Nasopharyngeal and Oropharyngeal Suctioning Video
Nasopharyngeal and Oropharyngeal Suctioning Video
Nasopharyngeal and Oral Suctioning by S. Hamilton | OPENPediatrics [Internet]. 2017. Available from: https://youtu.be/TUxQCPhaYbc?si=FINmYGiMw3R9z8Ix.
Endotracheal Tube Suctioning
Endotracheal Tube Suctioning
Equipment
Open Suctioning Technique (ETT or Trach) and Closed Suctioning Technique for Ventilated Patients (ETT or Trach)
- Clean gloves
- Mask and goggles
- Gown (if indicated)
- Appropriate sized manual ventilation bag attached to appropriate oxygen flow (if needed in tracheostomy suctioning)
- Blue pad
- Sterile suction catheter of appropriate size. Note suction depth measurement on sign located on suction cart as well as on patient kardex for reference.
- Suction source (wall-mounted or portable)
- Suction regulator and tubing attached to collection jar
- Stethoscope
- Container with sterile Normal Saline for flushing catheter
Procedure
- IDENTIFY patient and EXPLAIN procedure to patient and family. ENSURE child and family understand procedure and questions are answered.
- OBTAIN assistance from a second person (nurse, respiratory therapist, or physiotherapist)
- MONITOR child’s vitals signs and indications of inadequate oxygenation and ventilation before, during and after suctioning
- PERFORM hand hygiene and DON personal protective equipment, including clean gloves, mask, eye protection and gown (as indicated)
- AUSCULTATE chest before suctioning if indicated (i.e. if urgent suctioning is needed)
- Consider SUCTIONING oro-pharynx and nares with appropriate size yankaur/neosucker prior to tube suction as needed.
Open Suctioning Technique
- ATTACH appropriate sized sterile suction catheter to suction tubing
- MEASURE the length of the catheter to be inserted against the suction reference at the bedside or read markings on catheter to facilitate inserting catheter to appropriate depth.
NOTE: suction depth = length of hub (2 cm) + length of cannula (per packaging) + 0.5 cm - TURN gauge on suction regulator to ADJUST vacuum to read between 60 and 150 mmHg with suction catheter vent occluded.
Guideline pressures are:
• 60–75 mmHg for pre-term-1 month
• 75-90 mmHg for 0-3 years
• 90–112 mmHg for 3-10 years,
• 112–150 mmHg for 10 and older - POUR a small amount of 0.9% normal saline into paper cup. SUCTION a small amount of fluid from the container
- Assistant APPLIES clean gloves, mask and goggles; assistant CHECKS oxygen flow to manual ventilation device.
- With the catheter vent open, INSERT catheter in tracheostomy/ETT and quickly ADVANCE to pre-measured depth.
APPLY suction continuously by covering the catheter vent while withdrawing the catheter from the tracheostomy/ETT. As catheter is withdrawn, rotate the catheter with a twisting motion with the thumb and forefinger.
NOTE: Use brief suction periods of 10 seconds or less to minimize decreases in arterial oxygenation and to decrease airway trauma. If bradycardia or significant changes in vital signs or clinical appearance occur, withdraw the catheter and provide oxygen until the levels return to baseline.
- FLUSH and RINSE suction catheter with flush solution, as needed
- REPEAT procedure as necessary up to 3 times, or as tolerated; allowing 30 second pauses between passes.
NOTE: If secretions remain in the airway after three passes, allow a rest period before additional passes are made - ASSESS patient’s condition after each suction attempt
- Once the tracheostomy/ETT is cleared of secretions, SUCTION oro-pharynx and nares as necessary
- DISPOSE of equipment in garbage container
- ASSESS breath sounds to determine whether any pertinent changes have occurred after suctioning
- REMOVE personal protective equipment and PERFORM hand hygiene
Ventilator Closed Suctioning Technique
- ATTACH appropriate sized closed-suction catheter into ventilator circuit (French size should be 2 X ETT
or trach tube size). NOTE: usually a Respiratory Therapist responsibility - DETERMINE the proper catheter length for suctioning by reading instructions on catheter packaging
- TURN gauge on suction regulator to ADJUST vacuum to read between 60 and 150 mmHg with suction catheter vent occluded.
Recommended pressures are:
• 60–75 mmHg for pre-term-1 month
• 75-90 mmHg for 0-3 years
• 90–112 mmHg for 3-10 years,
• 112–150 mmHg for 10 and older - ADVANCE the catheter until the measured number is aligned with the lavage port (window). When the catheter is in the correct position, DEPRESS suction and hold while slowly withdrawing the catheter. NOTE: Support the catheter at the ETT or trach tube with one hand while withdrawing the catheter to prevent extubation
- ASSESS patient’s condition after each suction attempt
- PROVIDE 30 seconds of rest between suctioning passes
- To clean catheter:
- WITHDRAW the black tip of the catheter into the middle of the cleaning chamber (window).
- DEPRESS suction, and then gently squeeze
- saline solution into catheter
- flush the catheter between each pass of the catheter
- LOCK the suction catheter when finished suctioning and cleaning the catheter
- Once the ETT or tracheostomy tube is cleared of secretions, use another suction device to SUCTION the oral and nasal pharynx
- ASSESS breath sounds to determine whether any pertinent changes have occurred after suctioning
- REMOVE personal protective equipment and PERFORM hand hygiene
- CHANGE closed suction set-up when visibly soiled or every 7 days
Link to BCCH Local Practice Guideline for Suctioning Artificial Airways
Endotracheal Tube Suctioning [Internet]. 02.22.20216. Available from: https://www.youtube.com/watch?v=IftM_1TNaWE