Nasopharyngeal and Oropharyngeal Suctioning: Procedure (Nursing)

by Samantha Rhea, MSN, RN

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    00:04 So once we've got that wall suction on, this is where that sterile technique comes in.

    00:09 Okay, so to begin the skill, we're going to use sterile technique to open the suction catheter kit.

    00:16 Then we're going to go ahead and perform our hand hygiene again.

    00:20 Now once we open up our suction catheter kit, we've done our hand hygiene.

    00:24 Now we've got to pour the sterile saline solution into that sterile suction catheter kit or the sterile container.

    00:32 Now many times the saline solution is a stand alone equipment.

    00:37 So therefore here you notice we have not don sterile gloves yet.

    00:41 Same thing here is we're going to go ahead and open up the lubricant and then apply it to the sterile catheter inside that suction catheter kit.

    00:50 Now it's really important here that we maintain sterility of the suction catheter.

    00:56 Now that we have got our equipment ready, we can go ahead and don sterile gloves.

    01:02 Now we want to assign our dominant hand as sterile and our non-dominant hand as non-sterile.

    01:07 We'll kind of talk about why we're going to do that.

    01:11 Now with my sterile hand, this is the one I'm going to pick up my catheter and then with my non-dominant non-sterile hand, then we're going to have the suction tubing in that hand and we're going to attach these together.

    01:24 So with the catheter in my sterile hand, I'm going to dip a catheter into the sterile saline solution and suction a small amount of saline into that catheter to make sure suction is working appropriately.

    01:38 Now here after we've done this, we want to go ahead and also lubricate the catheter for insertion while maintaining sterility of the suction catheter.

    01:48 Lubrication is important before we insert.

    01:51 Now if the client is conscious and able, instruct them to cough and breathe deeply before inserting the suction catheter.

    01:59 Now here's where the part comes in that maybe a little uncomfortable for your patient.

    02:04 If they can help it or if it's okay, make sure you have the patient tilt their head back and expose the nostril or the oral cavity that you're going to go into.

    02:13 Now when we advance the catheter and we insert it, at this point, we do not apply suction here.

    02:20 So when we advanced the catheter just going down into the nasal pharyngeal cavity, you do not apply suction here, not yet.

    02:29 Now if the patient begins to cough, that could indicate we're an area we don't want to be.

    02:34 So make sure you stop and do not advance the catheter here.

    02:38 Now once we've advanced that catheter safely, now's the time to apply suction to either the mouth or the nasal cavity to remove those secretions.

    02:52 Hi, guys, you may wonder, "Okay, what is she wearing on her face?" Well, I've got a face shield on today as a big reminder for you that anytime that you suction the respiratory tract, we need to make sure that we protect our eyes, our nose and our mouth.

    03:09 So again, anytime you do a respiratory suction, make sure you protect yourself with the appropriate PPE.

    03:16 Now, I'm going to go ahead and show you how we do this skill.

    03:21 So we just talked about appropriate PPE for your patient.

    03:25 Now let's go and we're here with our patient now and assess our patient before we get started.

    03:30 So remember, as a nurse, we like to go back to that assessment piece.

    03:34 So again, before you start to insert a catheter, it's a great idea to assess the patient's nares if we're doing nasal suctioning, or their oral cavity if we're doing oral suctioning.

    03:45 Now when we're talking about the nares, one thing we can do to assess is simply take our pin light and also look for ourselves.

    03:55 So we want to look up there, see if there's any obstruction.

    03:58 Also, it's a great idea to ask your patient if they have a deviated septum for example, we want to avoid that nostril.

    04:05 Also, one thing we can have our patients do is take one finger and block one nostril and have them breathe in and see which one's more comfortable for the patient.

    04:15 Also, if we assess the oral cavity, we want to check for any lesions or anything like that before we insert the catheter.

    04:22 So now we've evaluated where we're going to go with that catheter.

    04:25 Make sure we check your patient's breathing, right? Because we're going to do suctioning here, and that can compromise the respiratory status.

    04:32 Now this is important because this is going to help us get a baseline.

    04:36 Now when we suction, we need to be really mindful that we don't hinder again their respiratory status.

    04:42 So it's a great idea to check on your patient, see how their breathing is, also to get an oxygen saturation to see where they're at.

    04:49 This again just gives us a great baseline.

