Compared to some complicated or invasive patient procedures that you perform, nasotracheal suctioning may not seem like a big deal. However, there are risks involved, and proper technique and patient monitoring are crucial.
Let’s review some of the most common mistakes encountered during nasotracheal suctioning and what you can do to correct them.
Incorrect vacuum pressure applied
It is essential to check the regulator to ensure the correct amount of suction is achieved. If the suction is too low, it won’t be effective, and if it is too high, it can cause tissue damage.
The American Association for Respiratory Care Clinical Practice Guidelines recommend the following for nasotracheal suctioning: suction pressure should be kept below -120 mm Hg in neonatal and pediatric patients and -200 mm Hg in adult patients.
Always be sure to follow your hospital’s protocols for setting your suction to the appropriate pressure.
Suctioning for too long
AARC guidelines also recommend limiting the time that suction is applied to less than 15 seconds. Extending this time frame increases the risk of complications such as injury and hypoxia.
Remember also that suction should only be applied while withdrawing the catheter, not during insertion.
Not using standard precautions
There is potential for exposure to body fluids while suctioning a patient, and standard precautions should always be implemented. This includes proper use of PPE and hand hygiene before and after the procedure. It’s vital to wear N95 with eye protection or PAPR, gloves, and a gown.
Suctioning routinely instead of as needed
While nasotracheal suctioning can be beneficial to improve a patient’s respiratory status, if it is done too frequently, it can cause trauma to the nasal airways, leading to swelling and further obstruction. Therefore, it is best to utilize this procedure when the patient shows signs of distress or inability to clear secretions rather than on a set schedule.
Forcing a catheter into a nare
Sometimes, due to a patient’s anatomy or positioning a catheter won’t easily pass through the nare to the trachea. In this case, DO NOT attempt to force it down – this causes further damage. Remove the catheter, and try repositioning the head or passing the catheter at a different angle. Make sure the catheter is well lubricated. Consider trying the other nare as well.
Inadequately preparing the patient
Nasotracheal suction can be uncomfortable for your patient. Always explain the procedure to your patient first. If appropriate, provide sedation or implement pain relief measures before suctioning. Lubricate the catheter with an approved water soluble product to make insertion easier. Assess your patient for signs of pain during the process.
Failing to recognize complications
In addition to monitoring your patient for comfort while suctioning, you must watch for signs of not tolerating the procedure. This includes bradycardia, decreased oxygen saturation, blood pressure changes, laryngospasm, bronchospasm, and increased intracranial pressure.
If complications are observed, stop suctioning and remove the catheter. Be ready with supplemental oxygen and initiate further interventions as needed.
Proper suctioning is important to maintain a patent airway for patients who cannot mobilize their own secretions. Using good clinical judgment, careful technique, and adhering to your hospital’s policies, you can perform this procedure safely for your patients.
Editor's Note: This blog was originally published in March 2022. It has been re-published with additional up-to-date content.
