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Xavier University - Ateneo de Cagayan

COLLEGE OF NURSING
Cagayan de Oro City, Philippines

VISION
STATEMENT Teaching-Learning Guide: N 107.2 & N 108.1 Enhancements
To be a
leading ASEAN Topic Suctioning
University
forming leaders Entry Competencies:
of character by Prior to the discussion, the student shall have acquired knowledge, skills & attitude in the care of clients across the lifespan with IV Therapy.
2033.
Time N 107.2 & N 108.1 (Classroom Guide)
Frame
MISSION Teaching-Learning References Evaluation
STATEMENT
Week Learning Outcomes Content Activities
Xavier Univer-
(Time allotment)
sity (Ateneo de
Cagayan) 1 Given a hypothetical or actual scenario or I.A Definition Aspiration of secretions (1 hour) First Rotation
forms men and situation related to the intravenous therapy, through a catheter attached to a suction RLE 10-30pt quiz
women of the students will be able to: machine or wall machine outlet. Student Input: Procedures
competence, Indication - Help to maintain a patent airway by Compilation for Paper & pen tests
conscience and
a. Define suctioning and its purpose removing secretions from the nares, pharynx, PPT presentation BSN4
commitment in
service of the and equipment needed. throat, and trachea by introducing a suction Enhancement
church, the b. Discuss different kinds of catheter Demonstration & Perry, A. & Rubrics
Global suctioning. Purpose: Return Potter, P.
community and c. Demonstrate & return demonstrate 1. To remove secretions that obstruct the Demonstration (2014). Clinical
the Filipino the proper procedure with rationale airway Nursing Skills
people. in suctioning. 2. To facilitate ventilation Gamefication and
d. Identify contraindications of 3. To obtain secretions for diagnostic purposes Techniques.
suctioning. 4. To prevent infection that may result from 8th edition. St
e. Emphasize the importance of accumulated secretions Louis,
maintaining sterility of the Equipment needed: Sterile suction catheter #14 Missouri.
procedure. or 16 for adult, #8 or 10 for children), two sterile Elsevier Mosby
gloves, sterile towel, suction source at 80-120
mmHg, sterile water, resuscitation bag, NSS (in
syringe), sterile cup for water, alcohol swabs,
Orig COURSE OUTLINE Template Prepared by XUCAT. Revised with permission by MGM P May 2011. TLG N 107.2 & N 108.1 1
Xavier University - Ateneo de Cagayan
COLLEGE OF NURSING
Cagayan de Oro City, Philippines

sterile water-soluble lubricant jelly, and face


shield.

I.B Types of IV Solutions and their respective


color and category:
a. Oropharyngeal suctioning - removes
secretions from the back of the throat.
b. Tracheal airway suctioning - extends into
the lower airway and is indicated to remove
respiratory secretions and maintain optimum
ventilation and oxygenation in patients who
are unable to independently remove these
secretions

I.C Assisting in initiating Intravenous Therapy


Assessment
Diagnosis
Planning
Implementation
Evaluation
(for detailed content refer to Appendix Table 1)

I.D Common suctioning contraindications


a. Facial or neck trauma/surgery
c. Acute head injuries c Bleeding disorders d.
Nasal bleeding
e. Epiglottitis or croup
f. Laryngospasm
g. Irritable airway
h. Gastric surgery

Prepared by: BSN 4 Supervising Clinical Instructor: Pinque, Mildred, RN, MN


Level IV Students Level IV Clinical Instructor
Orig COURSE OUTLINE Template Prepared by XUCAT. Revised with permission by MGM P May 2011. TLG N 107.2 & N 108.1 2
Xavier University - Ateneo de Cagayan
COLLEGE OF NURSING
Cagayan de Oro City, Philippines

MECHANICS:
1. BSN4 SNs to prepare TLG for the assigned topics; one TLG per topic
2. CIs to supervise the enhancement
2.1. collect the completed TLGs from BSN4 SNs
2.2. facilitate the SNs presentations during the enhancement sessions
2.3. grade the presentations using rubric
2.4. tests the SNs through paper and pen test/quiz (10-30 items per week);
3. Focus on issues, concerns and innovations related to the topics considered;
4. Case presentations per group to be facilitated during enhancement session (per agreed time by CI and SNs MT period);
5. Q&A Drills topics to align with CA2 calendar;
5.1. Each SN to prepare test items (1-10) with rationale and shares these with the group
5.2. Teaching-learning activities may vary in the drill: ppt presentation, games, etc
6. completed TLGs should be submitted to the supervising CI week prior to scheduled presentation;
7. For other concerns, please approach CI-in-charged or the level coordinator.

