This care plan assumes that the patient is conscious. However, if the patient is unconscious he should be nursed on his side (to prevent his tongue blocking the airway and to facilitate the drainage of secretions) and an artificial airway may be required. Oral or nasopharyngeal suctioning may be used. Oral suction is used for:
- unconscious or semi-conscious patients, e.g. post-operative recovery patients who are vomiting and do not have a gag reflex to prevent them from inhaling vomit or secretions
- patients who have had oral surgery or trauma resulting in blood and mucous secretions which need to be removed
- patients who are too weak to expectorate sputum from the pharynx.
Oral and nasopharyngeal suction are not the same as tracheal suction as they do not completely occlude a patient’s airway. As suctioning by these routes does not enter a sterile area the procedure is clean, rather than aseptic. However, the Yankuer (oral) sucker should be used for one patient only and changed daily. It can be a very distressing procedure
for the patient and should not be undertaken for prolonged periods. It may be used in conjunction with a Guedel airway if the airway needs to be maintained.
Equipment for oral suctioning
- Suction machine/piped suction.
- Suction tubing and oral suction catheter (e.g. Yankuer sucker).
- Sterile distilled water.
- Face mask.
- Eye shield.
- Towel or absorbent pad to protect patient’s clothes and bed linen.
Procedure for oral suctioning
- Explain procedure to Mr Barrett. (Even if the patient is unconscious explanations should be given, since many unconscious individuals are able to hear.)
- Prepare equipment.
- Attach suction tubing to suction machine and attach oral sucker to suction tubing, ensuring a tight fit.
TIP: You should regularly check that the suction machine is working and ready for use by plugging it in, switching it on and
kinking the suction tubing. This should cause the pressure dial to rise. Ensure that clean suction tubing is changed between
patients, and that a Yankuer (oral) sucker and flexible catheters are easily accessible to the machine.
- Position Mr Barrett in a semi-recumbent position with head turned towards you. If he is unconscious he should be nursed in a semi-prone position, facing you.
- Place a towel or pad under Mr Barrett’s chin.
- Switch the suction machine on and set suction level. Oral or nasopharyngeal suction should be gentle so that the mucous membrane, teeth, or gums are not damaged. Ideal suction levels for oral suction have little supporting evidence but experience suggests that 20 kilopascals (kPa) or 120 mmHg for wall suction units is the maximum pressure.
- Put on gloves, eye shield and mask.
- Ask Mr Barrett to open his mouth and assist him if necessary.
- Insert the Yankuer sucker into the mouth along one side and guide it along the inside of the cheek towards the oropharynx without applying suction. Suction is prevented by either kinking the suction catheter or leaving the hole in the Yankuer sucker open.
- Apply suction by either unkinking the tubing or occluding the hole in the Yankuer sucker, and remove secretions and debris from mouth as required. Do not force the sucker between the teeth or touch the posterior pharyngeal wall of the soft palate as it can make the patient gag or vomit.
- Release suction and remove oral sucker from Mr Barrett’s mouth. Oral suction should not be for prolonged periods as it can be very distressing to the patient.
TIP: Hold your breath while you suction because when you feel the need to breathe again that will indicate that the episode of
suctioning is long enough.
- Clean the sucker and tubing by suctioning through sterile water until all debris has been cleared.
- If further suctioning is required allow Mr Barrett to rest for at least 30 seconds and repeat above procedure. If he is able, ask him to deep breathe and/or cough between suctions so that secretions can rise to the upper airway.
- Document the quantity, colour, consistency and odour of secretions and the patient’s response to the procedure.