Download Adult Nasal and Oropharyngeal Suction

Title of Guideline (must include the word “Guideline” (not protocol,
policy, procedure etc.)
Author: Contact Name and Job Title
Guideline for Adult Nasal and Oropharyngeal
Suction
Eleanor Douglas, Lecturer/Practitioner
Physiotherapist &
Directorate & Speciality
Diagnostics and Clinical Support
Physiotherapy
Date of submission
Explicit definition of patient group to which it applies (e.g. inclusion
and exclusion criteria, diagnosis)
Version
If this version supersedes another clinical guideline please be
explicit about which guideline it replaces including version number.
Statement of the evidence base of the guideline – has the
guideline been peer reviewed by colleagues?
Evidence base: (1-6)
1
NICE Guidance, Royal College Guideline, SIGN
(please state which source).
2a
meta-analysis of randomised controlled trials
2b
at least one randomised controlled trial
3a
at least one well-designed controlled study without
randomisation
3b
at least one other type of well-designed quasiexperimental study
4
well –designed non-experimental descriptive
studies (i.e. comparative / correlation and case
studies)
5
expert committee reports or opinions and / or
clinical experiences of respected authorities
6
recommended best practise based on the clinical
experience of the guideline developer
Consultation Process
Ratified by:
Date:
Target audience
March 2015
These guidelines are only intended to cover the
use of orotracheal and nasotracheal suction in
the patient without an endotracheal or
tracheostomy tube.
Nasotracheal and orotracheal suction should
only be performed by staff who, have been
trained and deemed competent as per local
guideline with relevant training and education
being included in an in-service training
programme
3
Guideline for Adult Nasal and Oropharyngeal
Suction Fiona Moffatt, Critical Care Outreach
Team Physiotherapist, NUH Queens Campus
and Cheryl Crocker, Consultant Nurse Critical
Care (original authors)
1, 5 and 6
Nursing Practice Guidelines Group, Ward
Sisters/Charge Nurses, Nursing Development,
Practice Development Matrons (PDMs), Clinical
Leads, Matrons. Respiratory Physiotherapists,
CCOT, Clinical Quality, Risk and Safety
Manager, Trust Intranet
Matrons’ Forum
March 2015
All registered Nurses and Allied health
Professionals
Review Date: (to be applied by the Integrated Governance Team)
A review date of 5 years will be applied by the Trust. Directorates
can choose to apply a shorter review date; however this must be
managed through Directorate Governance processes.
This guideline has been registered with the trust. However, clinical
guidelines are guidelines only. The interpretation and application of
clinical guidelines will remain the responsibility of the individual
Nasal Ifand
Suction
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2020 Final
clinician.
in Oral
doubt
contact
a senior
or expert.
Caution is
advised when using guidelines after the review date
1
Contents
Introduction ..................................................................................................... 3
Description ................................................................................................... 3
Abbreviations ............................................................................................... 4
Indications ....................................................................................................... 4
Contraindications ............................................................................................ 5
Orotracheal suction ...................................................................................... 5
Relative Contraindications (Seek Medical Advice Prior To Insertion) ........... 5
Hazards ....................................................................................................... 5
Equipment List ................................................................................................ 6
Actions of Care ............................................................................................... 7
Further Reading & References ...................................................................... 14
Audit Points ................................................................................................... 16
Appendix 1 .................................................................................................... 17
Appendix 2 .................................................................................................... 18
Appendix 3 - Checklist for the Review and Approval of Procedural Documents
(to be used by authors and at the Matron’s Forum) ....................................... 19
Nasal and Oral Suction March 2015 Review March 2020 Final
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NOTTINGHAM UNIVERSITY HOSPITALS
NURSING PRACTICE GUIDELINES
NASAL AND OROPHARYNGEAL SUCTION
Introduction
Description
Oropharangeal and nasopharangeal suction is a technique intended to
stimulate a cough to remove excess secretions and / or aspirate secretions
from the airways which cannot be removed by the patient’s spontaneous
effort. A cough can be stimulated by the catheter in the pharynx
(oropharangeal suction) or it may be necessary to pass the catheter between
the vocal cords and into the trachea to stimulate a cough (nasopharangeal
suction). The trachea is accessed by insertion of a suction catheter either via
nasal passage and pharynx (nasotracheal suction) or via the oral cavity and
pharynx (orotracheal suction) using an airway adjunct. Nasotracheal suction
may be undertaken directly via the nostril without an airway adjunct.
However, in some situations, repeated suction is anticipated and therefore a
nasopharyngeal airway should be utilised. Secretions are removed by the
application of sub-atmospheric pressure via wall mounted suction apparatus
or portable suction unit.
N.B. These guidelines are only intended to cover the use of orotracheal and
nasotracheal suction in the patient without an endotracheal or tracheostomy
tube.
At all times, staff must adhere to their codes of professional conduct
(Nursing Midwifery Council 2008, Chartered Society of Physiotherapy
2002).
