Managing Oral Secretions

Mom holding young child who is having difficulty breathing.
Mom holding young child who is having difficulty breathing.
Suctioning Clears Blocked Airways   

Many medical conditions produce thick secretions that are difficult for weak individuals to clear out of their lungs. These secretions block the airway passages preventing oxygen from entering the bloodstream. What causes this problem? Suctioning may be the only way to remove these secretions at times to allow a person to breathe.  It could be many different factors contributing to the issue.

Overproduction of Phylum

Phylum produced naturally might be thicker than usual due to dehydration or more than usual due to allergy season. The additional amount is more than the individual can manage at one time and becomes overwhelming. It’s like a conveyor belt that goes out of control, and boxes start piling up; so does the “snot.” Before you know it, the person is drowning in phylum that keeps them from breathing the air they need.

Help Needed to Control Excess Phylum

A healthy person may be able to cough it up and out with the help of nebulizer treatments, coughing exercises, or postural drainage.  Someone who is weak or not responding to treatment may need help getting that stuff out of there. If that’s the case, suctioning may be ordered.

Three Suction Techniques Available

There are three ways to suction, depending on what type of access you have to the lungs.

  1. Nasotracheal – You insert the catheter through the nose and down the throat’s back into the lungs.
  2. Endotracheal – The person is using a home ventilator or has a tracheostomy. You insert the catheter through the endotracheal tube in the neck to suction.
  3. Oral-throat– You suction inside the mouth and down the throat but don’t enter the lungs.

How to Do Oral Suctioning

Suctioning at home is not a common practice. However, periodically, patients are sent home with suction equipment after getting a new trach or having many secretions to manage, and their diaphragms are weak.  There are also some medical conditions where excess phlegm production is constant, and keeping the amount under control is challenging. In those cases, suctioning is essential to help oxygen get through the obstacles to the bloodstream for use by the body.

   How to Do Oral Suctioning

Oral suctioning is not a sterile procedure.  You should wash your hands thoroughly and wear gloves to decrease the number of germs you are introducing into the mouth or that you might pick up from their mouth, but otherwise, being germ-free is not a concern. Just keep everything clean.

1  Check your suction machine to make sure it’s working. Setting it at 120-160 mm Hg pressure should be enough.  Less for children and smaller adults.  Check it by putting your finger against the tubing tip to see if you feel the suck when you turn it on. If you don’t, it’s not pulling pressure, and you need to check your setup.

2   If it‘s not working, make sure it’s plugged in, all connections are secure, the tubing isn’t kinked, and all attachments are in the correct “in” and “out” ports. If it still doesn’t work, call the company supplying the equipment to troubleshoot.

Yankauer's suction tips are commonly used to suction oral secretions.
Yankauer’s suction tips are commonly used to suction oral secretions.

Once you know it’s working, attach the Yankauer’s suction tip to the tubing. Have a glass of water sitting by to dip the tip into as a lubricant.

 Tell your family member what you plan to do. If their lips are dry, lubricate them in advance so they don’t crack as you stretch their lips. Also, put a towel under their head to protect the sheets and their clothes from getting wet.

Let them know when you are starting the process. Wet the Yankauer’s tip and slide it into the side of the mouth and down the cheek.  As you encounter drainage, put your finger over the suction port and withdraw the liquid.

6 They only stay in the mouth for a few seconds to watch for their tolerance to the procedure. Remove the Yankauer’s if they seem to need air.

Let them breathe. If they are on oxygen, you may give them extra breathes of oxygen between suction attempts.

8  Don’t repeat more than 2-3 times in a row without letting them rest for a long time to recover. Rinse the tubing out with water before trying again.

Yankauer’s can be reused but needs to be stored in a covered packaging of some type to stay clean between uses.

Reference. Beare, Patricia, G. and Judith L. Myers. (1990) Principles and Practice of Adult Health Nursing. At. Louis. The C.V. Mosby Company. 535.

Resource: YouTube video: Performing Oropharyngeal suctioning

Suctioning Through the Nose

Nasotracheal Suctioning 

Suctioning through the nose is also referred to as “Nasotracheal suctioning.”  It’s a lot like suctioning the mouth, but you’re going just a bit deeper and, therefore, might go into the lung by accident. I recommend using a sterile technique to reduce the risk of introducing new germs that could cause pneumonia for that reason. Mostly, the suction techniques are the same other than one being sterile and the other being clean.  Here are the steps.

Nasotracheal Suctioning Steps
  1. Thoroughly wash your hands.
  2. Check your equipment to make sure the suction works.
  3. Open all sterile packages onto your workspace carefully so that they do not get contaminated.
  4. Squirt a big glob of water-soluble lubricant on the corner of one of the sterile surfaces to run your catheter through just before you start to insert it. Also, sit a cup of room temperature water in a cup next to your workspace.
  5. Sit your family member upright at a 45o-90o
  6. If they use oxygen, make sure they are well oxygenated and have taken some good deep breaths before you get started.
  7. Put your sterile gloves on and open any last sterile packaging. Consider your dominant hand sterile and your non-dominate hand non-sterile.
  8. Run the catheter through the lubricate.
  9. Have the person’s head slightly bent forward and pass the catheter through the nostril as they inhale.
  10. When you either (1) feel a lot of secretions, (2) they start to cough stuff up, or (3) the catheter is approximately five-six inches inside, put your finger on the opening for suction, twist, and pull backward to remove the catheter.
Cleaning a nasotracheal suction catheter between attempts to suction the throat.
Cleaning a nasotracheal suction catheter between attempts to suction the throat.
Next Steps and Additional Pointers
  1. Apply continuous suction for only 10 seconds at a time to decrease possible tissue damage.
  2. Wrap the catheter around your hand as you pull it out each time before reinserting it for another attempt.
  3. Remind the person to take deep breaths to get more oxygen between each attempt.
  4. Rinse out the tubing with the water in the cup between attempts to keep it from clogging.
  5. Re-lubricate the tip each time to decrease trauma to the nose.
  6. Watch their breathing afterward to make sure they didn’t get too tired to try another attempt before moving forward again.

Caution:  Doing this too often can lead to oxygen levels getting too low and cause the nose to bleed. Be gentle and monitor the person’s ability to handle what’s happening to them.

Reference. Woods, Anne D. (2019) Lippincott Nursing Procedures. (8th.Ed.) Philadelphia: Wolthers Kluwer.561-562.

Resource: YouTube Video: Performing Nasotracheal Suctioning