Prepared by: Paayas, Mary Grace M., RN, MAN


Level IV Coordinator

Appendix

Table 1. Suctioning
STEPS RATIONALE
ASSESSMENT:
Take the vital signs of the patient. For baseline data.
Assess the clinical signs for the need of uctioning:
a. Adventitious (abnormal) breath sounds when the chest is auscultated
b. Change in mental status
c. Skin color
d. Rate and pattern of respirations
e. Pulse rate and rhythm
f. Decreased oxygen saturation
IMPLEMENTATION:

Orig COURSE OUTLINE Template Prepared by XUCAT. Revised with permission by MGM P May 2011. TLG N 107.2 & N 108.1 3
Xavier University - Ateneo de Cagayan
COLLEGE OF NURSING
Cagayan de Oro City, Philippines

Prior to performing the procedure, introduce self and verify the clients identity using Knowing that the procedure will relieve breathing problems is often reassuring and
agency protocol. Explain to the client what you are going to do, why it is necessary, and enlists the clients cooperation.
how he or she can participate.
Perform hand hygiene. Prevent spread of microorganisms.
Prepare the client:
- Position a conscious person who has a functional gag reflex in the semi-Fowlers - These positions facilitate the insertion of the catheter and help prevent aspiration of
position with the head turned to one side for oral suctioning or with the neck secretions
hyperextended for nasal suctioning.
- Position an unconscious client in the lateral position, facing you. - This position allows the tongue to fall forward, so that it will not obstruct the catheter
- Place the towel or moisture-resistant pad over the pillow or under the chin on insertion. The lateral position also facilitates drainage of secretions from the
pharynx and prevents the possibility of aspiration..
Prepare the equipment. Check function of suction and manual resuscitation bag. Make sure all equipment is functional before sterile technique is instituted.
Perform hand hygiene. Prevent spread of microorganisms.
Open the sterile suction package.
Apply the sterile gloves, or apply an unsterile glove on the nondominant hand and then The sterile gloved hand maintains the sterility of the suction catheter, and the unsterile
a sterile glove on the dominant hand. glove prevents the transmission of the microorganisms to the nurse.
With your sterile gloved hand, pick up the catheter and attach it to the suction unit.
Using the contaminated hand, disconnect the patient from the ventilator, CPAP device, Prevents contamination of the connection.
or other oxygen source.
Ventilate and oxygenate the patient with the resuscitation bag. In the spontaneously Ventilation before suctioning helps prevent hypoxemia.
breathing patient, coordinate manual ventilations with the patients own respiratory
effort.
Gently insert suction catheter as far as possible into the artificial airway without applying Suctioning on insertion helps prevent decrease oxygen in the airway.
suction. Most patients will cough when the catheter touches the carina.
Withdraw the catheter - 1 inch (2-3cm) and apply suction. Quickly rotate the catheter Failure to withdraw and rotate the catheter may result in damage to tracheal mucosa.
while its being withdrawn.
Limit suction time to no more than 10 seconds. Discontinue if heart rate decreases by Suctioning removes oxygen as well as secretions and may cause vagal stimulation.
30 beats per minute or oxygen increases by 40 beats per minute.
Bag patient between suction passes with the approximately four to five manual The oxygen removed by suctioning must be replenished before suctioning is attempted
ventilations. again.
Instill normal saline if ordered:

Orig COURSE OUTLINE Template Prepared by XUCAT. Revised with permission by MGM P May 2011. TLG N 107.2 & N 108.1 4
Xavier University - Ateneo de Cagayan
COLLEGE OF NURSING
Cagayan de Oro City, Philippines

a. Open prepackaged container and instill 3-5 mL normal saline into the artificial a. Instillation of the saline during inspiration will prevent the saline from being blown
airway during spontaneous inspiration. back out of the tube,
b. Bag vigorously and then suction. b. Bagging stimulates cough and distributes saline to loosen secretions.
Rinse catheter between suction passes by inserting tip in cup of sterile water and To prevent obstruction of catheter.
applying suction.
Continue making suction passes, bagging patient between passes, until the airways are Repeated suctioning in a short time itervak predisposes hypoxemia.
clear of accumulated secretions. No more than four suctioning passes should be made
per suctioning episodes.
Give the patient four to five sigh breaths with the bag, Allow maximal lung expansion and prevention of atelectasis.
Return the patient to the ventilation or apply CPAP or other oxygen-delivery device.
Suction oral secretions from the oropharynx above the artificial airway cuff.
Clean elbow fitting of resuscitation bag with alcohol; cover with a sterile glove or 4x4
gauze pad
Assess the effectiveness of suctioning.
- Auscultate the clients breath sounds to ensure they are clear of secretions. Observe
skin color, dyspnea, level of anxiety, and oxygen saturation levels.
Document relevant data.
- Record the procedure: the amount, consistency, color, and odor of sputum (e.g.,
foamy, white mucus; thick, greentinged mucus; or blood-flecked mucus) and the clients
respiratory status before and after the procedure. This may include lung sounds, rate
and character of breathing, and oxygen saturation.

Orig COURSE OUTLINE Template Prepared by XUCAT. Revised with permission by MGM P May 2011. TLG N 107.2 & N 108.1 5