SUCTIONING

Suctioning is the removal of material through the use of negative pressure,

as in suctioning an operative wound during and after surgery to remove
exudates. It is a procedure that is done to help keep a patient's airway open
and free of secretions. When a patient has a breathing tube in place, he or
she will require intermittent suctioning. The frequency will depend on the
quantity and thickness of the secretions.

PURPOSE:
• To assist in the removal of bronchial secretions that cannot be
expectorated by the patient spontaneously.

INDICATIONS:
1. Visible presence of secretions in tube orifice
2. Coarse tubular breath sounds on auscultation in patient unable to
cough or without artificial airway in place.
3. Patient with an artificial airway.

Precautions/Complications,
1. Hypoxia
2. Vagal stimulation: Cardiac arrhythmia
3. Tracheitis
4. Damage to mucus membranes
5. Airway occlusions
6. Sudden death
7. Bleeding disorders

EQUIPMENT:
1. suction source (wall suction regulator with collection bottle or portable
suction machine)
2. sterile suction kit (contains suction catheter, sterile gloves, sterile
solution container, may contain a small container of sterile normal
saline)
3. sterile water-soluble lubricant
4. extension tubing connected to suction device
5. small bottle of sterile water or normal saline if not included in the kit
6. personal protective devices; gown, mask, goggles or face shield if
spattering is likely

PROCEDURE:
1. assess the client’s need for suctioning; inability to effectively clear the
airway by coughing, coarse, bubbling or gurgling noises with
respiration
2. Choose the most appropriate route. If nasopharyngeal approach is
considered, inspect the nares with a penlight to determine patency.*
3. Explain the procedure to the client. Advice that suctioning may cause
coughing or gagging by emphasizing the importance of clearing the
airway.
4. wash your hands
5. Position the client in a High Fowler’s or Semi-Fowler’s position. If the
client is unconscious or otherwise unable to protect his or her airway,
place in a side-lying position.
6. connect extension tubing to suction device, if not already in place and
adjust suction control to between 110 and 120 mmHg
7. Put on gown and mask and goggles or face shield if indicated.
8. Using sterile techniques open the suction kit. Consider the inside
wrapper of the kit to be sterile.
9. Open a packet of sterile water-soluble lubricant and squeeze out the
contents of the packet onto the sterile field.
10.If sterile solution (water or saline) is not included in the kit, pour about
100 ml of solution into the sterile container provided in the kit.
11. Carefully, lift the wrapped gloves from the kit without touching the
inside of the kit or the gloves themselves. Lay the wrapped gloves
down next to the suction kit and open the wrapper. Put on the gloves
using sterile gloving technique.
12. If a cup of sterile solution is included in the suction kit, open it.
13.designate one hand as sterile and the other as clean
14. Using sterile hand, pick up the suction catheter. Grasp the plastic
connector and between your thumb and forefinger and coil the tip
around your remaining fingers.
15. Pick up the extension tubing with your clean hand. Connect the suction
catheter to the extension tubing taking extra care not to contaminate
the catheter.
16. Position your clean hand with the thumb over the catheter suction
port.
17. Dip the catheter tip into the sterile solution and activate the suction.
Observe as the solution is drawn into the catheter.
18. For or pharyngeal suctioning, ask the client to open his/her mouth.
Without activating the suction, gently insert the catheter and advance
it until you reach the pool of secretions or until the client coughs.
19.For nasopharyngeal suctioning, estimate the distance from the tip of
the client’s nose to the earlobe and grasp the catheter between your
thumb and forefinger at a point equal to this distance from the
catheter’s tip.
20.Dip the tip of the suction catheter into the water soluble lubricant to
coat catheter tip liberally.
21.Insert the catheter tip into the nares with the suction control port
uncovered. Advance the catheter to the point marked by your thumb
and forefinger.
22.If resistance is met, do not force the catheter. Withdraw it and attempt
insertion via the opposite nares.
23.Apply intermittent suction by occluding the suction control port with
your thumb at the same time slowly rotate the catheter by rolling
between your thumb and fingers while slowly withdrawing it. Apply
suction for no longer than 15 seconds at a time.
24.Repeat steps 23 until all the secretions have been cleared, allowing
brief rest periods between suctioning episodes.
25.Withdraw the catheter by looping it around your fingers as you pull it
out.
26.Dip the catheter tip into the sterile solution and apply suction.
27.Disconnect the catheter from the extension tubing. Holding the coiled
catheter in your gloved hand, remove the glove by pulling it over the
catheter. Discard catheter and gloves in an appropriate container.
28.Discard remaining supplies in the appropriate container.
29.Wash your hands.
30.Provide the client with oral hygiene as indicated or desired.
31.Document the procedure, noting the amount, color and client’s
response to the procedure.