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When suctioning, ensure the patient understands the importance of relaxing and breathing at a normal rate during the procedure.
Oxygenate the patient before and after the procedure, and closely monitor his or her oxygenation status and heart rate.
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. Although production is minimal in the healthy state, disease states can increase the amount or change the character of sputum. Examining sputum helps diagnose and treat several conditions ranging from simple bronchitis to lung cancer.
In many cases, suctioning is indicated to collect sputum from patients unable to spontaneously produce a sample for laboratory analysis. Sometimes suctioning provokes violent coughing, causes vomiting and aspiration of stomach contents, and induces constriction of pharyngeal, laryngeal, and bronchial muscles. In addition, suctioning may cause hypoxemia or vagal overload, causing cardiopulmonary compromise and increases in intracranial pressure.2
The oropharynx can be suctioned using a rigid tonsil tip suction catheter or Yankauer suction catheter. The lower airway can be suctioned through the nose (nasotracheal suctioning) or through an artificial airway (endotracheal or tracheostomy tube suctioning). The two techniques used for endotracheal suctioning are the open method, which requires that the patient be removed from the ventilator, and the closed method, which uses a sterile, closed inline suction catheter.
Sputum specimens are collected for three major reasons: cytologic examination, culture and sensitivity testing, and acid-fast bacilli (AFB) smear testing. Cytologic or cellular examination of sputum may identify aberrant cells or cancer. Sputum collected for culture and sensitivity testing can be used to identify specific microorganisms and determine the most appropriate antibiotics. An AFB smear is used to support the diagnosis of tuberculosis.
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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 him or her either to place his or her 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.
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 triggers the cough reflex.
Suctioning longer than 15 seconds can cause hypoxia and mucosal damage.1
If the patient shows signs of becoming hypoxemic during the procedure, discontinue the procedure immediately and provide oxygen as ordered.
Rationale: Suction can damage mucosa if applied during withdrawal.
Rationale: Placing the specimen in a separate bag protects the label from being damaged.
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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