Skill 45[1]..Nasotracheal Suctioning.pdf

SKILL 45

Nasotracheal Suctioning

EQUIPMENT

Appropriately sized resuscitation equipment (mask, valve,

bag)

Appropriately sized suction catheter pack (#8 to #10 French

for children, #5 to #8 French for infants)

Mask, gloves, and goggle

Suction source (wall suction or portable suction machine)

Suction source canister and connecting tubing

Oxygen source and delivery source

Normal saline and container

K-Y Jelly

Moisture resistant disposable bag

8. Position child as needed to complete procedure using

least restrictive immobilizing techniques (use assistant

as necessary).

9. Oxygenate child above baseline oxygen saturation.

10. Don mask, gloves, goggles, and gown (as needed).

Observe standard and droplet precautions according to

policy.

11. Using dominant hand, remove protective covering, pick

up suction catheter and connect it to the suction tubing

with nondominant hand. Check suction pressures once

the suction catheter is connected.

12. Encourage the child to cough to help pool secretions in

hypopharynx.

13. Determine the correct distance to advance suction

catheter. This is done by measuring from the tip of the

child’s nose to the opening of the ear; note position on

the catheter.

14. Moisten the suction catheter using normal saline or K-Y

Jelly. Using a downward motion, aiming toward midline,

advance the catheter into the nare no further than the

premeasured distance. (For oropharyngeal suction pull

the tongue forward using gauze. Advance the catheter

about 10–15 cm along one side of the mouth.)

15. Apply intermittent suctioning by covering the suction

control hole with thumb. Gently rotate the catheter

while withdrawing the catheter. Limit continuous suc-

tion within the airway to no more than 5 (infants)–15

(child) seconds.

16. Reoxygenate the child to baseline oxygenation satura-

tion.

17. Clean the catheter by wiping with sterile gauze and

flushing tubing with normal saline.

18. Repeat steps 13–15 as needed to clear the nasopharynx

of secretions, alternating nares. Allow 20–30-second

intervals between each episode of suctioning. Limit suc-

tioning to a total of 5 minutes.

19. Assess respiratory status, including respiratory rate,

color, and effort. Auscultate breath sounds.

20. Comfort and praise child.

NOTE: Requires order from physician to implement

procedure. Suction only when assessment indicates

need. Coordinate suctioning with other pulmonary

hygiene interventions, e.g., inhaled bronchodilators,

chest physiotherapy. Provide adequate hydration to

minimize mucosal drying and promote ciliary action.

SAFETY

1. Be prepared to maintain airway and initiate resuscita-

tion measures should the child exhibit progressive signs

of respiratory or cardiac distress.

2. Initiate “Code Blue” and provide resuscitation if child

experiences respiratory or cardiac failure.

3. If both the oropharynx and nasopharynx are to be suc-

tioned, use separate sterile catheters to prevent trans-

mission of microorganisms.

PROCEDURE

1. Gather equipment. Improves organization and effective-

ness.

2. Assemble suction canister and connecting tubing to suc-

tion source. Set suction levels as follows: 80–100 mm Hg

for infants and children under 10–12 years, 100–120

mm Hg for older children. Ensure appropriate resusci-

tation equipment (mask, valve, bag) is at bedside.

3. Wash hands. Reduces transmission of microorganisms.

4. Identify an assistant to help position, hold, and comfort

child as necessary.

5. Prepare child and family. Consider having someone sup-

port or comfort the child. Enhances cooperation and

parental participation and reduces anxiety and fear.

6. Perform baseline respiratory assessment.

7. Open and prepare suction pack and normal saline con-

tainer, maintaining clean technique.

continued

SKILL 45

Nasotracheal Suctioning

continued

DOCUMENTATION

Assess and document the following prior to and following

the procedure.

1. Child’s general condition.

2. Client assessment prior to and immediately following

administration of oxygen. Include oxygen saturation, res-

piratory rate and effort, color, breath sounds, and heart

rate. Complete appropriate scoring tool (bronchiolitis

score or croup score) as indicated.

3. Color, consistency, and amount of secretions.

4. Note oxygen requirements, type of oxygen delivery

device, and flow rate immediately and every 4 hours (if

using a hood, FiO 2 , flow rate, and temperature every 4

hours) or more frequently as needed.

5. Any complications that occurred.

6. Notify doctor should complications or unexpected

responses occur.

7. Client cardiorespiratory assessment every 4 hours, or

more frequently if needed, type and flow rate of oxygen

on follow-up visits.

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