Safety

• Using water-soluble lubricant helps avoid lipoid aspiration pneumonia. Excessive lubricant can occlude the catheter.
• Be sure to insert the catheter as the patient inhales, especially when inserting the catheter into the trachea. Inhalation opens the epiglottis.
• Do not insert the catheter during swallowing, or the catheter will probably enter the esophagus. Never apply suction during catheter insertion. The patient should cough. If the patient gags or becomes nauseated, the catheter is probably in the esophagus and must be removed.
• When using the nasal approach, perform tracheal suctioning before pharyngeal suctioning whenever possible. The mouth and pharynx contain more bacteria than the trachea.  
• Monitor the patient’s vital signs and saturation of peripheral oxygen (SpO₂) throughout the suction procedure. Stop suctioning if the patient’s pulse drops by more than 20 beats/min or increases by more than 40 beats/min, or if the pulse oximetry reading falls below 90%—or by more than 5% from the patient’s baseline.

Equipment

(Roll cursor over items to see labels)

Pulse oximeter

Suction tubing

Suctioning Kit

• Catheter
• Sterile gloves
• Sterile drape
• Container for sterile saline or water

1 L bottle sterile normal saline

Emesis basin and Oral hygiene supplies

Face shield, mask, goggles (optional)

Stethoscope

Delegation

The skill of nasotracheal suctioning may not be delegated to NAP. 

Preparation

• Assess for risk factors for upper or lower airway obstruction, including obstructive lung disease, pulmonary infection, impaired mobility, sedation, decreased consciousness, seizures, presence of a feeding tube, decreased gag or cough reflex, and impaired swallowing ability.
• Be alert for anxiety, lack of concentration, lethargy, fatigue, dizziness, irritability, pallor, dyspnea, and use of accessory muscles. Throughout the procedure, monitor vital signs (including peripheral blood oxygen saturation) and assess for signs of airway obstruction requiring suctioning, including wheezing, crackles, or gurgling; restlessness; ineffective coughing; absent or diminished breath sounds; tachypnea; hypertension or hypotension; cyanosis; decreased consciousness, especially acute; excessive nasal secretions, drooling, or gastric secretions; and vomitus in the mouth.
• Assess for anatomical factors that may influence airway function: recent surgery; head, chest, or neck tumors; facial or nasal trauma; and neuromuscular disease or factors that affect the volume and consistency of secretions, including fluid imbalance, inadequate humidity, infection, allergies, or sinus drainage.
• Evaluate a patient’s need for suctioning, and consider contraindications such as the following:
  • Facial or neck trauma/surgery or gastric surgery
  • Bleeding disorders or nasal bleeding
  • Epiglottitis or croup
  • Laryngospasm or irritable airway
• Explain and assess the patient’s understanding of the procedure. Advise the patient that temporary coughing, sneezing, gagging, or shortness of breath can be expected.
• Help the patient assume a position that is comfortable for both of you, such as the semi-Fowler’s position or sitting upright with the head hyperextended, unless contraindicated.

Follow-up

• Compare the patient’s vital signs, cardiopulmonary assessments, and SpO₂ values before and after suctioning.
• Ask the patient if breathing is easier and congestion is decreased.
• Observe the character of airway secretions.

Documentation

• Record the amount, consistency, color, and odor of secretions, as well as the size of catheter, route of suctioning, and the patient’s response to suctioning.
• Document the patient’s presuctioning and postsuctioning vital signs, cardiopulmonary status, and ventilation measures.