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 with suctioning, 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 extremely important to check the regulator to make sure that the correct amount of suction is achieved. If the suction is too low, it won’t be effective, yet 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:
- 60-80 mm Hg for neonates
- 80-100 mm Hg for infants
- 100-120 mm Hg for children
- 100-150 mm Hg for adults.
Always be sure to follow your hospital’s protocols for setting your suction to the appropriate pressure.
Suctioning for too long
Also according to AARC guidelines, the amount of time that suction is applied should be limited to less than 15 seconds. The risk of complications such as injury and hypoxia increases when this time frame is exceeded.
Remember also that suction should only be applied while withdrawing the catheter, not during insertion.
Not using standard precautions
There is a 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. Due to risks from COVID-19, it’s important to wear N95 with eye protection or PAPR, gloves, and a gown.
Suctioning routinely, not as needed
While nasotracheal suctioning can be very beneficial in improving 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 that are present, rather than on a set schedule.
Forcing a catheter into a nare
There are times that due to a patient’s anatomy or positioning that a catheter won’t easily pass through the nare to the trachea. In this case, do NOT attempt to force its way down, causing 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.
Not adequately preparing the patient
Nasotracheal suction can be uncomfortable for your patient. Make certain to always explain the procedure to your patient first. If appropriate, provide sedation or implement pain relief measures prior to suctioning. Make sure to 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 patient 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 such as these are observed, stop suctioning and remove the catheter. Be ready with supplemental oxygen and initiate further interventions as needed.
Proper suctioning is an important step in maintaining a patent airway for patients that cannot mobilize their own secretions. By using good clinical judgement, careful technique, and adhering to your hospital’s policies, you can perform this procedure safely for your patients.