Hyperoxygenate the patient and closely monitor the patient’s vital signs before and after the sputum collection suctioning procedure.
Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
Sputum is produced by cells lining the respiratory tract. It is normal for healthy lungs to produce sputum, but certain conditions can change the characteristics of sputum or increase the amount of sputum produced. Sputum collection may be used to diagnose and determine treatment for a respiratory infection.
Suctioning may be needed to collect sputum from patients unable to spontaneously produce a sputum sample for laboratory analysis. Although suctioning may be a necessary procedure, it may provoke violent coughing or gagging, which may lead to vomiting or laryngeal or bronchial spasms.undefined#ref3">3 In addition, there may be other adverse responses such as hypoxemia, cardiac dysrhythmias due to vagal nerve stimulation, mucosal trauma, and increased intracranial pressure.1,3 Generally, suctioning is well tolerated with minor discomfort and adverse reactions.
The oropharynx can be suctioned using a rigid tonsil tip suction catheter or Yankauer suction catheter before sputum collection from the lower airways. The lower airways may be suctioned through the nose (nasotracheal suctioning) or through an artificial airway (endotracheal or tracheostomy tube suctioning). The two techniques used for artificial airway suctioning for sputum collection include the open method (Figure 1), which uses a single-use open catheter primarily on patients who do not require mechanical ventilation, and the closed method (Figure 2), which uses a sterile sleeved closed suction catheter that does not require disconnection from the ventilator. For patients who require mechanical ventilation, the closed method using the sleeved closed suction catheter is preferred to reduce the incidence of hypoxemia and lung derecruitment, which may occur when the patient is disconnected from the ventilator.3 Sputum collection should be performed using proper sterile technique so that the sputum specimen is fresh and uncontaminated.
Sputum specimens may be collected for many reasons but the most common are microscopic examination using a direct smear and culture and sensitivity. The direct smear uses a staining method that helps determine the type or shape of microorganism in the specimen. The culture and sensitivity test identifies specific microorganisms that cause the respiratory infection and helps to determine the most effective antibiotic treatment.4
Rationale: High Fowler or semi-Fowler positioning promotes full lung expansion and facilitates the patient’s ability to cough.
If the patient has a surgical incision or localized area of discomfort, instruct the patient to either place the hands firmly over the affected area or to place a pillow over the area.
Rationale: Splinting the painful area minimizes muscular stretching and discomfort during coughing, which makes coughing more productive.
If using the sleeved suction catheter or closed suction method (Figure 2), ensure that the sleeved suction catheter is new and uncontaminated.
Rationale: Inserting the catheter without applying suction minimizes hypoxemia and trauma to the airway as the catheter is inserted.
Rationale: Entrance of the catheter into the larynx and trachea usually triggers the cough reflex.
Suctioning longer than 15 seconds can cause hypoxia and mucosal damage.3
If the patient shows signs of becoming hypoxemic during the procedure, discontinue the procedure immediately and provide oxygen as ordered.
Rationale: Excessive coughing or prolonged suctioning can alter the patient’s respiratory pattern and cause hypoxia.
Rationale: The procedure can be uncomfortable. If the patient becomes short of breath, anxiety may develop.
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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