RETDEM

SUCTIONING THE OROPHARYNGEAL AND NASOPHARYNGEAL AIRWAYS
GOAL: To exhibit improved breath sounds and a clear, patent airway.
1. Bring equipment to the bedside for an organized approach.

2. Perform hand hygiene and PPE to avoid the spread of microorganisms.
3. Identify the patient.
4. Close the curtains and doors to provide privacy.
5. Determine and verify the suction order. Assess for pain then administer medication to reduce trauma.
6. Explain the procedure even if the patient is not alert and reassure that procedure will stop if there is a sign of
respiratory difficulty.
7. Adjust the bed to a comfortable working height and lower side rails to prevent back strain. If conscious, place
the patient in a semi – fowlers and if not, in lateral position, facing me.
8. Place towel or waterproof pad across the patient’s chest to protect bed linens.
9. Adjust suction to appropriate pressure. Put on clean gloves and occlude the end of the connecting tubing to
check suction pressure and place it.
 Wall Unit
- Adult: 100–150 mm Hg; Neonates: 60–80 mm Hg; Infants: 80–125 mm Hg; Children: 80–125 mm
Hg; Adolescents: 80–150 mm Hg
 Portable Unit
- Adult: 10–15 cm Hg; Neonates: 6–8 cm Hg; Infants: 8–10 cm Hg; Children: 8–10 cm Hg;
Adolescents: 8–15 cm Hg
10. Open sterile suction package. The open wrapper becomes a sterile field to hold other supplies. Remove the
sterile container, touching only the outside. Set it up on the work surface and pour sterile saline into it.
11. Place a small amount of water-soluble lubricant on the sterile field and avoid touching the sterile field to reduce
trauma.
12. Increase the patient’s supplemental oxygen level to prevent hypoxemia.
13. Put on face shield and mask. Put on sterile gloves. The dominant hand will manipulate the catheter and
must remain sterile. The non-dominant hand is considered clean and will control the suction valve (Y-
port).
14. With dominant hand, pick up sterile catheter and the connecting tubing with the non-dominant hand then
connect to maintain sterility.
15. Moisten the catheter to the container for lubrication. Occlude Y-tube to check suction.
16. Encourage the patient to take several deep breaths to prevent hypoxemia.
17. Apply lubricant to the first 2 to 3 inches of the catheter to reduce trauma.
18. Remove the oxygen delivery device. Do not apply suction and hold the catheter between your thumb and
forefinger.
19. Insert the catheter.
 For nasopharyngeal suctioning: insert a catheter through the naris and nose floor, roll it between fingers,
and advance it 5-6 inches to reach the pharynx.
 For oropharyngeal suctioning: insert catheter through the mouth, along the side of the mouth toward the
trachea. Advance the catheter 3 to 4 inches to reach the pharynx.
20. Suction the catheter by intermittently occluding the Y-port with non-dominant hand, gently rotate as its
withdrawn and not more than 10-15 seconds at a time.
21. Replace the oxygen delivery device using non-dominant hand, have the patient take several deep breaths.
22. Flush catheter with saline, assess effectiveness of suctioning and repeat. Wrap the suction catheter with
dominant hand.
23. Allow at least a 30-second to 1-minute interval if needed. No more than 3 suction passes should be made per
suctioning. Encourage the patient to cough and deep breathes between suctioning. Suction the oropharynx
after suctioning the nasopharynx.
SUCTIONING AN ENDOTRACHEAL TUBE: OPEN SYSTEM
13. With dominant hand, pick up sterile catheter and connecting tubing with the non-dominant hand then connect.
14. Moisten the catheter into the container. Occlude Y-tube to check suction.
15. Hyperventilate the patient with non-dominant hand and manual resuscitation bag and delivering 3-6 breaths to
prevent hypoxemia.
16. Open the adapter on the mechanical ventilator or remove the manual resuscitation bag with non-dominant hand
to prevent contamination.
17. Using dominant hand, gently and quickly insert the catheter into the trachea and advance to the predetermined
length to reduce trauma.
18. Apply suction by intermittently occluding the Y-port on the catheter with the thumb of non-dominant hand, and
gently rotate the catheter when withdrawn. (no 10-15 sec)
19. Hyperventilate the patient with non-dominant hand, delivering 3-6 breaths. Replace oxygen delivery device and
have deep breaths. If mechanically ventilated, close adapters or replace tubing, using the sigh mechanism.
20. Flush catheter with saline. Assess suctioning effectiveness, and wrap around dominant hand between attempts.
21. Allow at least 30-second to 1min interval if additional suctioning is needed with no more than 3 suction.
Suction the oropharynx after the trachea.
SUCTIONING A TRACHEOSTOMY: OPEN SYSTEM
13. Moisten the catheter to the container. Occlude Y-tube to check suction.
14. Using non-dominant hand, hyperventilate the patient, delivering 3-6 breaths or use sigh mechanism.
15. Open the adapter on the mechanical ventilator or remove oxygen delivery setup with non-dominant hand.
16. Using dominant hand, gently and quickly insert the catheter into the trachea and advance the catheter to the
predetermined length.
17. Apply suction by intermittently occluding the Y-port on the catheter with the thumb of non-dominant hand, and
gently rotate the catheter when withdrawn. (no 10-15 sec)
18. Hyperventilate the patient with non-dominant hand, delivering 3-6 breaths. Replace oxygen delivery device and
have deep breaths. If mechanically ventilated, close adapters or replace tubing, using the sigh mechanism.
19. Flush catheter with saline, assess suctioning effectiveness, and wrap around dominant hand between attempts.
20. Allow at least a 30-second to 1-minute interval if needed. No more than 3 suction passes should be made per
suctioning. Encourage the patient to cough and deep breathe between suctioning. Suction the oropharynx
after suctioning the nasopharynx.
21. When completed, remove gloves and catheter, dispose in the appropriate receptacle, and assist the patient in a
comfortable position, raise the bed rail and place in the lowest position.
22. Turn off suction, remove supplemental oxygen, face shield and mask, and perform hand hygiene to avoid the
spread of microorganisms.
23. Offer oral hygiene after suctioning for comfort.
24. Reassess patient’s respiratory status: rate, effort, oxygen saturation, and lung sounds to prevent complications.
25. Remove additional PPE, if used. Perform hand hygiene to avoid the spread of microorganisms.

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SUCTIONING THE OROPHARYNGEAL AND NASOPHARYNGEAL AIRWAYS

GOAL: To exhibit improved breath sounds and a clear, patent airway.

1. Bring equipment to the bedside for an organized approach.

SUCTIONING AN ENDOTRACHEAL TUBE: OPEN SYSTEM

SUCTIONING A TRACHEOSTOMY: OPEN SYSTEM

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