Wester n Mindanao State University

College of Nursing
Zamboanga City

Level III - SKILL POCEDURES

NAME: _________________________________ ROTATION: _____________________

SECTION: _______________________________ DATE: _________________________

Evaluation Checklist
PERFORMANCE EVALUATION CRITERIA

OROPHARYNGEAL SUCTIONING

 3 - Excellent (Able to correctly perform all task at a given time)

 2 - Satisfactory (Able to perform correctly almost all task at a given time)
 1 - Needs Practice (Unable to perform correctly all task at a given time)

ACTION 1 2 3 Remarks

Assessment

1. Check agency’s protocol to determine whether a

physician’s order is required.

2. Confirm the client’s ID using two identifiers according to

agency’s protocol.

3. Assess the client's blood gas or oxygen saturation values

and check vital signs.
4. Determine for conscious patient: Note whether he can
cough and produce sputum.
Determine for unconscious: Note the drainage from the
mouth.

5. Washes hands thoroughly. Gathers the necessary

equipment prior to starting the technique. Close room
door or curtain.

6. Explains to the client/family how procedure helps clear

airway secretions and relieves some breathing problem.
Explain the coughing, gagging is normal and lasts only for
few seconds. Encourage client to cough out secretions.

7. 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.

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

Implementation

9. Don sterile gloves and put on appropriate PPE.

10. Turns on suction to check the system and regulate the

pressure (infants 80-100mmHG; children 100-120 mmHg;
adults 120-150 mmHg)

11. Fills the container with sterile distilled water or normal

saline
12. Pick up the catheter with your dominant hand and attach
it to the suction tubing. Using the non-dominant hand to
control the valve while your dominant hand manipulates
the catheter.

13. Lubricate 3”to 4” of the catheter tip with irrigating

solution.

14. Instruct the client to cough and breathe slowly and

deeply several times before beginning suction.
15. Uses padded tongue blade to separate the teeth if
necessary.

16. Gently introduce the catheter into the client’s mouth.

Advance it 3 to 4 inches (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. If obstruction
is encountered, withdraw a small amount and gently
reinsert, never use any force to push the catheter
down.
17. 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. Apply suction for only
10 to 15 seconds.
18. 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.
19. Observe respiratory status. 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.
20. Flush the connecting tubing with normal saline
solution. Discard the used items.
21. Turns off suction source and detaches catheter from
tubing. Then, wrap it around your dominant (sterile) hand
and pull back the sterile glove over the soiled catheter
and discard

22. Remove towel and place in a laundry bin, reposition client

to side lying position

23. Discard disposable materials used in appropriate

receptacle.

24. Remove PPE and dispose in appropriate receptacle.

Perform hand hygiene.

Evaluation

25. Let the client rest after 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. Compare assessment finding
before and after.

26. Assess the effectiveness by observing respiration and

auscultating the lung.

27. Monitor closely for any adverse reactions and until all
physiological parameters have returned to baseline
values.
 28. Ensure there are supplies available for the next suctioning
event.

29. Records the procedure: amount, color, odor, and

consistency of the secretion.

30. Documents breathing status before and after the

procedure.

Others

31. Washes hands after the procedure.

31 items x 3 = 93 Total Score

Rating Score

1.0 -------------- 93 -------------- 90

1.25 -------------- 89 -------------- 86

1.5 -------------- 85 -------------- 82

1.75 -------------- 81 -------------- 78

2.0 -------------- 77 -------------- 74

2.25 -------------- 73 -------------- 70

2.5 -------------- 69 -------------- 66

2.75 -------------- 65 -------------- 61

3.0 -------------- 60 -------------- 56

Total Score : _____________________

Rating : _____________________

Student Signature: ___________________

C.I. Signature : _____________________

Date : _____________________

Prepared By: LEVEL III-FACULTY

Noted By: Nerissa C. Mariga, MAN, RN

Level III- Coordinator

Recommending Approval: Desdimona C. Sakandal, RN,RM,MN

Clinical Coordinator

Approved By: Hashim N. Alawi Jr., RN, MN

Dean
 Western Mindanao State University
College of Nursing
Zamboanga City

Level III - SKILL POCEDURES

NAME: _________________________________ ROTATION: _____________________

SECTION: _______________________________ DATE: _________________________

Evaluation Checklist

NASOPHARYNGEAL SUCTIONING

 3 - Excellent (Able to correctly perform all task at a given time)

 2 - Satisfactory (Able to perform correctly almost all task at a given time)
 1 - Needs Practice (Unable to perform correctly all task at a given time)

ACTION 1 2 3

Assessment

1. Check agency’s protocol to determine whether a physician’s

order is required.

