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Oral Suction Training

Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

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Page 1: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Oral Suction Training

Page 2: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Section one

What is oral suction?

When is oral suction indicated?

Contraindications to oral suction

Adverse effects of suction

Anatomy and physiology of the upper airway

Page 3: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

What is oral suction

‘Airway suctioning removes excess secretions from the respiratory tract by the insertion of a suction catheter and the application of a negative pressure’ (Anderson, 2006).

Page 4: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Indications for oral suction

Audible secretions from the mouth with the inability to cough and clear independently AspirationReduced oxygen saturationsIncreased airway pressure when ventilated could be due to airway occlusion by secretions (Webb et al., 1999)

Sputum retention due to impaired mucociliary action (Anderson, 2006)

Page 5: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Contraindications

Cardiovascular instabilityOrofacial surgery/trauma

Upper oesophageal/trachea surgerySevere coagulation defects

Page 6: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Adverse effects of suctionMost common with oral suction:1. Bronchospasm - Introduction of infection2. Anxiety to patient - GaggingOther affects to be considered

Mucosal trauma (e.g. haemorrhage, ulceration)·         Pneumothorax·         Atelectasis, especially in infants·         Arrhythmias } these can·         Bradycardias } lead to a·         Vasovagal stimulation } cardiac arrest·         Hypoxaemia/hypoxia·         Respiratory arrest·         Pulmonary haemorrhage·         Disturbace/breakdown of anastomosis·         Raised intracranial pressure Hyper/hypotension Interruption of mechanical ventilationYoung 1984, Carroll 1988, Young 1988, Salyer 1990, Noll et al 1990, Ashurst 1992, Fiorentini 1992, AARC Clinical Practice Guidelines 1993, Odell et al 1993, Copnell &

Fergusson 1995, Glass & Grap 1995, Macmillan 1995, Blackwood 1998

Page 7: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Anatomy and physiology

http://www.ambulancetechnicianstudy.co.uk/images/RESPIR.gif

Page 8: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Anatomy and physiology continued…..

Secretions are carried by the action of cilia, which are small hairs which line the upper and lower respiratory tractThe mucus and debris move with the cilia in an upwards direction where they are usually swallowed or expectoratedThe action of the ‘mucociliary escalator’ provides an effective defence mechanism for the respiratory tract

http://www.hhmi.org/images/bulletin/sept2005/cilia_detail.jpg

Page 9: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Section two

Page 10: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Checks required before suctioning

Collect all appropriate equipment-Sterile suction catheters – Correct size- Functioning suction unit- Sterile Gloves (optional)- Apron, disposable bag- Oral airway (as necessary)- Water to flush suction tubing

Goggles/ face visors for eye/ face protection should be worn where there is a risk of blood, body fluids, secretions and excretions splashing into the face and eyes- (Department of Health 2001) As of August 2005, following a critical incident, it is now mandatory that goggles be worn for all types of suction (open, closed, tracheostomy, NP or OP airway) and also when performing Manual hyperinflation.

Page 11: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Safety checks-All equipment is working in accordance

with the manufacturers guidelines-In-date electrical sticker- No loose wires- Tubing is in tact and attached correctly

Assess patient- Respiratory rate (12-14 breaths per min)- Difficulties in breathing I.e. increased

WOB- Audible secretions- Facial colour- Cyanosis

Page 12: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Oral Suction Application1. Communicate with the patient – Gain consent2. Organise equipment3. Wash hands4. Position the patient5. Don gloves ensuring one sterile glove, this must not

come into contact with anything barr the suction catheter

6. Remove the catheter from the sterile sleeve and introduce it slowly into the oral cavity

7. Pass to the back of the mouth to stimulate a cough or yield visible secretions from the front of the oral cavity

8. On withdrawing the catheter, gently apply suction by placing your finger over the suction port control

9. Wrap catheter around glove and then pull back the glove over the soiled catheter

10. Flush suction tubing with water11. Assess patient12. Wash hands13. Repeat as required14. Document in notes

Page 13: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Suction pressures

• 60 – 100 mmHg (8 – 13.3 kPa) in children/neonates (Brookes 1999)

