Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
Bronchospasm or laryngospasm, as a result of suctioning, can be severe and prolonged, and, in some cases, can be life-threatening without intervention.
Sputum is produced by cells that line the respiratory tract. Although production is minimal in the healthy patient, disease processes can increase the amount or change the character of sputum. Examination of sputum aids in the diagnosis and treatment of many conditions such as bronchitis, bronchiectasis, tuberculosis (TB), pneumonia and pulmonary abscess, or lung cancer.undefined#ref3">3
In many cases, suctioning is indicated to collect sputum from a patient who cannot spontaneously produce a sample for laboratory analysis. Suctioning may provoke violent coughing, induce vomiting, and result in aspiration of stomach contents. Suctioning may also induce constriction of the pharyngeal, laryngeal, and bronchial muscles. In addition, suctioning may cause hypoxia or vagal overload, causing cardiopulmonary compromise and an increase in intracranial pressure.
Sputum for cytology, culture and sensitivity, and acid-fast bacilli (AFB) are three major types of sputum specimens.3 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 which antibiotics are the most sensitive. The AFB smear is used to support a diagnosis of TB. A definitive diagnosis of TB also requires a sputum culture and sensitivity.3
Regardless of which sputum test is ordered; a sputum specimen should be collected first thing in the morning due to a greater accumulation of bronchial secretions overnight.
Rationale: Suctioning or coughing up secretions can trigger the gag reflex. If a patient has recently eaten, this may also trigger vomiting.
Rationale: The high Fowler or semi-Fowler position promotes full lung expansion and facilitates the ability to cough.
Rationale: Touching the inside of the sterile container may compromise the laboratory test results.
Rationale: Expectorant must come from the lungs. Saliva is not sputum.3
Ensure that the container is tightly closed before wiping to prevent contaminating the specimen.
Rationale: Connecting the suction tubing to the sputum trap establishes suction that passes through the sputum trap to aspirate a specimen.
Rationale: The tracheobronchial tree is a sterile body cavity. Sterile gloves allow for manipulating the sterile suction catheter without contaminating it.
Sterile gloves or eye protection is not required if a sleeved suction catheter is used.
Rationale: Connecting the sterile suction catheter or the sleeved suction catheter to the rubber tubing on the sputum trap allows aspirated sputum to go directly to the trap instead of to the suction tubing.
Rationale: Inserting the tip of the suction catheter without applying suction minimizes hypoxia and trauma to the airway as the catheter is inserted.
Rationale: Entering the larynx and trachea triggers the cough reflex.
Limit the duration of each suction pass to less than 15 seconds and limit the number of passes to a maximum of three to help minimize hypoxia, airway trauma, and cardiac arrhythmias.4
If the patient becomes hypoxic during the procedure, discontinue the procedure immediately and provide supplemental oxygen.
Rationale: Suction can damage mucosa if applied during withdrawal.
Ensure that the sputum trap is tightly sealed before wiping to prevent contaminating the specimen.
Rationale: Excessive coughing or prolonged suctioning can alter the patient’s respiratory pattern and cause hypoxia.
Rationale: The procedure can be uncomfortable. Anxiety may develop if the patient becomes short of breath.
Rationale: Abnormal sputum characteristics may indicate disease entities.
Report unusual sputum characteristics or changes in the characteristics of the sputum to the practitioner.
Rationale: An AFB culture indicates whether abnormal cells or microorganisms are in sputum.
Adapted from Perry, A.G. and others (Eds.). (2022). Clinical nursing skills & techniques (10th ed.). St. Louis: Elsevier.
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