Show Open Resources for Nursing (Open RN) Suctioning via the (mouth) and nasopharyngeal (nasal) routes is performed to remove accumulated saliva, pulmonary secretions, blood, vomitus, and other foreign material from these areas that cannot be removed by the patient’s spontaneous cough or other less invasive procedures. Nasal and pharyngeal suctioning are performed in a wide variety of settings, including critical care units, emergency departments, inpatient acute care, skilled nursing facility care, home care, and outpatient/ambulatory care. Suctioning is indicated when the patient is unable to clear secretions and/or when there is audible or visible evidence of secretions in the large/central airways that persist in spite of the patient’s best cough effort. Need for suctioning is evidenced by one or more of the following:
In emergent situations, a provider order is not necessary for suctioning to maintain a patient’s airway. However, routine suctioning does require a provider order. For oropharyngeal suctioning, a device called a is typically used for suctioning mouth secretions. A Yankauer device is rigid and has several holes for suctioning secretions that are commonly thick and difficult for the patient to clear. See Figure 22.5 for an image of a Yankauer device. In many agencies, Yankauer suctioning can be delegated to trained assistive personnel if the patient is stable, but the nurse is responsible for assessing and documenting the patient’s respiratory status. Figure 22.5 Yankauer Suction Tip Yankauer suction devices are made of rigid firm plastic. The nurse or assistive personnel who performs suctioning with these devices should use care to protect the patient’s soft mucous membranes and prevent unnecessary trauma.Nasopharyngeal suctioning removes secretions from the nasal cavity, pharynx, and throat by inserting a flexible, soft suction catheter through the nares. This type of suctioning is performed when oral suctioning with a Yankauer is ineffective. See Figure 22.6for an image of a sterile suction catheter. Figure 22.6 Sterile Suction CatheterExtension tubing is used to attach the Yankauer or suction catheter device to a suction canister that is attached to wall suction or a portable suction source. The amount of suction is set to an appropriate pressure according to the patient’s age. See Figure 22.7 for an image of extension tubing attached to a suction canister that is connected to a wall suctioning source. Follow agency policy regarding setting suction pressure. Pressure should not exceed 150 mm Hg because higher pressures have been shown to cause trauma, hypoxemia, and atelectasis. The following ranges are appropriate pressure according to the patient’s age:
Checklist for Oropharyngeal or Nasopharyngeal SuctioningUse the checklist below to review the steps for completion of “Oropharyngeal or Nasopharyngeal Suctioning.” StepsDisclaimer: Always review and follow agency policy regarding this specific skill.
Sample DocumentationSample Documentation of Expected FindingsPatient complaining of not being able to cough up secretions. Order was obtained to suction via the nasopharyngeal route. Procedure explained to the patient. Vital signs obtained prior to procedure were heart rate 88 in regular rhythm, respiratory rate 28/minute, and O2 sat 88% on room air. Coarse rhonchi present over anterior upper airway. No cyanosis present. Patient tolerated procedure without difficulties. A small amount of clear, white, thick sputum was obtained. Post-procedure vital signs were heart rate 78 in regular rhythm, respiratory rate 18/minute, and O2 sat 94% on room air. Lung sounds clear and no cyanosis present. Sample Documentation of Unexpected FindingsPatient complaining of not being able to cough up secretions. Order was obtained to suction via the nasopharyngeal route. Procedure explained to the patient. Vital signs obtained prior to procedure were heart rate 88 in regular rhythm, respiratory rate 28/minute, and O2 sat 88% on room air. Coarse rhonchi present over anterior upper airway. No cyanosis present. After first pass of suctioning, patient began coughing uncontrollably. Procedure was stopped and emergency assistance was requested from the respiratory therapist. Post-procedure vital signs were heart rate 78 in regular rhythm, respiratory rate 18/minute, and O2 sat 94% on room air. Coarse rhonchi continued to be present over anterior upper airway but no cyanosis present. Dr. Smith notified and a STAT order was received for a chest X-ray and to call with results. Suction of secretions through the mouth, often using a Yankauer device. Rigid device used to suction secretions from the mouth. |