2. Assess the client's blood gas or oxygen saturation values and

check vital signs.
3. Assess the client's history for a deviated septum, nasal
polyps, nasal obstruction, traumatic injury, epistaxis, or
mucosal swelling.
4. Determine for conscious patient: Note whether he can cough
and produce sputum
Determine for unconscious: Note the drainage from the
mouth.

5. Gathers the necessary equipment prior to starting the

technique.

6. Confirm the client’s ID using two identifiers according

to agency’s protocol.
7. Washes hands thoroughly.

Implementation

8. Explains procedure to the patient/family, provide privacy by

drawing the screens and / or closing the door.
9. 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.
Open the bottle of normal saline solution. Open the
waterproof trash bag.
10. Turns on suction to check the system and regulate the
pressure. May be set to 100-150 mmHg. Occlude the end of
the tubing

11. Fills the container with sterile distilled water or normal saline

12. 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.
13. Place a towel across the client's chest.
14. Using strict aseptic technique, open the suction catheters kit.
Dons the glove consider your dominant hand sterile and your
non-dominant hand clean.

15. Pick up the catheter with your dominant hand and attach it
to the suction tubing. Using the non-dominant hand to
control the valve while your dominant hand manipulates the
catheter.

16. Lubricate 3”to 4” of the catheter tip with irrigating solution.

17. Instruct the client to cough and breathe slowly and

deeply several times before beginning suction.
18. Measures the distance from the tip of the nose to the tip of
the earlobe, 13 cm. (5 in)

19. Lubricates the catheter tip with water soluble jelly.

20. Leaves vent of the catheter open, elevate the tip of the nose
with your non-dominant hand and gently introduces the
catheter along the floor of the nose with the patient facing
straight forward. Continue to advance the catheter,
approximately 5” to 6”, until you reach the pool of secretions
or the client begins to cough.
Removes and inserts catheter at another angle or nostril if
obstruction is encountered.

21. Using intermittent suction, withdraw the catheter from

the nose with a continuous rotating motion to minimize
invagination of the mucosa into the catheter's tip and
side ports.
22. Between passes, wrap the catheter around your
dominant hand to prevent contamination and clear the
lumen of the catheter by dipping it in the water and
applying suction. Repeat procedure as necessary.
23. Alternates nostrils when introducing the catheter

24. After completing suctioning, pull your sterile glove off

over the coiled catheter and discard it and the nonsterile
glove along with the container of water in trash
receptacle.
25. Flush the connecting tubing.
26. Turn off suction device.

27. Assist client to comfortable position. Offer assistance

with oral and nasal hygiene. Replace oxygen device if
 used.
28. Dispose of disposable supplies
29. Remove and discard PPE. Perform hand hygiene

Evaluation

30. If clinically indicated, hyperoxygenate for at least 1-minute

following suctioning. Let the client rest after suctioning while
continuing to observe.

31. Assess the effectiveness by observing respiration and

auscultating the lung.

32. Monitor closely for any adverse reactions and until all
physiological parameters have returned to baseline values.

33. Ensure there are supplies available for the next suctioning
event.

34. Records the procedure: amount, color, odor, and consistency

of the secretion.

35. Documents breathing status before and after the procedure.

Others

36. Washes hands after the procedure.

36 items x 3 = 108 Total Score

Rating Score

1.0 -------------- 108 -------------- 104

1.25 -------------- 103 -------------- 99

1.5 -------------- 98 -------------- 94

1.75 -------------- 93 -------------- 90

2.0 -------------- 89 -------------- 85

2.25 -------------- 84 -------------- 79

2.5 -------------- 80 -------------- 75

2.75 -------------- 74 -------------- 70

3.0 -------------- 69 -------------- 65

MPL

Total Score : _____________________

Rating : _____________________

Student Signature: ___________________

C.I. Signature : _____________________

Date : _____________________
Prepared By: LEVEL III-FACULTY

Noted By: Nerissa C. Mariga, MAN, RN

Level III- Coordinator

Recommending Approval: Desdimona C. Sakandal, RN,RM,MN

Clinical Coordinator

Approved By: Hashim N. Alawi Jr., RN, MN

Dean