When suctioning, ensure that 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 the patient’s 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. Sputum production is minimal in the healthy state, but certain conditions can increase the amount or change the characteristics of sputum. Sputum collection may be used to diagnose and determine treatment for a respiratory infection.
In many cases, suctioning is indicated to collect sputum from patients unable to spontaneously produce a sputum sample for laboratory analysis. Although suctioning is a necessary procedure and generally well tolerated with minor discomfort, there may be complications associated with sputum collection with suctioning. Suctioning may provoke violent coughing that may lead to vomiting or spasms of the pharyngeal, laryngeal, and bronchial muscles.undefined#ref4">4 In addition, suctioning may cause hypoxemia or vagal overload, causing cardiopulmonary compromise and increases in intracranial pressure.1
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 requires that the patient be removed from the ventilator and the closed method (Figure 2), which uses a sterile, sleeved inline closed suction catheter that does not require disconnection from the ventilator. 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 identifies specific microorganisms that cause the respiratory infection and helps to determine the most effective antibiotic treatment.2
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.4
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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