If the patient develops respiratory distress during the suctioning procedure, immediately withdraw the catheter and supply additional oxygen and ventilatory breaths as needed.
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. A sputum specimen collection may be necessary for laboratory testing. Sputum specimen collection should be performed using proper sterile technique so that the sputum specimen is uncontaminated.
The most common reason to obtain a sputum specimen is for a 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.undefined#ref5">5
A sputum specimen should be obtained from the lower airways. Suction should be performed through the nose (nasotracheal suctioning) if the patient does not have an artificial airway. Use of a nasopharyngeal airway should be considered to reduce mucosal trauma and lessen the risk of cross contamination from the nasal passage. If an artificial airway is already present, suction should be performed through the existing artificial airway (endotracheal or tracheostomy tube suctioning).
The two techniques used for suctioning include the open suction method (Figure 1), which uses a single-use open catheter primarily on patients who do not have an artificial airway, and the closed suction method (Figure 2), which uses a sterile sleeved closed catheter (or inline suction) for patients with an artificial airway, who may also be on a mechanical ventilator. The closed suction method (or inline suction) is preferable for patients who are being mechanically ventilated because it does not require the mechanical ventilator to be disconnected. Disconnecting the mechanical ventilator may lead to lung derecruitment and hypoxemia and risk of cross-contamination.1
Generally, suctioning is well tolerated with minor discomfort and adverse reactions; however, there are risks associated with suctioning. The most serious risks are related to hypoxemia. Hypoxemia and vagal nerve stimulation of the airway can result in cardiac arrhythmias, laryngeal spasm, bradycardia, and hypotension.4 Other risks include trauma and bleeding caused by the suction catheter.
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Keep the soft-rubber tubing on the specimen trap protected in the packaging to prevent cross contamination.
If using the 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.2,4
If the patient shows signs of becoming hypoxemic during the procedure, discontinue the procedure immediately and provide oxygen as ordered.
*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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