Policy 7-3-59
Page 1 of 3
UTMB RESPIRATORY CARE SERVICES
PROCEDURE-Nasotracheal Suctioning
Nasotracheal suctioning
Formulated: 11/03
Effective:
Reviewed:
12/03/03
5/31/05
NASOTRACHEAL SUCTIONING
Purpose
Scope
To standardize the use of Naso-tracheal suctioning, a component of
bronchial hygiene therapy
NTS is intended to remove accumulated secretions, blood, vomitus, and
other foreign material from the trachea that cannot be removed by the
patient’s spontaneous cough or other less invasive procedures. NTS has
been used to avoid intubation that was solely intended for the removal of
secretions.
NTS refers to the insertion of a suction catheter through the nasal passage
and pharynx into the trachea in order to aspirate accumulated secretions or
foreign material
Audience
Physician’s
Order
Indications
Contra
Indications
Possible
Hazards/Com
plications
All licensed respiratory therapist of the Respiratory Care Services
Department


Order for NTS or Naso-tracheal suctioning
Frequency of NTS or Naso-tracheal suctioning
The need to maintain a patent airway and remove secretions or foreign
material from the trachea in the presence of the inability to clear secretions,
audible evidence of secretions in the large/central airways that persist in
spite of patient’s best cough effort.

Occluded nasal passages

Nasal Bleeding, Epiglottitis or croup

Acute head, facial, or neck injury

Coagulopathy or bleeding disorder

Laryngospasm

Irritable airway

Upper respiratory tract infection

Mechanical trauma

Hypoxia/hypoxemia

Cardiac dysrhythmias/arrest

Bradycardia

Increase in blood pressure

Hypotension

Respiratory Arrest
Policy 7-3-59
Page 2 of 3
UTMB RESPIRATORY CARE SERVICES
PROCEDURE-Nasotracheal Suctioning
Nasotracheal suctioning
Procedure
Formulated: 11/03
Effective:
Reviewed:
12/03/03
5/31/05

Uncontrolled coughing

Gagging/vomiting

Laryngospasm

Bronchoconstriction/bronshospasm

Pain

Nosocomial infection

Atelectasis

Misdirection of Catheter

Increased ICP




Assesses patient and patient airway; determines preferred naris
Preoxygenates patient for at least 30 seconds
Adjusts suction to appropriate level; lubricates naris or
nasopharyngeal airway with water-soluable lubricant
Removes pillow and positions patient’s head.
Puts on sterile gloves and maintains clean technique throughout
procedure
Attaches catheter to suction source
Reassures patient; removes oxygen source
Inserts catheter into the nare
Passes catheter into the oropharynx and into trachea; confirms
positioning
Advances catheter until resistance is met (without suction applied)
Applies suction and rotates/ withdraws catheter for a maximum of
10 to 15 seconds.
Frequently assesses patient for oxygenation status, including pulse
oximetry
Re-oxygenate patient for at least 1 minute.

Reassesses patient and repeat if necessary.









Policy 7-3-59
Page 3 of 3
UTMB RESPIRATORY CARE SERVICES
PROCEDURE-Nasotracheal Suctioning
Nasotracheal suctioning
Formulated: 11/03
Effective:
Reviewed:
Discontinuation of
orders
Patients will be evaluated after every treatment. A complete pulmonary
assessment will be done every 72 ours as indicated. Based on the
assessment, the therapist will make recommendations for changes in
therapy or discontinuance as needed.
References
AARC Clinical Practice Guidelines: “Nasotracheal Suctioning,”
Respiratory Care 1992;37:898-901
12/03/03
5/31/05
Butler, Thomas J., Close, Janice R., Close , Robert J. Laboratory Exercises
for Competency in Respiratory Care.1998:255.