1. (OROPHARYNGEAL AND ENDOTRACHEAL SUCTIONING ) SUCTIONING

2. Learning Objectives To understand the suctioning. To know the Type of suctioning To know purpose and indication of suctioning. To know the articles required for suctioning. To know the steps of Oropharyngeal suctioning. To know the steps of Endotracheal suctioning. To understand the nurses responsibilities for suctioning.

3. SUCTIONING Suctioning means the act or process of sucking. The act or process of removing the secretion / water from a space in order to pull something in to that space.

4. Oropharyngeal suctioning Oropharyngeal suctioning is the process of removing secretions from the oral cavity and pharynx.

5. Purposes To remove the secretions that obstructs the airway. To facilitate ventilation. To obtain secretions for diagnostic purposes. To prevent infection that may result from accumulated secretions.

6. INDICATIONS Inability to generate effective cough. Secretion in airway Aspiration of gastric secretion.

7. CONTRAINDICATIONS Severe nose bleeding. Acute head or face injury. Leakage of CSF

8. Articles Needed Appropriate size sterile suction catheter. (6-7.) Portable or wall suction unit with connecting tubing. Sterile water/Normal saline in a sterile bowl. Clean disposable gloves. Water soluble lubricant. Facemask. Mackintosh. Kidney tray or paper bag. Gauze piece.

9. Procedure 1.Assess the sign and symptom indicating presence of upper airway secretion or obstruction, restlessness. 2.Explain procedure to the clients and importance of coughing during procedure. 3.Place the patients in a semi-fowlers position. Head of beds should be (30-45 degree) 4.Turn on suction and adjust to appropriate pressure. For Adult-100-120mmHg and Child-95-110mmHg.

10. Cont.… 5.Wash hands and Apply clean disposable gloves. 6.Connect one end of connecting tubing to suction machine and other to suction catheter. 7.Suction small amount of sterile water from bowl. 8.Insert catheter into mouth along with gum line to pharynx. Move catheter in oral cavity until secretions are cleared. For 10-15 sec. 9.Rinse catheter with water in bowl until connecting tubing is cleared of secretions.

11. Cont.… 11.Reassess client’s respiratory status. 12.Wash and rinsed used article with warm soapy water and dry with paper towels. 13.Wash hands and Document the procedure in nurse’s record sheet.

12. ENDOTRACHEAL SUCTIONING Removal of secretions from trachea through an endotracheal tube with the help of a mechanical suction device.

13. Purposes To maintain patent airway by removing secretions To prevent lower respiratory tract infection from retained secretions.

14. Articles Needed Sterile suction catheter with cover. 12-16 Fr. Sterile water. Sterile gloves. Mask. Gown. Kidney tray. Alcohol swabs. Sterile towel. Bowl. Gauze pieces. Stethoscope. Resuscitation bag with oxygen. (AMBU BAG) Suction source portable or wall suction unit.

15. Procedure 1.Assess the sign and symptom indicating presence of lower airway secretion and rate of respiration. 2.Explain procedure to the clients. 3.Place the patients in a semi-fowlers position. If patients is unconscious placed in the lateral position facing you. 4.Assembles articles and Check functioning of suction apparatus. 5.Wear mask and wash hands.

16. Cont.… 6.Open sterile catheter pack and place catheter into sterile tray, fill the bowl with sterile water. 7.Done sterile gloves. Dominant hand is kept sterile and will be used for suctioning 8.Connect suction catheter to the suction source. 9.Using clean hand disconnect patients from ventilator, place ventilator connector on the sterile towel.

17. Cont.… 10. Ventilate and oxygenate the patients with the resuscitation bag(AMBU BAG), compress firmly 4-5 times with clean hand. 11.Lubricate the catheter by dipping it into sterile water. 12.Turn on suction source with clean hand and Pinch the catheter and insert it in endotracheal tube about 12.5 cm. 13.Apply suction by releasing thumb by releasing the pinch on the catheter. Gently rotate catheter with thumb. Apply suction for only 10 seconds.

18. Cont.… 14.Rinsed catheter between suction passes by inserting tip in cup of sterile water. 15.Repeat suctioning, allow patients to take rest at least 1 minute. No more than 4 suction passes should be made per suctioning. 16.When airway become clear, return the patients to the ventilator 17.Turn off suction and disconnect catheter from suction tubing and Replace the articles, clean ambubag with alcohol, and wash hands.

19. Nurses Responsibilities Before procedure:-  Assess the client before suctioning.  Explain the procedure to the clients and relatives also.  Check doctor prescription before suctioning.  Place the client in comfortable position (fowler’s position) for expansion of lungs.  Arrange the articles and check its working condition.

20. Nurses Responsibilities During procedure:-  A suction attempt should last only 10-15 sec. during this time, the catheter is inserted, the suction is applied and discontinued and the catheter is removed.  At least 20-50 sec intervals between each suction and limit suction to 5 minutes in total.  Report the doctor if any symptoms such as dyspnea, tachycardia, respiratory rate 40 breathes per minutes.

21. Nurses Responsibilities After procedure:-  Replace all the articles in proper place.  Evaluate the patient progress by observing vital sign and color, saturation.  Record the procedure with date and time on the nurse’s record.

22. Summary Oropharyngeal and endotracheal suctioning is very essential procedure performed by nurse’s, to prevent the infection, chance of aspiration and remove the secretions.

23. References 1.Delaune sue c. & Lander Patricia k. Fundamental of nursing: standard and practice 3rd edition., Thomson sanat printers Haryana, 2007 2.The Royal Marsden Hospital (2000). Manual of Clinical Policies and Procedures. Blackwell Science. 3.Jacob A, Rekha R, Tharachand S J. Clinical nursing procedures: The art of nursing practice. 2nd ed. Jaypee publications: Newdelhi; 2007. 4.Clement I. Basic concepts on nursing procedures. Jaypee publications: Newdelhi; 2007. 5.Wong D L. Wong and Whaley’s: Clinical manual of Pediatric nursing. 4th ed. Mosby publications: Philadelphia.2000 6.Pittman RN. Regulation of tissue oxygen. San Rafael(CA): Morgan and Claypool life sciences;2011. 7.Picket shawn A.2001 OCTOBER 2, Oral suctioning. Retrieved from:htpp//www.ahhc-1.com/educational-pieces-clients-article.php?id=32. 8.Thiel M, Chaukker A, et al. (2005) suctioning prevents hypoxia,journal.pbio.0030174.

24. ? Any Questions?