OROPHARYNGEAL &

NASOPHARYNGEAL SUCTIONING
 This method removes secretions from the
upper respiratory tract. Even though the
upper airways are not sterile, sterile
technique is recommended for all suctioning
to avoid introducing pathogens into the
airways.
 Purpose

 To remove secretions that obstruct the

airway.
 To facilitate ventilation.
 To prevent infection that may result from
accumulated secretions.
 Assessment

 Restlessness
 Gurgling sounds during respiration
 Adventitious breath sounds when the chest is
auscultated
 Change in mental status
 Skin color
 Rate and pattern of respirations
 Pulse rate
Discontinue the suctioning and apply oxygen
if heart rate decreases by 20 beats per
minute or increase by 40 beats per minute, if
BP increases, or if cardiac arrhythmia is
noted.
 Suctioning may cause the occurrence
of:

 Hypoxemia – initially resulting in tachycardia

and increased blood pressure, and later
causing cardiac ectopy, bradycardia,
hypotension, and cyanosis.
 Vagal stimulation resulting in bradycardia.
 Equipment
 Sterile towel/ Moisture resistant pad
 Sterile water
 Water soluble lubricant jelly
 Suction catheter
 Stethoscope
 Suction Unit/ Suction source
Implementation with Rationale

 Explain to the client what you are going to do,

why it is necessary, and how he or she can
cooperate. Inform the client that suctioning will
relieve breathing difficulty and that the
procedure is painless but may be
uncomfortable and stimulate the cough gag or
sneeze reflex.
 Wash hands and observe other appropriate
infection control procedures.
 Provide for client privacy
 Ascertain that the suction apparatus is
functional. Place suction tubing within the
easy reach.
 Prepare the Client.

 Position a conscious person who has a

functional gag reflex in the semi fowler’s
position with the head turned to one side for
oral suctioning or with the neck hyper
extended for nasal suctioning.
 Position an unconscious client in lateral
position facing you.
 Place the towel or moisture resistant pad
over the pillow or under the chin.
 Prepare the Equipment
 Set the pressure on the suction gauge, and turn on
the suction.
 Wall Unit:
 Adult: 100 – 120 mmHg
 Child: 95 – 110 mmHg
 Infant: 50 – 95 mmHg
 Portable Unit:
 Adult: 10 -15 mmHg
 Child: 5 -10 mmHg
 Infant: 2 - 5 mmHg
 Open the lubricant if performing
nasopharyngeal suctioning.
 Monitor oxygen saturation via oximeter and
heart rate during suctioning.
 Open the sterile suction package.
 Set up the cup container, touching only the
outside.
 Pour sterile water or saline into the container.
 Aseptically glove both hands. Designate one
hand (usually the dominant one) as “sterile”
and other hand as “contaminated.”
 With your sterile gloved hand, pick up the
catheter and attach it to the suction unit.
 Make an approximate measure of the depth
for the insertion of the catheter and test the
equipment.
– Measure the distance between the tip of
the client’s nose and the earlobe, or about
13 cm.(5 inches) for an adult.
– Mark the position on the tube with the
fingers of the sterile gloved hand.
– Test the pressure of the suction and the
patency of the catheter by applying your
sterile gloved finger or thumb to the port to
create suction
 Lubricate catheter with the anaesthetic jelly
and pass the catheter into the nostril and
back into the pharynx.
 Oropharyngeal Suction

 Pull the tongue forward if necessary using

gauze.
 Do not apply suction (that is leaving your
finger off the port) during insertion
 Advance the catheter about 10-15 cm (4-6
inches) along one side of the mouth into the
oropharynx.
 Nasopharyngeal Suction

 Place the patient in a semi fowler’s position if

possible.
 Measure distance between the tip of the
client’s nose and the earlobe or about 13 cm
(15 inches) for an adult.
 Without applying suction, insert the catheter
at the premeasured or recommended
distance into either nares and advance it
along the floor of the nasal cavity.
 Specific positioning of catheter for deep
bronchial suctioning:
– For left bronchial suctioning, turn the
patient’s head to the extreme right, chin
up.
– For right bronchial suctioning, turn the
patient’s head to the extreme left, chin up.
– Never apply suction until catheter is in the
trachea. Once correct position is
ascertained, apply suction and gently
rotate catheter while pulling it slightly
upward. Do not remove catheter from the
trachea.
 Perform Suctioning:
 Apply your finger to the suction control thumb
to start suction, and gently rotate catheter.
 Apply suction for 5-10 seconds while slowly
withdrawing the catheter then remove your
fingers from the control and remove the
catheter. A suction attempt should last only
10 to 15 seconds. During this time, the
catheter is inserted, the suction applied and
discontinued, and the catheter removed.
 Clean the catheter and repeat
suctioning as above

 Wipe off the catheter with sterile gauze if it is

thickly coated with secretions.
 Flush the catheter with sterile water or saline.
 Relubricate the catheter, and repeat
suctioning until the air passage is clear .
 Allow 20 to 30 seconds intervals between
suctioning and limit suctioning to 5 minutes in
total.
 Alternate nares for repeat suctioning.
 Encourage the client to breathe deeply and
to cough between suctions.
 Obtain a specimen if required. Use a sputum
trap.
 Promote client comfort. Offer to assist the
client with oral or nasal hygiene and assist
the client to a position that facilitates
breathing.
 Dispose of equipment and ensure availability
for the next suction.
 Empty and rinse the suction container as
needed. Change the catheter and container
daily.
 Assess the effectiveness of suctioning.
Auscultate the client’s breath sounds to
ensure they are clear of secretions. Observe
skin color, dyspnea and level of anxiety.
 Document relevant data. Record the
procedure, the amount, consistency, color
and odor of sputum.
 Unexpected Situations and
Associated Interventions

 The catheter or sterile gloves touches an

unsterile surface.
 Patient begins to cough and appears
cyanotic.
 The patient vomits during suctioning.
 Secretions appear to be stomach contents.
 Epistaxis is noted with continued suctioning
Infant and Child Considerations

 For infants, use 6F to 8F catheter.

 For children, use 8F to 10F catheter.