PNSG 216 Unit 7 - Suctioning PDF

Suctioning PNSG 216: UNIT 7 REVISED NOV 2023 This Photo by Unknown Author is licensed under CC BY  ▪ The oropharynx extends behind the mouth from the soft palate above the hyoid bone and contains the tonsils. ▪ The nasopha...

Suctioning PNSG 216: UNIT 7 REVISED NOV 2023 This Photo by Unknown Author is licensed under CC BY  ▪ The oropharynx extends behind the mouth from the soft palate above the hyoid bone and contains the tonsils. ▪ The nasopharynx is located behind the nose and extends to the level of the soft palate. Pharyngeal Anatomy Suctioning – When is it used? When coughing does not adequately clear respiratory secretions and secretions are interfering with oxygenation May include: ◦ Oropharyngeal/nasopharyngeal (back of throat) ◦ Orotracheal/nasotracheal (go into the trachea) ◦ An artificial airway such as a tracheostomy or endotracheal (RN,RT,PT) (sterile procedure) What is your scope of practice?  LPN Restrictions: ▪ Put an instrument or a device, hand or finger beyond the point in the nasal passages where they normally narrow ▪ LPNs suction the nasal passages beyond the point where they normally narrow after successfully completing additional education and with an order LPN SCOPE ▪ LPNs carry out nasopharyngeal swabs after successfully completing additional education of PRACTICE ▪ LPNs do not: GUIDELINES a) Insert nasogastric (NG) tubes b) Insert orogastric (OG) tubes c) Carry out nasopharyngeal washes ▪ LPNs provide tracheostomy care to clients*: a) With well-established tracheostomies b) After successfully completing additional education and with an order (*Trach care=Semester 3) Assessment: Questions How would you know if your client needs suctioning? What specific signs might you see? What assessments would you perform first? How often would you suction? What would you monitor during suctioning? Assessment: Answers How would you know if your When a client is unable to clear client needs suctioning? secretions with coughing What specific signs might you Abnormal RR, adventitious sounds, see? nasal secretions, gurgling, drooling, vomitus in the mouth and coughing without clearing secretions What assessments would you V/S, pulse oximetry, lung assessment perform prior to suctioning? If secretions are identified by inspection or auscultation, suctioning is required (p. 984) How often would you suction? Not done routinely What would you monitor during Colour, pulse oximetry, pulse, RR, suctioning? sound Suctioning Equipment ▪ Sterile suction catheter ▪ Water-soluble lubricant ▪ Gloves ▪ Regulator/container ▪ Bowl ▪ Face shield ▪ Towel ▪ water  Procedure for suctioning 1. Assess client’s need for suction. 2. Either wall or portable suction is used. 3. Set regulator on wall to provide a negative pressure of 100 – 150 mmHg for adults). Portable 7-15 mmHg. 4. Apply gloves. Apply mask or face shield. 5. Fill sterile bowl with 100ml sterile normal saline. 6. Attach suction catheter or Yankauer (also known as tonsil suction) to connecting tubing. 7. May leave nasal cannula on if using – masks must be removed so be prepared to reapply if SpO2 drops or respiratory distress develops.  Oropharyngeal Suctioning (P&P p.984) 8. Lubricate catheter with water. 9. Insert catheter or Yankauer into the client’s mouth. 10. With suction applied, move catheter around mouth, pharynx and gum line until secretions cleared. 11. Encourage client to cough and repeat if needed. 12. Suction water or saline from basin through catheter until catheter cleared of secretions. 13. Place catheter in a clean, dry area for reuse with suction turned off. 14. Replace O2 if needed.  Nasopharyngeal Suctioning (P&P p.985) 8. Apply sterile gloves (or one sterile and one clean) 9. Attach tubing (with non-sterile hand) 10. Suction small amount of normal saline from bowl. 11. Squeeze small amount of sterile water-soluble lubricant 6 – 8 cm of distal end of catheter. 12. Remove O2 if used. 13. Without applying suction, gently insert the catheter into the naris during inhalation. 14. Follow natural course of naris; slightly slant catheter downward and advance to back of pharynx. Nasopharyngeal Suctioning 15. In adults insert the catheter about 20 cm or a distance from tip of nose to base of earlobe. 16. Apply intermittent suction for up to 10 seconds by placing and releasing non-dominant thumb over catheter vent. 17. Slowly withdraw catheter while rotating it back and forth between thumb and forefinger. 18. Rinse catheter and place in a clean dry area for reuse with suction turned off. Videos Oropharyngeal Suctioning (non-sterile procedure) (3:15) https://www.youtube.com/watch?v=7XyfHY9iSWY Nasopharyngeal suctioning (sterile technique) (8:51) http://www.youtube.com/watch?v=TwNSNodYfEw&feature=rel ated References Potter, P. & Perry, A. (2019). Canadian fundamentals of nursing. (6th Ed. Revised). Elsevier: Toronto, Canada.