Fundamentals of Nursing Q 295
Which action by the nurse represents proper nasopharyngeal/nasotracheal suctioning technique?
A. Lubricate the suction catheter with petroleum jelly before and between insertion.
B. Apply suction intermittently while inserting the suction catheter.
C. Rotate the catheter while applying suction.
D. Hyper oxygenate with 100% oxygen for 30 minutes before and after suctioning.
Correct Answer: C. Rotate the catheter while applying suction.
Rotating the catheter prevents pulling of tissue into the opening on the catheter tip and the side. Suction is used to clear retained or excessive lower respiratory tract secretions in patients who are unable to do so effectively for themselves. This could be due to the presence of an artificial airway, such as an endotracheal or tracheostomy tube, or in patients who have a poor cough due to an array of reasons such as excessive sedation or neurological involvement.
Option A: Suction catheters may only be lubricated with water or water-soluble lubricant and petroleum jelly such as Vaseline has an oil base. Lubricate the outside of the airway with a water-soluble/aqueous gel (e.g. KY Jelly). Initially, choose the larger nostril that is clear from other tubes (e.g. nasogastric tube). Insert the tip of the NPA into the nostril, then slightly lift the nares up and direct the airway to follow a path along the floor of the nose, parallel to the hard palate.
Option B: No suction should ever be applied while the catheters are being inserted because this can traumatize tissues. Apply a gentle partial rotation to the NPA if resistance is felt during insertion e.g. from opposition against the turbinates. If this does not relieve the resistance/obstruction then withdraw the airway and try the other nostril before selecting a smaller size.
Option D: The client should be hyper-oxygenated for only a few minutes before and after suctioning and this is generally limited to clients who are intubated or have a tracheostomy. Hyper-oxygenate the patient if able (increase mask flow rate or FiO2) delivery of 100% oxygen for > 30 secs prior to the suction event.