7.12 : Suctioning the Nasopharyngeal Airway

Nasopharyngeal suctioning is a procedure to remove secretions from the upper part of the respiratory tract that the patient cannot clear independently. It helps maintain airway patency and prevents complications such as aspiration pneumonia.

Equipment Required

1. Suction machine with adjustable pressure settings
2. Sterile suction catheters (appropriate size for the patient)
3. Sterile gloves
4. Sterile saline or water (for irrigation or lubrication)
5. Water-soluble lubricant
6. Personal protective equipment (PPE): mask, goggles, and gown
7. Oxygen delivery system (if needed)
8. Resuscitation bag with mask (if required)

Pre-Procedural Preparation

1. Hand Hygiene and PPE: Perform hand hygiene and don PPE to prevent infection transmission.
2. Patient Explanation and Consent: Explain the procedure to the patient to obtain informed consent and cooperation.
3. Assessment: Assess the patient's respiratory status, including oxygen saturation, breath sounds, and the need for suctioning.
4. Equipment Check: Ensure the suction unit functions correctly and set the appropriate suction pressure (usually 100-120 mmHg for adults).
5. Positioning: Place the patient in a semi-Fowler's position to reduce the chance of aspiration and aid breathing.

Nasopharyngeal Suctioning Procedure

1. Sterile Technique: Open the suction catheter package and maintain sterility - don sterile gloves to maintain asepsis to prevent nosocomial infections.
2. Catheter Preparation: Attach the sterile suction catheter to the suction tubing. If necessary, lubricate the distal end of the catheter with water-soluble lubricant. Properly preparing the catheter and ensuring sterility reduces the chances of introducing harmful pathogens into the airway.
3. Pre-oxygenate: If the patient is on supplemental oxygen, increase the flow rate before and after suctioning to prevent hypoxia, which can occur during suctioning due to the temporary removal of the oxygen supply.
4. Insertion of the Catheter: Gently insert the catheter into one nostril, aiming posteriorly and slightly downward along the floor of the nasal cavity, without applying suction. Gentle insertion without suction reduces the risk of traumatizing the sensitive nasal mucosa and causing nosebleeds or other injuries.
5. Suction Application: Once the catheter is in place, applying intermittent suction while gently rotating and withdrawing the catheter. Suctioning while withdrawing the catheter prevents excessive negative pressure in one spot, which could cause trauma or hypoxia, and ensures more effective secretion removal.

Post-Procedural Care

1. Reassessment: Immediately reassess the patient's respiratory status and oxygen saturation after suctioning.
2. Patient Comfort: Offer tissues and assist the patient in cleaning around the nose and mouth if needed.
3. Documentation: Record the procedure, noting the amount and characteristics of secretions removed, any complications, and the patient's tolerance.