The Memorial Souad Kafafi Medical Center Skills Competency Checklist

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Antonia Neal
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1 The Memorial Souad Kafafi Medical Center Skills Competency Checklist Title: Nasotracheal Suctioning Critical Elements 1. Position the patient in semi-fowler s position with his head hyperextended, unless contraindicated. 2. Place the linen-saver pad or towel on the patient s chest. 3. Put on a face shield or goggles. 4. Turn on the wall suction or portable suction machine and adjust the pressure regulator according to agency policy (typically mm Hg for adults, mm Hg for children, and mm Hg for infants). 5. Test the suction equipment by occluding the connection tubing Open the suction catheter kit or the gathered equipment if a kit isn t available. Open the water-soluble lubricant. Don sterile gloves (alternatively, put a sterile glove on the dominant hand and a clean procedure glove on the nondominant hand); consider the dominant hand sterile and the non-dominant hand non sterile. Pour sterile saline into the sterile container using the no dominant hand. Pick up the suction catheter with the dominant hand and attach it to the connection tubing, maintaining sterility of the hand and the catheter. Put the tip of the suction catheter into the sterile container of normal saline solution and suction a small amount of normal saline solution through the suction catheter. Apply suction by placing a finger over the suction control port of the suction catheter. Using the no dominant hand, remove the oxygen delivery device, if present. Has the patient take several slow deep breaths. If the patient s oxygen saturation is < 94%, or if he is in any distress, you may need to give supplemental oxygen before, during, and after suctioning. See Procedure Checklist Chapter 35: Administering Oxygen by Cannula, Face Mask, or Face Tent. Approximate the depth to insert the suction catheter (measure the distance between the tip of the nose to the tip of the ear lobe and down to the bottom of the neck [for adults about 20 cm]); be careful not to contaminate the catheter while measuring. MET NOT MET

2 14. Lubricate the suction catheter tip with water-soluble lubricant Using the dominant hand, gently but quickly insert the suction catheter into the naris and down into the pharynx. Advance the suction catheter with inspiration to the predetermined distance, being careful not to force the catheter. Place a finger (thumb) over the suction control port of the catheter. Apply suction while withdrawing the catheter, using a continuous rotating motion. 18. Apply suction for no longer than 10 seconds After the catheter is withdrawn, clear it by placing the tip of the catheter into the container of sterile saline and applying suction. Lubricate the catheter and repeat suctioning as needed, allowing intervals of at least 30 seconds between suctioning. Reapply oxygen between suctioning efforts, if required. 21. Replace the oxygen source. Coil the suction catheter in the dominant hand (alternatively, wrap it around the dominant hand). Hold the catheter while 22. pulling the sterile glove off over it. Discards the glove containing the catheter in a water- resistant receptacle (e.g., bag) designated by the agency. 23. Using the no dominant hand, clear the connecting tubing of secretions by placing the tip into the container of sterile saline. Dispose of equipment and makes sure new suction supplies are 24. readily available for future suctioning. 25. Provide mouth care. Comments: Validated by: Date Validated: Employee Name: Education Department Clinical Instructor / Ms. Marwa Hassan

3 The Memorial Souad Kafafi Medical Center Skills Competency Checklist Title: Oropharyngeal and Nasopharyngeal Suctioning Critical Elements MET NOT MET 1. Positions the patient: a. For oropharyngeal suctioning: Semi-Fowler s position with his head turned toward the nurse. b. Nasopharyngeal suctioning: Semi-Fowler s position with his head hyperextended (unless contraindicated). 2. Place the linen-saver pad or towel on the patient s chest. 3. Put on a face shield or goggles. 4. Turn on the wall suction or portable suction machine and adjust the pressure regulator according to policy (usually 100 to 120 mm Hg for adults, 95 to 110 mm Hg for children, and 50 to 95 mm Hg for infants). 5. Test the suction equipment by occluding the connection tubing Open the suction catheter kit or the gathered equipment if a kit is not available If using the nasal approach, open the watersoluble lubricant. Don sterile gloves; keep the dominant hand sterile; consider non- dominant hand non sterile. Pour sterile saline into the sterile container, using the nondominant hand. Pick up the suction catheter with the dominant hand and attach it to the connection tubing (to suction). Put the tip of the suction catheter into the sterile container of normal saline solution and suction a small amount of normal saline solution through the suction catheter. Apply suction by placing a finger over the suction control port. Approximate the depth to which to insert the suction catheter: a. Oropharyngeal suctioning: Measure the distance between the edge of the patient s mouth and the tip of the patient s ear lobe. b. Nasopharyngeal suctioning: Measure the distance between the tip of the patient s nose and the tip of the patient s ear lobe. Using the non-dominant hand, remove the oxygen delivery device, if present. Have the patient take several slow deep breaths. If the patient s oxygen saturation is < 94%, or if he is in any distress, administer supplemental oxygen before, during, and after suctioning. See Procedure Checklist Chapter 35: Administering Oxygen by Cannula, Face Mask, or Face Tent..

