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Steps of Performing Sterile Suctioning for Different Types of Artificial Airways

- The steps of performing sterile suctioning vary depending on the type of artificial airway that the patient has. The most common types of artificial airways are endotracheal tube (ETT), tracheostomy tube (TT), and nasopharyngeal tube (NPT).

- Endotracheal tube (ETT) is a plastic tube that is inserted through the mouth or nose into the trachea to provide mechanical ventilation or oxygenation. It is secured with tape or a cuff that is inflated to seal the airway.

- Tracheostomy tube (TT) is a metal or plastic tube that is inserted through a surgical opening in the neck into the trachea to bypass the upper airway obstruction or facilitate long-term ventilation. It can have an inner cannula that can be removed for cleaning and a cuff that can be inflated or deflated depending on the patient’s condition.

- Nasopharyngeal tube (NPT) is a soft rubber or plastic tube that is inserted through the nose into the pharynx to provide oxygenation or humidification. It is used for patients who have difficulty breathing through the mouth or who need frequent suctioning.

- The general steps of performing sterile suctioning for any type of artificial airway are as follows:

  • Assess the patient’s need for suctioning by observing for signs and symptoms of airway obstruction, such as increased respiratory rate, decreased oxygen saturation, adventitious breath sounds, restlessness, agitation, cyanosis, or coughing.
  • Check the prescriber’s order for suctioning, including the frequency, duration, pressure, and type of catheter.
  • Gather the equipment and supplies needed for suctioning, such as suction device, tubing system, collection container, catheter, saline solution, gloves, sterile drape, PPE, oxygen source, and stethoscope.
  • Explain the procedure to the patient and obtain consent if possible. Provide privacy and ensure comfort. Position the patient in semi-Fowler’s or Fowler’s position to facilitate breathing and drainage.
  • Perform hand hygiene and don PPE. Open the sterile equipment and supplies using aseptic technique. Connect the suction tubing to the suction device and adjust the pressure according to the prescriber’s order. Test the suction by occluding the vent with the thumb.
  • Preoxygenate the patient with 100% oxygen for 30 seconds to 3 minutes before suctioning to prevent hypoxia. Monitor the patient’s vital signs and oxygen saturation during this step.
  • Insert the catheter into the artificial airway using sterile technique. For ETT and TT, insert the catheter until resistance is met or until the patient coughs. For NPT, insert the catheter until it reaches the pharynx. Do not apply suction while inserting the catheter.
  • Apply intermittent suction by placing and releasing the thumb over the vent while withdrawing the catheter slowly. Rotate the catheter between the thumb and forefinger to remove secretions from all sides of the airway. Limit each suction pass to no more than 10 seconds to prevent hypoxia and mucosal damage.
  • Rinse the catheter and tubing with saline solution or water after each suction pass to clear secretions and prevent infection. Reoxygenate the patient with 100% oxygen for 30 seconds to 3 minutes after each suction pass to restore oxygenation.
  • Repeat steps 7 to 9 until no more secretions are obtained or until three passes are completed. Do not suction more than three times in a row to prevent complications. Allow at least one minute of rest between each suction pass to prevent fatigue and distress.

- Remove the catheter and tubing from the artificial airway and disconnect them from the suction device. Discard the used catheter and gloves into a biohazard bag or container. Clean the collection container and tubing with disinfectant solution. Turn off the suction device.

- Assess the patient’s response to suctioning by monitoring vital signs, oxygen saturation, breath sounds, secretions, and comfort level. Provide oral or nasal care as needed. Reposition the patient and ensure safety .

- Perform hand hygiene and remove PPE. Dispose of waste materials according to facility policy. Clean the environment and equipment as needed .

- Document the procedure and findings, including the date, time, type, size, and frequency of suctioning, the amount, color, consistency, and odor of secretions, the patient’s tolerance and response, any complications or interventions, and any teaching or evaluation done.

Questions on Steps of Performing Sterile Suctioning for Different Types of Artificial Airways

Correct Answer is C

Explanation

Sterile suctioning is not performed to monitor vital signs. Although vital signs may be monitored during the procedure, it is not the primary purpose of suctioning.

Correct Answer is ["A","B","C","D"]

Explanation

Glass suctioning catheters are not used for sterile suctioning due to the risk of breakage, which can lead to serious injuries and complications.

Correct Answer is C

Explanation

Feeling lightheaded may be a common sensation during and after suctioning due to the stimulation of the gag reflex, but it does not necessarily contraindicate the procedure. It is essential to ensure adequate oxygenation and provide proper support during the procedure to minimize this discomfort.