    04:53 Now before we get started, don't forget to protect your patient.

    04:56 So if you've got a towel or maybe like an absorbent pad like I have here.

    05:00 Great idea, just in case you get any mucus or some secretions on the patient's linen, we want to protect that.

    05:16 Okay, so now I've got my patient protected.

    05:18 And before we get started, this may seem a little funny, but make sure you turn on your wall suction.

    05:24 So we're going to go to our unit and make sure this is turned on.

    05:28 The reason why we want to do this because if you start to get sterile, you don't want to have to stop and think, "Oh, no, I haven't turned on my suction yet." So make sure you check that, that it's working properly before you get started.

    05:41 So let's go ahead and dive into our skill.

    05:43 So first, let's go ahead and open up our suction catheter kit.

    05:47 Now if you guys remember, we're going to use sterile technique on this because again, we're talking about the respiratory tract.

    05:53 Now, anytime you're talking about sterile equipment, if you remember, it's typically enclosed in a package.

    05:59 Also one tip that's really helpful.

    06:01 If you're opening up something that's sterile, usually, there's going to be a list on there of what's inside the package, if there's multiple equipment needed.

    06:10 So just know that, so that's really helpful.

    06:13 So I'm going to go ahead and open up my sterile suction catheter kit.

    06:17 And no, we don't want to touch the inside with our bare hands.

    06:27 So I'm going to place that to the side and you may see a pair of gloves here.

    06:31 So for us to add anything to it, I am going to have to remove those, you may think, okay, hold on a minute, she just told me not to touch the inside of that.

    06:39 But these are the gloves that we would put on if we're going to do this procedure.

    06:45 Also, notice they're enclosed in a package, the package is going to be on the table.

    06:51 Also, the gloves itself are sterile.

    06:53 And these are encased in this package.

    06:55 So don't worry about that.

    06:56 So let's go ahead and remove the gloves.

    06:59 So if we can, we want to pinch in the middle or be really careful not to tear the package here and get rid of those.

    07:08 So now that that's open, we do not want to touch inside that.

    07:12 Now there's some variation here.

    07:14 We talked about some steps earlier, that you know, there's a variation on how nurses are going to do everything right.

    07:21 And that's okay, as long as with this particular skill, you maintain sterility.

    07:26 And again, so each nurse kind of does it a certain way.

    07:30 However, me as a nurse, this is how I like to do it just to try to prep everything I can before I put on my sterile gloves.

    07:38 So I'll show you how I do this.

    07:40 So first, we want to go ahead and prep our sterile saline.

    07:43 And remember keywords sterile, because again, it's the respiratory system, we want to make sure this is sterile saline.

    07:52 Let me open this and go ahead and add it to my sterile field.

    07:58 Now you see what I've got here for the sterile saline that totally works, you may have like a bottle, for example.

    08:07 And you can use that as well as long as it's sterile whatever equipment you've got.

    08:13 All right, this is our lubricating package.

    08:15 So this is really important to lubricate the catheter for comfort when you insert it in our patient.

    08:21 Now, you'll see some nurses go ahead and hold out the catheter and put this on here.

    08:27 I will tell you just from my personal experience, sometimes it's hard to make sure you hit the catheter in the air like this.

    08:33 Also, I want to make sure I don't touch this package to the sterile catheter.

    08:38 So me, I go ahead and put it in the sterile tray itself, that way I can eliminate that possibility.

    08:51 Okay, so I'm just going to add it to my sterile field.

    08:58 All right, that should work right there for me.

    09:00 So now I'm going to go ahead, once I've got everything done, it'd be great idea to go ahead and perform our hand hygiene here again, then I want to go ahead and don my sterile gloves.

    09:11 So again, anytime you do a sterile procedure, it's a great idea to have another pair, sometimes we may drop it, it could be the wrong size, whatever that may be, always a great idea to bring an extra pair.

    09:28 So think of this as a separate sterile field.

    09:32 When you open up the package, this parts going on the table, and you want to open this up where you can see the wings.

    09:42 So just as a refresher here, when you're putting on sterile gloves, there's always these great little flaps that's how you know it should be facing the top and that's what you want.

    09:52 So let me get a hold of my wings here and open this up.

    09:56 So notice how these want to flap in.

    09:59 I really like to turn that on the corners to make sure it doesn't inhibit my sterile field or contaminated.