4 Lubricate and insert the suction catheter: a. Oropharyngeal suctioning 1) Lubricate the catheter tip with normal saline. 2) Using the dominant hand, gently but quickly insert the suction catheter along the side of the patient s mouth into the Oropharynx. 3) Advance the suction catheter quickly to the premeasured distance (usually 7 to 10 cm in the adult), being careful not to force the catheter. b. Nasopharyngeal suctioning 1) Lubricate the catheter tip with the water-soluble lubricant. 2) Using the dominant hand, gently but quickly insert the suction catheter into the naris. 3) Advance the suction catheter quickly to the premeasured distance (13 to 15 cm in the adult), being careful not to force the catheter. 4) If resistance is met, try using the other naris. Place a finger (thumb) over the suction control port of the suction catheter and start suctioning the patient. Apply suction while withdrawing the catheter in a continuous rotating motion. 15. Limit suctioning to 5-10 seconds. After the catheter is withdrawn, clear it by placing the tip of the 16. catheter into the container of sterile saline and applying suction. Lubricate the catheter and repeats suctioning as needed, allowing at least 20-second intervals between suctioning. For 17. nasopharyngeal suctioning, alternate nares each time suction is repeated. Coil the suction catheter in the dominant hand. Pull the sterile glove off over the coiled catheter. (Alternatively, wrap the 18. catheter around the dominant gloved hand and hold the catheter while removing the glove over it.) Comments: Validated by: Date Validated: Employee Name: Education Department Clinical Instructor / Ms. Marwa Hassan

5 The Memorial Souad Kafafi Medical Center Skills Competency Checklist Title: Orotracheal Suctioning Critical Elements MET NOT MET 1. Position the patient in semi-fowler s position with his head turned facing the nurse. 2. Place the linen-saver pad or towel on the patient s chest. 3. Put on a face shield or goggles. 4. Turn on the wall suction or portable suction machine and adjust the pressure regulator according to agency policy (typically mm Hg for adults, mm Hg for children, and mm Hg for infants). 5. Test the suction equipment by occluding the connection tubing Open the suction catheter kit or the gathered equipment if a kit isn t available. Don sterile gloves (alternatively, put a sterile glove on the dominant hand and a clean procedure glove on the nondominant hand); consider the dominant hand sterile and the non-dominant hand non sterile. Pour sterile saline into the sterile container using the nondominant hand. Pick up the suction catheter with the dominant hand and attach it to the connection tubing, maintaining sterility of the hand and the catheter. Put the tip of the suction catheter into the sterile container of normal saline solution and suction a small amount of normal saline solution through the suction catheter. Apply suction by placing a finger over the suction control port of the suction catheter. Using the no dominant hand, remove the oxygen delivery device, if present. Have the patient take several slow deep breaths. If the patient s oxygen saturation is < 94%, or if he is in any distress, you may need to give supplemental oxygen before, during and after suctioning. See Procedure Checklist Chapter 35: Administering Oxygen by Cannula, Face Mask, or Face Tent. Approximate the depth to insert the suction catheter (measure distance between the edge of the mouth to the tip of the earlobe and down to the bottom of the neck [for adults about 15 cm]); be careful not to contaminate the catheter while measuring. 14. Lubricate the suction catheter tip with normal saline.

6 15. Comments: Using the dominant hand, gently but quickly insert the suction catheter along the side of the patient s mouth into the oropharynx. Advance the suction catheter with inspiration to the predetermined distance, being careful not to force the catheter. Place a finger (thumb) over the suction control port of the catheter. Apply suction while withdrawing the catheter, using a continuous rotating motion. Apply suction for no longer than 10 seconds After the catheter is withdrawn, clear it by placing the tip of the catheter into the container of sterile saline and applying suction. Lubricate the catheter and repeat suctioning as needed, allowing intervals of at least 30 seconds between suctioning. Reapply oxygen between suctioning efforts, if required. Replace the oxygen source. Coil the suction catheter in the dominant hand (alternatively, wrap it around the dominant hand). Hold the catheter while pulling the sterile glove off over it. Discard the glove containing the catheter in a water resistant receptacle (e.g., bag) designated by the agency. Using the non-dominant hand, clear the connecting tubing of secretions by placing the tip into the container of sterile saline. Dispose of equipment and make sure new suction supplies are readily available for future suctioning. Provide mouth care. Validated by: Date Validated: Employee Name: Education Department Clinical Instructor / Ms. Marwa Hassan

Complex Care Hub: Oral and Nasal Suctioning

Complex Care Hub: Oral and Nasal Suctioning Table of Contents Complex Care Hub Manual: Oral and Nasal Suctioning... 1 1. What is suctioning and why do we do it?... 2 2. When to suction a child... 2 3.