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Best Practice
Nasotracheal and orotracheal suction should only be undertaken when
other less invasive techniques have proved unsuccessful, and where the
secretions are causing physiological deterioration and / or distress
(Pedersen et al., 2008) Indications that the patients may need suctioning
include audible secretions in upper airway or noisy crackles, on
auscultation, palpable secretions, ineffective or weak coughing,
desaturation despite increased oxygen requirements or raised respiratory
rate.
Nasotracheal and orotracheal suction should only be performed by staff
who, have been trained and deemed competent as per local policy with
relevant training and education being included in an in-service training
programme. In addition, opportunities should be offered locally to
competent practitioners at all levels wishing to maintain their skills in
tracheal suction.
Abbreviations
mmHg
kPa
Sp02
Fi02
TB
ICP
ABGs
NPA
millimetres of mercury
Kilopascals
Oxygen saturation
Fraction of inspired oxygen
Tuberculosis
Intracranial pressure
Arterial blood gas
Nasopharangeal airway
Indications
Airway suction is indicated to maintain a patent airway and remove excess
secretions or aspirate from the trachea, when:
1. The patient is unable to clear the airway spontaneously
2. The secretions / aspirate are of detriment to the patient e.g. hypoxaemia
3. All other methods to remove secretions / aspirate have failed (such as
positioning, physiotherapy techniques, cough assist methods &
nebulisers).
Best Practice
Tracheal suction is an invasive, blind, high-risk procedure with uncertain outcome,
and therefore should only be undertaken when a clear indication has been
identified via assessment. Nurses should work closely with the physiotherapy team
when considering any of these procedures.
Secretions/aspirate may be deemed as detrimental when they cause the patient
distress, or physiological derangement e.g. impaired ABGs, reduced SpO2 and/or
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increased
respiratory
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Contraindications
Nasotracheal suction
 Severe coagulopathy and / or unexplained haemoptysis
 Laryngospasm (stridor)
 Basal skull fractures, or cerebrospinal fluid leakage via the ear
 Severe bronchospasm
 Recent oesophageal or tracheal anastamoses, or tracheo-oesophageal
fistula
 Occluded nasal passages
 Nasal bleeding
 Recent oral / nasal surgery
Orotracheal suction
 Severe coagulopathy and / or unexplained haemoptysis
 Laryngospasm (stridor)
 Acute neck, facial or head injury (particularly basal skull fractures, or
cerebrospinal fluid leakage via the ear)
 Severe bronchospasm
 Recent oesophageal or tracheal anastamoses, or tracheo-oesophageal
fistula
 Loose teeth or crowns
 Intact gag reflex (relative contraindication)
Relative Contraindications (Seek Medical Advice Prior To Insertion)
 Acute neck, facial or head injury
 Haemodynamic instability
 Nasal/oral burns, due to infection risk
 Signs suggestive of raised or labile intracranial pressure
 Coagulopathy (Low Platelets <40)
Hazards
 Mechanical trauma – that is trauma to airway mucosa particularly
associated with poor technique and excessive suction pressures
 Hypoxia / hypoxaemia
 Cardiac arrhythmias
 Fluctuations in blood pressure
 Vasovagal stimulation – eliciting bradycardia and hypotension
 Respiratory arrest / apnoea
 Gagging / vomiting (particularly orotracheal suction)
 Aspiration
 Laryngospasm
 Bronchospasm
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



Pain
Infection
Bleeding
Atelectasis – area of lung collapse particularly associated with excessive
suction pressures or prolonged coughing
 Increase in intracranial pressure
 Misdirection into the oesophagus (patient may swallow the catheter)
 Patient distress and discomfort
Equipment List
Suction source with adjustable pressure regulator
Collection vessel and connector tubing
Sterile, multi-eyed suction catheters of appropriate size – use the smallest
size catheter to be effective, ideally 10-12 FG
Sterile water (dated, named and timed) plus container
Clean disposable examination gloves
Apron
Sterile disposable co-polymer examination gloves
Eye protection and/or mask if indicated
Orotracheal suction: Guedel airway of appropriate size (Appendix 1, diagram
A)
Nasotracheal suction: Lubricating gel, nasopharyngeal airway (optional) of
appropriate size (Appendix 2, Diagram B).
Oxygen supply and delivery device
Sputum trap if specimen required
Monitoring equipment (pulse oximeter)
Ensure emergency equipment available if required
Refer to General Actions for All Procedures.
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Actions of Care
ACTION
RATIONALE
Assess the patient’s
requirements for suctioning:
Abnormal breathing,
physiological deterioration and
/ or distress, audible secretions
in upper airway or noisy
crackles on auscultation,
coughing, desaturation or
raised respiratory rate (AARC,
2010, & Wood, 1998b)
Ensure informed consent is
given where able as per Trust
policy.