• 90 - 115 mmHg (12 - 15.3kPa) in adults (Salyer 1990)

 

Page 14: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Areas to monitor post suction Recheck the areas that you observed pre

suction application- Respiratory rate (12-14 breaths per min)- Difficulties in breathing I.e. increased

WOB- Audible secretions- Facial colour- Cyanosis

It is recommended that suction be performed on an ‘as needed’ basis after thorough assessment and not routinely

Page 15: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Disposal/Cleaning of EquipmentAs per protocol

Documentation

Reporting Faulty Equipment

Page 16: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Section three

PRACTICAL!Now it’s your turn……..

Page 17: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

Section four

Competences

Certificate of achievement

Page 18: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

References/Useful information• Anderson, J (2006) Physiotherapy Service – Clinical guidelines: Airway Suctioning.

Hull and East Yorkshire Hospitals• AARC. Endotracheal Suctioning Of Mechanically Ventilated Adults And Children

With Artificial Airways. AARC Clinical Practice Guideline. Respiratory Care 1993; Vol 38, (4), Pp 500 – 504.

• Ashurst S. Suction Therapy In The Critically Ill Patient. British Journal Of Nursing 1992; Vol 1, (10), Pp 485 – 489.

• Blackwood B. The Practice And Perception Of Intensive Care Staff Using The Closed Suctioning System. Journal Of Advanced Nursing 1998; Vol 28, (5), Pp1020 – 1029.

• Brooks D, Solway S, Graham I, Downes L And Carter M. A Survey Of Suctioning Practices Among Physical Therapists, Respiratory Therapists And Nurses. Canadian Respiratory Journal, November/ December 1999; Vol. 6, (6), Pp513 – 520.

• Carroll P.F. Lowering The Risks Of Endotracheal Suctioning. Nursing 1988; Vol 88, No 5 Pp46 - 50

• Copnell B And Fergusson D. Endotracheal Suctioning: Time Worn Ritual Or Timely Intervention? American Journal Of Critical Care 1995. Vol 4, (2), Pp100 – 105.

• Department Of Health. Standard Principles For Preventing Hospital Acquired Infections. Journal Of Hospital Infection 2001; 47 (Supplement): S21 – S37.

• Fiorentini A. Potential Hazards Of Tracheobronchial Suctioning. Intensive and Critical Care Nursing 1992, No 8. Pp217 – 226

• Glass C.A And Grap M.J. Ten Tips For Safer Suctioning. American Journal Of Nursing 1995; No. 5, Pp51 – 53.

Page 19: Oral Suction Training. Section one What is oral suction? When is oral suction indicated? Contraindications to oral suction Adverse effects of suction

• Hough, A• Macmillan C. Nasopharyngeal Suction Study Reveals Knowledge

Deficit. Nursing Times 1995; Vol 91, (50), Pp28 – 30. • Noll M.L, Hix C.D and Scott G. Closed Tracheal Suction Systems:

Effectiveness And Nursing Implications. AACN - Clinical Issues In Critical Care Nursing 1990; Vol 1, Pp 318 - 328

• Odell A, Allder A, Bayne R, Everett C, Scott S, Still B And West S. Endotracheal Suction For Adult, Non-Head Injured Patients. A Review Of The Literature. Intensive And Critical Care Nursing 1993; No 9, Pp274 – 278

• Salyer. Paediatric Intensive Care. 3rd Edition 1990; Mosby St Louis U. .A, Pp 972 – 977

• Tuton, F (2005) Knowledge and Skills Guidelines on: Performing Oral Suction. Northamptonshire Healthcare Trust

• www.laerdal.com• Young C.S. A Review Of The Adverse Effects Of Airway Suction.

Physiotherapy 1984; Vol 70, (3), Pp104 - 106 • Young C. S. Airway Suctioning; A Study Of Paediatric Physiotherapy

Practice. Physiotherapy 1988; Vol 74, Pp13 – 15