Nsg: Suctioning Flashcards
What is suctioning?
Bronchial hygiene involving the mechanical aspiration of secretions from the:
Nasopharynx
Oropharynx
Trachea
Determine the need for suctioning.
- Pt rate, depth, and ease of breathing.
- Pt inability to remove own secretions by couging.
- Presence of wet loose cough
- Presence of excessive and/or thick secretion and noisy breathing.
- Signs of Hypoxia ( Cyanosis), restlessness, agitation, tachycardia.
- Signs of resp distress (Nasal flaring), accessory muscles, tachypnea, SOB, decr. SaO2.
Can suctioning irritate mucous membranes and increae seretion if performed too often?
Yes, so suctioning is based on clinical need, not schedule.
What are the Routes for Suctioning?
OONNE
1) Oral: Mouth
2) Oropharyngeal: into oropharynx through mouth
3) Nasopharyngeal: into nasopharynx though nose
4) Nasotracheal: To the level of the laryngopharnx+ trach
5) Enchotracheal + Tracheostomy: For pts who need Artificial ventilaton.
potential problems of suctioning
1) Pt distress
2) Hypoxia (obstruction w/ catheter, duration of procedue, suction flow and pressure and size of catheter)
3) Soft tissue damange/bloody aspirate
4) Stridor (Narrowing airway usually heard on inspiration), bronchospasm
5) Gagging/voming, then aspiration.
6) Vasovagal stimulation causing bradycardia + hypotension
7) arrhythmias/HTN
8) Infection (by septic tools that weren’t cleaned)
9) Raised ICP for pt’s w/ traumatic brain injury)
Contraindication of suctioning
1) Severe bronchospasm, irritable airways
2) stridor (narrow airway = cannot breathe)
3) Basal Skull fracture
4) Severe epitaxis = could aspirate blood
5) Leakage of CSF
6) Coagulopathy + bleeding disorders = suctioning could cause tissue damage and lead to bloody aspirate
7) jaw fractures (cannot open mouth to suction)
8) Loose teeth (could dislodge teeth and be swalloed/ choking hazard)
Catheter suction size selection.
Oropharyngeal: 12FG
Nasopharngeal: 10-12FG
Child: 8-10FG
Vacuum pressure selection.
The greater the pressure with the suction catheter, the greater the degree of muscosal drainage b/c pulling on mucosa lining.
Adult: 80-120mmHg
Child:70-100mmHg
What do you need for suctioning?
1) Suctiong Unit
2) Recptacle
3) Connection tubing
4) Yankur suction (Tonsil tip)
5) Water soluble lubricant
6) 0.9% NS
7) Suction catheters w/ correct size
8) Resuscitation equipment in area if needed b/c of resp distress.
9) sterille gloves to maintain sterility of catheter
Nasopharyngeal Insertion
pg. 1351K
(sterile technique)
Measure from Tip of nose to Ear lobe
-Elevate tip of nose
-Tubing in non dominant hand
-catheter in dominant hand
-If right handed, be on pts right side.
-dip catheter tip in lubricant
-gently insert with inclination till slight resistance
-Rotate catheter till resistance is overcome (helps dislidge secretions)
-Advance catherer 5”-6” untill pool of secretions or pt coughs
Oropharyngeal Insertion
(Doesn’t need to be sterile, but is better)
-Moisten Yankauer or suction catheter w/ sterile water/saline to reduce frictoin.
(measure catheter from Tip of nose to Ear lobe)
-Insert in pt mouth
-advance 3”-4” along side of pt mouth till pool of secretions or pt cough.
-Watch for stimulation of gag relflex while inserting
-Suction both sids of mouth
-Intermittent suction, withdraw with rotaing motion
-***If secretions are thick, clear lumen by dipping in in NS + apply suction.
-Repeat till sounds stop/breathing is quiet.
-Flush connecting tube when done.
Listen to lungs for Adventicious sounds.
While suctioning, what are some special considerations?
- Alternate b/w nostrils
- Do not go bw nostril and mouth (bring extra catheters)
- If excessive oral secretions, consider tonsil tip catheter
- Is s/s of hypoxia occur, stop suctioning and apply O2.
- Do not suction for longe than 10 seconds.
- Do not suction while inserting catheter into pt mouth-
- Allow intervals b/w suctioning to see how pt is tolerating and if it is working. 30sec-1min
Post suctioning
Assess:
- RR
- HR and rhythm
- Skin colour
- SaO2
- Lung sounds
Place suction accessible to pt.
Assist pt to position that helps O2 and comfort.
What are some signs that suctioning has worked?
- Decr. breathing effort
- Decr. RR
- Visible evidence of removal of secretions
- Absence of audible secretions in large airways
- Pt colour improves
What to document?
-Amount and characteristics of secretions
-If specimen was obtained and what tests were requested.
-Pt tolerance during procedure.
-Note condition before and after, and any adverse effects
-Comunicate observations and recommendations for further interventions to promote continuity of care
-Notify MD of any abnormal findings
(If pt has ventolin, suction first (if needed) so ventolin has a clear airway to work on)