    10:11 Okay, now if you guys remember, there's actually a 1 inch border around a sterile field so that way we can move this or manipulate that.

    10:21 So now I want to go ahead and start with my gloves.

    10:23 Again, this is gonna vary and practice is key with these things.

    10:27 Now, some people like to start with their dominant or their non-dominant hands, it's totally up to you when whatever you're comfortable with.

    10:35 Here's an example, I actually am right-handed, but I like to start with my left.

    10:38 So, now let's take a look at the gloves.

    10:41 Just as a recap here.

    10:43 You see how there's that cuff folded.

    10:45 Now think about like a cuff on a shirt when you pull it back, that's the part inside that's touching your skin.

    10:52 That's why we can touch this cuff here.

    10:54 So now I'm going to go ahead and pinch this, because again, this part is going to touch my skin.

    11:01 I'm going to try to open this up and slide my hand in like a pizza.

    11:05 And I'm just going to take my time here, don't get in a rush.

    11:09 So I'm going to try to wiggle my fingers in there.

    11:12 Notice as well, when I donned sterile gloves or put those on, I like to keep this up, I don't want to accidentally drag this and contaminate my gloves.

    11:24 So just try to manipulate, wiggle that on and pull those on.

    11:30 And sometimes guys, sometimes you may tear it, that's okay.

    11:34 That's why it's a great idea to do backup.

    11:36 Now really mines here at the end of the cuff.

    11:38 But just in case, I'm going to go ahead and get rid of these because I actually already have another pair here.

    11:43 Alright, so now that I've got these on because I want to kind of move this out of the way guys, I'm not above using an elbow and moving this or just pinch the middle and get rid of this.

    11:53 So we can touch that later, we can get rid of all that stuff later.

    11:57 So now that I've got my sterile gloves on.

    12:00 Now, here's an important piece of the skill because obviously, I'm going to have to touch equipment.

    12:05 And also I've got sterile stuff here as well.

    12:08 So you need to decide which hands going to stay sterile and which one's going to be non-sterile.

    12:13 So I'm right-handed, so I like to keep this a sterile.

    12:17 So now I'm going to take this and with my sterile hand, I'm going to pick up the catheter because remember, inside here a sterile.

    12:26 So again, I'm touching inside, I'm going to move this a little closer to me.

    12:32 I'm going to make sure when I grab this that I get a good grip of this and this catheter doesn't go all over the place, so I'm going to get a hold of it.

    12:42 So my right hand is going to be my sterile one, like you see.

    12:45 And now I've got a hold of my suction control here.

    12:48 Now I'm going to take my, what we call our non-dominant non-sterile or you may hear my dirty hand is what I'm gonna refer it to.

    12:56 Now I can touch equipment that's not sterile.

    12:59 So here's this and now we're going to connect.

    13:03 Okay, so this is important here because you see this hand holding the catheter will maintain sterility.

    13:11 Notice I'm being really careful about this catheter.

    13:14 Now this one's important because this is my dirty hand and this is what's going to control suction here.

    13:20 So that's why we've got assigned one hand versus the other.

    13:24 So now if you remember your suctions on, I want to take my catheter and I want to dip it into the saline and suck that up just to make sure suctions working and clearing the catheter.

    13:36 Also, I want to take this and also lubricate the tip as well.

    13:41 Now this is a great time if your patient is conscious and awake, you want them to instruct to cough and deep breathe that may help to get some secretions a little bit higher up in the throat and that will be easier for suctioning.

    13:55 Also, if your patient can help you, you want them to tilt their head back and that will expose the nostrils a little bit better because today we're going to do nasal pharyngeal suctioning.

    14:06 Alright, so now I'm going to go ahead and make sure I lubricate my catheter.

    14:16 And now that we've got this lubricated, I can go ahead and get ready to insert.

    14:21 Now again, notice the positioning on our patient.

    14:23 This is really important here.

    14:26 So with the patient, if they begin to cough, that's okay.

    14:31 Sometimes you've got to really just assess your patient here.

    14:34 Now you can imagine this thing going to the back of your mouth, you're probably gonna cough, it's gonna take a little bit, that's pretty normal.

    14:42 So if that happens, make sure you assess your patient.

    14:46 Also, this is a little bit of a higher level skill, right? This can be a little bit scary for honestly if it's new to you as the nurse also for the patient.

