Skill 73

Suctioning

Nasopharyngeal, Nasotracheal, and Artificial Airway

Oropharyngeal suctioning removes secretions only from the back of the throat. Tracheal airway suctioning extends into the lower airway to remove respiratory secretions and maintain optimum ventilation and oxygenation in patients who are unable to independently remove these secretions. When a patient’s oxygen saturation measurement falls below 90%, it is a good indicator of the need for suctioning. Assess patients to determine frequency and depth of suctioning. Some patients require suctioning every 1 or 2 hours, whereas others need it only once or twice a day (AARC, 2004).

Delegation Considerations

The skills of nasotracheal suction and suctioning a new artificial airway tube cannot be delegated to nursing assistive personnel (NAP). When the patient has an established tracheostomy and is stable, you can delegate suctioning. The nurse directs the NAP about:

▪ Any unique modifications of the skill, such as the need for supplemental oxygen or the use of a clean-versus-sterile suction technique.

▪ Appropriate suction limits for suctioning tracheostomy tubes (TTs) and risks of applying excessive or inadequate suction pressure.

▪ Signs and symptoms of hypoxemia, such as a change in the patient’s respiratory status, confusion, and restlessness, and to report these signs immediately to the nurse.

▪ Reporting any change in secretion quality, quantity, and color.