PATIENT CARE
JOB AID
Developed by:
Associate Nursing Administrator
Formulated:
Revised: 2/12;
VI-B-20
Job Aid #
Approved by CPC- 2/12
Task/Process
Suctioning of the Adult Patient
To provide a guide for suctioning of the patient.
Purpose :
Materials:
June 2006
Reviewed:
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● Wall suction or portable suction apparatus
● Collection container and connecting tubing
● Water-soluble lubricant
● Normal saline solution or sterile water
● Closed suction: Clean gloves, Mask, Eyewear, protective gown
● Open Suction: Commercially prepared suction kit containing a sterile catheter,
disposable container and sterile gloves
● Tonsil tip suction device
● Nasopharyngeal or oropharyngeal airway (optional for frequent suctioning)
● Self-inflating manual resuscitation bag-valve device connected to 100% oxygen
FOR ALL PATIENT CARE PROCEDURES, BE SURE TO DO THE FOLLOWING:
As appropriate, Verify or secure order, verify informed consent, introduce yourself and identify the
patient per policy, explain procedure, wash your hands and use appropriate PPE as required for the
procedure.
ORAL OR NASAL
SUCTIONING
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1. Place the patient in semi-Fowler’s or high Fowler’s position, if tolerated, unless
contraindicated.
2. Turn on the suction from the wall or portable unit and ensure functioning properly
3. Using aseptic technique open the suction catheter kit or the sterile catheter, container,
and gloves. Put on the gloves; non-dominant hand is non-sterile. Using your
Non-dominant hand, pour the sterile water or saline into the sterile container.
4. With your non-dominant hand, place a small amount of water-soluble lubricant on the
sterile area.
5. Pick up the catheter with your dominant (sterile) hand and attach it to the connecting
tubing. Use your non-dominant hand to control the suction valve while your dominant
hand manipulates the catheter.
6. Instruct the patient to cough and breathe slowly and deeply several times before
beginning suction.
7. Insert the catheter:
FOR NASAL INSERTION:
1. Exam the patient’s nares for deviated septum, obstruction or swelling.
2. If nasal airway is in place, insert the suction catheter into the airway without
applying suction. If no airway is in place, raise the tip of the patient’s nose
with your non-dominant hand to straighten the passageway. Without applying suction,
gently insert the suction catheter into the patient’s nares. Gently advance the
catheter approximately 5” to 6” (12.7 to 15 cm) until you reach the pool of secretions
or the patient begins to cough.
FOR ORAL INSERTION:
1. Without applying suction, gently insert catheter in the patient’s mouth. Advance it
3 - 4 inches (7.6 - 10 cm) along the side of the patient’s mouth until you reach the
pool of secretions or the patient begins to cough.
2. Using intermittent suction, withdraw the catheter from either the mouth or the nose
with a continuous rotating motion. Apply suction for only 10 to 15 seconds at a time.
3. Repeat the procedure until gurgling or bubbling sounds stop and respirations are
quiet.
4. Upon completion, flush the connecting tubing with normal saline solution or water.
5. Documentation should include the date, time, reason for suctioning, and technique
used; amount, color, consistency, and odor (if any) of the secretions; the patient’s
respiratory status before and after the procedure; any complications and the nursing
action taken; and the patient’s tolerance for the procedure.
TRACHEAL
SUCTION
(ADULT)
Non-Intubated
Patient
Equipment:
● Oxygen source
● Wall or portable suction
● Collection container
● Connecting tube
● Suction catheter kit
● Sterile water-soluble lubricant
● NS or sterile water ● Self-inflating manual resuscitation bag-valve device
● PPE (Eyewear, mask, gown, gloves)
Preparation
1. Gather equipment and place at bedside. Choose appropriate size suction catheter
(diameter should not be any larger than one half the inside diameter of the
tracheotomy or endotracheal tube).
2. Attach collection container to suction unit and connecting tube to collection
container.
3. Assess patient for pre-suction vital signs and breathe sounds. If nasotracheal
suctioning assess patient’s history for deviated septum, nasal polyps, nasal
obstruction, nasal trauma, epistaxis or mucosal swellings.
4. Wash your hands.
5. Explain procedure and reason for suctioning to patient.
6. Position patient in a semi-fowlers or high fowler position unless contraindicated.
7. Open, date and label the liter sterile normal saline or sterile water bottle, or open and
attach the sterile normal saline flush to the closed tracheal suctioning system for
endotracheal suction.
8. Set suction pressure between 100 - 120 mm Hg.
Insertion of Suction Catheter In a Non-intubated Patient
1. Follow steps 1-9 of preparation.
2. Open sterile water soluble lubricant
3. Use strict aseptic technique to open suction catheter and apply sterile gloves.
4. Use non-dominant hand to pour normal saline or sterile water into the sterile
container, found in the suction catheter kit. This hand is now your non-sterile hand.