    14:54 So bring another experienced nurse in to help monitor the patient.

    14:58 Now we can go ahead insert and apply suction.

    15:01 So when we do this, we want to go ahead insert into the nasal cavity.

    15:07 Now notice before I start, notice here with my thumb, I am not applying suction yet that's really important, okay? So when we advance the catheter, you do not apply suction.

    15:21 So I'm going to advance my catheter.

    15:25 And again, the length is going to kind of depend on the patient.

    15:29 So once I'm about to, once I'm applying suction, now I can go ahead and put my thumb down.

    15:34 Now once it's inserted, when I remove it, I've got to do this intermittently.

    15:38 So again, once we withdraw, I'm going to intermittently apply suction with my thumb while I'm withdrawing it.

    15:47 So you notice to maintain sterility of the catheter, I can go ahead and make sure that I keep this in my sterile hand.

    15:55 Now, this is really important that sometimes you may have to do this a couple of times, and that's all right.

    16:00 But you want to make sure you give your patient adequate rest, you can imagine that again, we're going down the respiratory tract and the patient may have a hard time breathing.

    16:10 If they do, let the patient relax, let them just kind of calm down a little bit, reapply oxygenation if needed.

    16:19 So just know that.

    16:21 So again, many times you're going to have to do this, 2 or 3 times.

    16:26 So once I withdraw it, I want to reapply suction to clean out my catheter here.

    16:31 So to apply suction, don't forget, I'm going to put my thumb on there, suck up my sterile saline to clean out cath, clean out the catheter and do another pass.

    16:40 So let me show you that again.

    16:42 So again, without suction my fingers off.

    16:46 I'm going to insert down the patient's nasal cavity.

    16:54 Again, see my thumb, no suction here.

    16:57 And then when we're ready to suck, we're going to go intermittent suction.

    17:03 Withdraw and wrap it around in my hand into a continuous motion and then withdraw it.

    About the Lecture

    The lecture Nasopharyngeal and Oropharyngeal Suctioning: Procedure (Nursing) by Samantha Rhea, MSN, RN is from the course Suctioning: Nasopharyngeal and Oropharyngeal (Nursing).

    Included Quiz Questions

    1. “Oropharyngeal suctioning is not a sterile procedure.”
    2. “I need sterile gloves to open the suction catheter kit.”
    3. “Only one of my hands is sterile during the procedure.”
    4. “Only my sterile hand will touch the suction catheter.”
    1. The student nurse assigns their non-dominant hand as their “sterile” hand.
    2. The student nurse uses their sterile hand to control the suction valve.
    3. The student nurse lubricates the catheter for insertion while maintaining the sterility of the suction catheter.
    4. The student nurse uses their sterile hand to attach the suction catheter to the suction tubing.
    1. The nurse must assess the situation to determine the appropriate personal protective equipment (PPE) required for the procedure.
    2. The nurse must assess the client’s breathing.
    3. The nurse must have the client take their gown off, so it is not soiled during the procedure.
    4. The nurse must assess the client’s nares by having the client block both nostrils simultaneously and attempt to breathe through their nose.
    1. Yes. As long as the nurse avoids the nare where the septum deviates.
    2. Yes. As long as the nurse only uses the nare where the septum deviates.
    3. Yes. The nurse can use either nare without special consideration.
    4. No. The nurse can only use oropharyngeal suctioning on a client with a deviated septum.
    1. Apply lubricant that has already been introduced to the sterile field onto the suction catheter.
    2. Guide the suction catheter into the client’s nare.
    3. Turn on the wall suction
    4. Apply suction
    1. Cough
    2. Deep breathe
    3. Tilt their head backward
    4. Hold their breath
    5. Tilt their head forward
    1. When dipping the catheter in sterile saline
    2. When withdrawing the suction catheter from the client’s nasopharynx
    3. When advancing the suction catheter into the client’s nasopharynx
    4. When dipping the catheter in lubricant
    1. By dipping the tip of the catheter in sterile saline and applying suction
    2. By dipping the tip of the catheter in sterile saline
    3. By dipping the tip of the catheter in tap water
    4. By removing the catheter from the suction tubing and rinsing it in the sink

    Author of lecture Nasopharyngeal and Oropharyngeal Suctioning: Procedure (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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