Suctioning: Nasopharyngeal

Procedure for Nasopharyngeal Suctioning

PATIENT ALERT: Monitor patient’s vital signs and oxygen saturation using pulse oximetry throughout suction procedure. If the patient’s pulse drops more than 20 beats per minute or increases more than 40 beats per minute, or if pulse oximetry falls below 90% or 5% from baseline, cease suctioning. Any deteriorating changes in the patient’s physiologic status during suctioning requires termination of the procedure, hyperoxygenation, and other appropriate interventions (e.g., position change).2 Assess patient for risk factors and signs and symptoms of airway obstruction. Also assess for contraindications to nasotracheal suctioning (e.g., facial trauma/surgery, bleeding disorders, nasal bleeding, epiglottitis, croup, laryngospasm, irritable airway).

Assist patient to semi-Fowler’s or similar position, and perform hand hygiene. Connect tubing to suction machine, turn on device, and set volume regulator. For one-time use catheter, use aseptic technique to open sterile drape, pour 100 mL normal saline solution or sterile water into basin, and squeeze lubricant onto open sterile catheter package. With sterile gloved hands, secure catheter to tubing. Check equipment function by suctioning small amount of normal saline solution from basin. Coat distal 6 to 8 cm of catheter with lubricant. Remove oxygen delivery device, if any. Without applying suction, gently but quickly insert catheter into nares during inhalation and follow natural course of nares down. For nasopharyngeal suction, insert catheter approximately 16 cm in adults, 8 to 12 cm in older children, or 4 to 8 cm in infants and younger children. 

  a.  If needed, turn patient’s head to right to suction left mainstem bronchus; turn head to left to suction right mainstem bronchus.
Apply intermittent suction for up to 10 seconds. Encourage patient to cough and deep breathe. Replace oxygen delivery device, if any. Rinse catheter and tubing in normal saline or water until cleared. Repeat suctioning, if needed, after 1 to 2 minutes.

Completing the Procedure
1.  Disconnect catheter from tubing. Pull glove off, turning it inside out over coiled catheter. Pull off other glove over first glove in same way. Turn off suction.
2.  Remove towel, reposition patient, and readjust oxygen to original level.
3.  Discard all supplies appropriately. Perform hand hygiene.
4.  Compare patient’s respiratory assessments before and after suctioning. Observe airway secretions.