Correct Answer is A

Explanation

Using an artificial airway at night, such as a tracheostomy tube, indicates that the patient may require suctioning to maintain airway patency. While having an artificial airway increases the risk of infection and other complications, it is not a contraindication for sterile suctioning if clinically indicated.

Correct Answer is A

Explanation

Performing hand hygiene before and after the procedure is vital for infection control, but it is not the most crucial measure to prevent cross-contamination during sterile suctioning. While hand hygiene is essential for reducing the spread of infections, using PPE provides an additional layer of protection during the procedure.

Correct Answer is D

Explanation

When suctioning patients with an artificial airway, using disposable plastic catheters is preferred to reduce the risk of infection. Disposable catheters are single-use and discarded after each procedure, minimizing the potential for contamination and cross-infection between patients.

Correct Answer is A

Explanation

A catheter with a single opening is not ideal for suctioning thick secretions. It may not provide sufficient suctioning power and could lead to ineffective removal of secretions from the patient's airway.

Correct Answer is ["A","D","E"]

Explanation

Wearing gloves and a mask during suctioning helps protect the nurse from exposure to the patient's bodily fluids and potential infectious agents. Repeat steps 7 to 9 until no more secretions are obtained or until three passes are completed. Do not suction more than three times in a row to prevent complications. Allow at least one minute of rest between each suction pass to prevent fatigue and distress .

Correct Answer is A

Explanation

Inserting the catheter into the artificial airway using sterile technique is part of the procedure but should be preceded by wearing proper PPE to maintain a sterile environment.

Correct Answer is ["B","C","E"]

Explanation

Providing encouragement and support to the client throughout the procedure is crucial for their comfort and cooperation. Suctioning can be uncomfortable, and the client may need reassurance during the process.

Correct Answer is C

Explanation

(Incorrect) Advising the patient to take slow deep breaths to increase oxygen levels may not be sufficient to address the oxygen saturation drop, which requires immediate intervention.

Correct Answer is B

Explanation

(Incorrect) Promising to suction quickly may not address the client's worry and might compromise the effectiveness of the procedure, as thorough suctioning is necessary.

(Incorrect) Assessing the patient's response to suctioning is essential, but ensuring safety and repositioning take precedence immediately after the procedure.

<p>Preoxygenating the patient with 100% oxygen is not a step required before suctioning. Preoxygenation may be necessary before some procedures, but it is not specifically indicated for sterile suctioning.</p>

<p>Increasing the suction pass time is not recommended as it can exacerbate the patient&#39;s condition and lead to complications. The focus should be on stopping suctioning and providing appropriate interventions.</p>

<p>Providing oral or nasal care after suctioning helps maintain the patient&#39;s airway, promote comfort, and prevent infections.</p>

<p>Before performing sterile suctioning on a patient with an endotracheal tube (ETT), the nurse should preoxygenate the patient with 100% oxygen. Suctioning can temporarily decrease oxygen levels in the airway, and preoxygenation helps prevent hypoxia during the procedure.</p>

<p>Suctioning more than three times in a row is not recommended because it can lead to hypoxia and tissue trauma. Frequent suctioning can reduce the oxygen levels in the airway and cause damage to the delicate tissues.<strong> </strong></p>

<p>Dismissing the patient&#39;s anxiety by stating that suctioning is routine may not effectively address the patient&#39;s feelings and may not be comforting.<br /> </p>

<p>The nurse should respond by acknowledging the discomfort and pausing the procedure to reposition the nasopharyngeal tube. Repositioning can help alleviate the discomfort while ensuring the oxygenation needs are still met.</p>

<p>Increasing the suction pressure for one last pass is not necessary and may cause harm to the patient&#39;s airway. Proper suctioning technique involves limiting the suctioning time and pressure to avoid tissue damage and potential complications.</p>

<p>Changing the tracheostomy ties every 24 hours is the appropriate action. Regular changing of the ties helps prevent complications such as skin breakdown, ensures a secure fit of the tracheostomy tube, and reduces the risk of infection.</p>

<p>Limiting the suctioning time to 5 seconds is too short to effectively clear secretions from the airway, especially in patients with excessive or tenacious secretions. Sufficient time is needed to ensure proper removal of respiratory secretions and maintain the patient&#39;s airway patency.</p>

<p>Rinsing the catheter and tubing with saline after each suction pass helps maintain patency and prevent the accumulation of secretions, ensuring effective suctioning during the procedure.</p>
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