5. Place small amount of sterile water soluble lubricant on sterile field.
6. Remove suction catheter from the wrapper with your sterile hand, keeping catheter
coiled so it will not touch a non-sterile object.
7. Pick up connecting tube with non-sterile hand and attach to suction catheter (in
sterile hand).
8. While holding sterile suction catheter in sterile hand, place tip of catheter in sterile
saline or water solution and suction a small amount through catheter. This lubricates
the inside and out side of the catheter.
9. Next dip suction catheter tip in water-soluble lubricant.
10. Have patient take 3-6 deep breaths prior to suctioning. If supplemental oxygen is
being used, evaluate the need for pre-oxygenation.
11. Slightly tip patient’s head back.
12. Insert catheter into nostril while gently rolling between fingers to help advance
catheter through turbinates.
13. As the patient inhales, quickly advance catheter as far as possible.
DO NOT APPLY SUCTION DURING INSERTION.
14. If patient coughs during insertion, briefly hold catheter still, and then resume
advancement when the patient inhales.
TRACHEAL
SUCTION
(ADULT)
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Insertion of Suction Catheter
In An Intubated Patient Without The Closed Tracheal Suction System
1. Follow steps 1-9 of preparation.
Intubated
patient
After Suctioning
Documentation
2. Pre-oxygenate patient either with a hand held resuscitation bag or ventilator for 30
seconds. To use resuscitation bag: set oxygen flow meter at 15 l/m, disconnect
patient and deliver 5-6 breaths with resuscitation bag. If patient is on PEEP,
evaluate need for use of a PEEP valve with the resuscitation bag. To use ventilator,
manually deliver 5-6 breaths by pressing the manual breath button.
3. Disconnect the patient from the ventilator with non-sterile hand.
4. Insert suction catheter gently into the endotracheal tube or tracheotomy tube with
sterile hand.
5. Advance suction catheter without applying suction until you meet resistance. If
patient coughs, pause briefly, and then resume advancement.
In An Intubated Patient With Closed Tracheal Suctioning System
1. Follow steps 1-8 of preparation.
2. Only pre-oxygenate if patient’s condition warrants. This system maintains patient’s
tidal volume, oxygen concentration, and PEEP delivered by the ventilator while being
suctioned, reducing the occurrence of suction induced hypoxemia.
3. Hold/stabilize ventilator tubing and T-piece parallel to patient’s chin. Turn knob to
open prior to suction.
4. With your thumb and index finger of your other hand, advance the suction catheter
through the endotracheal tube and into the patient’s tracheobronchial tree.
5. DO NOT SUCTION DURING ADVANCEMENT.
Suctioning
After catheter insertion, apply suction intermittently by removing and replacing your
thumb over the control valve.
1. Remove suction catheter as you apply suction. If patient is intubated, suction
catheter will be in protective sleeve. If patient not intubated or closed tracheal
suction system is not in place, roll the suction catheter between your thumb and fore
finger and keep it in your sterile hand.
2. Never suction for more than 10 seconds at one time.
3. Resume oxygen delivery and hyper-oxygenation prior to continuing.
4. Observe patient and allow to rest briefly before next suctioning.
5. Encourage patient to cough between suctioning attempts.
6. Observe secretion color and thickness for documentation purposes and possible
need to flush catheter.
7. If patient not using closed tracheal suctioning system, place catheter tip in sterile
normal saline or water and apply suction briefly to flush suction catheter. If patient
has a closed tracheal suctioning system, pull suction catheter back as far as
possible, squeeze normal saline flush and simultaneously apply suction to flush
catheter.
8. The timing of each suction procedure and length of rest period depends on the
patient’s tolerance of the procedure and absence of complications. Complications
may include anxiety, cardiac arrhythmias, tracheal or bronchial trauma, hypoxemia,
hypertension, hypotension and bleeding.
1.
2.
3.
4.
5.
Hyper-oxygenate the patient.
Assess for upper airway suctioning needs. Use tonsil suction to clear oral airway.
Discard gloves and suction catheter in red trash bag.
Wash hands.
Auscultate lungs bilaterally and assess vital signs.
Documentation should include the date, time, reason for suctioning, and technique
used; amount, color, consistency, and odor (if any) of the secretions; the patient’s
respiratory status before and after the procedure; any complications and the nursing
action taken; and the patient’s tolerance for the procedure.
Reference: AACN Procedure Manual for Critical Care (2011) 6th Ed.: pp 79-87
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