SDE: Clinical Guidelines Ch7V

Clinical Procedure Guidelines for Connecticut School NursesPrintable version | Back to Contents
7
Specialized Health Care Procedures

V. Suctioning (non-tracheostomy)

Definitions

Using a battery or electronic vacuum (suction) device to remove upper airway secretions or fluid that the student cannot expectorate spontaneously.

Purpose

To remove secretions or fluid that may contribute to upper airway obstruction, increased respiratory effort, the potential for respiratory distress, aspiration, or increased risk of infection.

Methods

Oropharyngeal Suctioning: Removing secretions or fluid from the mouth and pharynx (anatomic area from the soft palate to the upper most aspect of the esophagus)

Nasopharyngeal Suctioning: Removal of secretions or fluids from either nostril to the pharynx

Equipment

An electric or battery /rechargeable operated portable suction machine with pressure gauge; flexible extension suction tubing; suction catheter sizes per IHCP (8 Fr to 14 Fr are most common); Yankauer catheters may be an option for clearing oral secretions; towel or disposable pad or cloth.

Procedure

Oropharyngeal and Nasopharyngeal Suctioning (general procedures)

  1. As with all invasive procedures, carefully consider an appropriate and safe location based on degree of urgency and physical design of the school/class/health office.
  2. Using appropriate personal protective equipment.
  3. Confirm that respiratory assessment requires suctioning procedure.
  4. Ensure that suction machine has the appropriate level of subatmospheric pressure:
    1. Standard maximal pressure for children ranges from 80–120 mm Hg.
    2. Maximal pressure can be determined by turning on suction and occluding extension tubing by folding it in half. Pressure reading on gauge when tubing is completely occluded is the maximal suction pressure.
  5. The option of using a sterile catheter should be determined per treatment procedure authorization and IHCP. (See procedures specific to oropharyngeal and nasopharyngeal suctioning below.)
  6. Positioning of the student is based on the clinical situation:
    1. Students in wheelchairs or other supportive seating devices can remain sitting upright or reclined up to, but not exceeding, semi-fowlers or 45 degrees.
    2. Students who are lying either on the floor or health office couch should be turned on their side. This position may be commonly associated with a student experiencing a seizure who may require supplemental oxygen and/or suctioning.
  7. Respiratory assessment should be an ongoing process to determine:
    1. How well the student is tolerating the procedure.
    2. The amount of time and suction attempts that are clinically indicated.

Oropharyngeal Suctioning

  1. Using appropriate personal protective equipment.
  2. Attach the specified suction catheter to the suction extension tubing.
  3. Start by gently suctioning visible secretions from the oral cavity.
  4. Proceed to the pharynx, as clinically indicated, using caution to minimize gagging, which may increase the risk of vomiting.

Nasopharyngeal Suctioning

  1. Using appropriate personal protective equipment.
  2. Aseptic technique using a sterile catheter is the standard for this procedure.
  3. Approximate the insertion length of the catheter by measuring the catheter from the nose to the ear, and use the thumb and forefinger of your nondominant hand to mark the catheter at that point of maximal insertion.
  4. Dip the catheter tip in sterile water-soluble lubricant to minimize trauma to the nasal mucosa.
  5. Without applying suction gently introduce the catheter into the nostril and slowly proceed along the floor of the nasal cavity.
  6. If unable to continue inserting downward toward the pharynx, remove catheter while applying suction and attempt insertion in the other nostril.
  7. If able to insert to the pharynx, up to the maximal insertion point, apply suction while rotating and withdrawing catheter.
  8. Duration of suction should not exceed 15 seconds.
  9. If additional suction passes are required:
    1. wait at least 30 seconds while performing appropriate aspects of the respiratory assessment and determining the student’s toleration of the procedure;
    2. cleanse the catheter with sterile water; and
    3. re-lubricate as indicated.

Delegation Consideration

Oropharyngeal or nasopharyngeal suctioning can only be performed by the RN, LPN, or RT.

Select Nursing Considerations

  1. Nasopharyngeal suctioning is not commonly performed in school. Students requiring this procedure may have a 1 to 1 (1:1) nurse assigned to them based on nursing assessment.
  2. Consider activating EMS/911 for students who experience apnea, unresolved cyanosis, or respiratory/cardiac distress despite appropriate suctioning attempts.
  3. Bradycardia may occur as a result of vagal stimulation at the posterior oropharynx with vigorous suctioning.
  4. The use of pulse oximetry is an optional component of the respiratory assessment and should be determined in collaboration with the family, authorizing prescriber, and district medical adviser, as indicated.
  5. Some children learn to suction their own mouths at home. This practice in the school setting would require very thoughtful consideration and assessment by the school nurse, with authorization from the health care provider and parents.

Reference

Bowden, V.R., and Greenberg, C.S. (2008). Pediatric Nursing Procedures, 2nd edition. Philadelphia, PA: Lippincott Williams and Wilkins.

 




Content Last Modified on 3/29/2017 11:30:10 AM