter during insertion.
1 It can cause injury to the patient's mucous membranes.
2 If obstruction is encountered, call the Charge Nurse immediately for assistance.
(14) Advance the catheter to the posterior oral/nasal pharynx.
(a) Stimulate a cough reflex if the patient is unable to cough effectively.
(b) If patient has a mouth full of vomitus or secretions, clean this area first before stimulating cough in order to avoid aspiration and introduction of infection.
(15) Begin suctioning by placing the thumb of your nondominant hand over the catheter valve or Y-connector.
(a) Rotate the catheter while withdrawing to prevent irritation to the oral/nasal mucosa.
(b) Suction all secretions from the area.
(16) Suction for no more than 15 seconds. Suctioning for more than 15 seconds may cause hypoxia. Allow the patient to rest for 2 to 3 minutes between catheter insertions.
(17) Rinse the catheter in the cup of water after each insertion.
(18) Repeat the suctioning procedure as necessary until the patient's airway is clear.
(19) Remove your gloves and discard them and the catheter in the waste receptacle.
(20) Reobserve the patient for evidence of airway obstruction due to secretions.
(21) Assist the patient to a comfortable position while maintaining a patent airway.
(22) Discard equipment or return it to the appropriate area.
(a) Suction collection bottles should be emptied and rinsed every 8 hours and cleaned with soap and water every 24 hours.
(b) Connecting tubing should be rinsed after each suctioning and changed in accordance with the local infection control policy.
(23) Wash your hands. Record the procedure and report significant observations to the Charge Nurse. You must include:
(a) Time and frequency of the procedure.
(b) Specific observations including color, amount, consistency, color of secretions, respirations, and breath sounds.
(c) Patient's reaction to the procedure and position in the bed, if appropriate.
(d) Any suction catheter or equipment changes.
(e) All of the patient teaching done and the patient's apparent level of understanding.