Prepare patient by giving
analgesia if required and
reassurance and information
To determine whether suctioning is
necessary Oro or nasotracheal
suctioning should be performed only
when necessary (Pedersen et al.,
2008) Patient must have information to
consent to procedure and feel
reassured. NB there will be patients
who lack capacity to consent
See NUH consent to Examination or
Treatment policy (Ref CL/CGP/020)
2
3
Close Curtains
Wash & dry hands & put on
non-sterile examination gloves,
(on both hands at the patient’s
bedside), apron, and eye
protection/mask if indicated.
To maintain patient privacy
Minimises risk of cross infection to
patient or operator (Saving lives DoH,
2007, Day et al., 2002)
4
Check correct functioning of
vacuum source and set
negative pressure to up to a
maximum of 20kilo Pascals
(kPa)/ 150 mmHg.
Minimises the risk of mechanical
trauma. Note that increased pressures
do not facilitate better removal of
secretions. (Glas, 1995, Wood, 1998,
Day et al., 2002, Branson, 1993) and
may result in complication e.g. trauma
& atelectasis
1.
To maintain privacy & dignity and to
avoid distress for other patients
Best Practice
The use of eye protection and a mask is recommended if the patient has
such infections as TB, meningococcal meningitis or any blood or air borne
virus. For further advice, contact the Infection Control team.
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ACTION
RATIONALE
5.
Where possible, position the
patient to ensure their airway is
open, either in high side lying
or sitting upright
Minimises the risk of misdirection of the
catheter into the oesophagus.
Care to keep position safe where spinal
injury is involved
6.
Patients with high oxygen
requirements (>40%) may
require pre-oxygenation prior to
suctioning
Optimise oxygenation if
necessary by increasing the
patient’s fraction of inspired
oxygen (Fi02) for at least 30
seconds. Oxygen must be
prescribed, and should be
given at maximum rate safely
tolerated by the patient Caution
in patients requiring controlled
oxygen therapy. For example in
patients with COPD(see NUH
CLMM032 In-patient Oxygen
Therapy Guideline )
Minimises the risk of hypoxia /
hypoxaemia and cardiac dysrhythmias
(Thompson et al., 2000, Branson et al.,
1993)
7a. Orotracheal suction:
wash & dry hands & put on
non-sterile examination gloves
on both hands at the patient’s
bedside Insert a Guedel Airway
if the patient has a GCS of 8 or
less. (see appendix for sizing
guide)
Prevent cross infection
Provides a patent route for passage of
the suction catheter and prevents the
patient biting down on the catheter.
Patient with a GCS of 8 or less will
have an incompetent airway and there
is a risk of aspiration should the patient
vomit during suction.
7b. Nasotracheal suction:
wash & dry & put on nonsterile examination gloves on
both hands at the patient’s
bedside
Insert nasopharyngeal airway,
if repeated nasotracheal
suction is anticipated.
Provides a more comfortable route for
repeated passage of the suction
catheter and less damage to the
mucosa with repeated suction.
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(Appendix 2, diagram C)
8.
9.
9
Open suction catheter
packaging. The suction
catheter used should occlude
less than 50% the lumen of the
oro-or nasopharyngeal tube
(AARC, 2010) Connect suction
catheter tubing, ensuring that
catheter remains within the
sterile pack. Put sterile copolymer glove on dominant
hand and use that hand to
withdraw catheter from pack.
Minimises risk of cross infection to
patient or operator. Using the correct
sized catheter minimises the risk of
hypoxaemia
ACTION
RATIONALE
Insert suction catheter via
guedel airway, or nostril. Aim to
time this with patient’s
inspiratory phase. If using a
nasopharyngeal airway or
nostril, decant a small amount
of sterile water into a jug or a
receiver and then dip the end
of the suction catheter into a
small amount of sterile water
this may facilitate passage prior
to inserting the catheter by
adding some lubrication . If
performing suction directly via
the nostril, introduce the
catheter and progress it gently
towards the back of the nose
with an upward inclination.
Once resistance is felt, gently
rotate the catheter until the
resistance is overcome.
Do not apply suction during
insertion. The catheter should
be inserted no further than the
carina (or when resistance is
Minimises mechanical trauma to airway
passages and patient discomfort.
(Wood, 1998b, Celik, 2000, Day et al.,
2002)
Reduces risk of damage to the carina
and subsequent vagal stimulation.
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felt) and retracted a maximum
of 1 – 2 cms.
10. Continue to insert catheter until
a resistance is felt or a cough
elicited. Withdraw by a
maximum1- 2 cms before
applying suction to ensure tip
of catheter is not abutting the
carina.
Minimises the risk of mechanical
trauma to carina and subsequent vagal
stimulation. Withdrawing the catheter
too far from the point of resistance or
from the point of cough stimulation may
result in some secretions remaining in
the airway.
11. Remove catheter if misdirection Maximises effectiveness of procedure
into the oesophagus is
and minimises risk of aspiration.
suspected (e.g. gagging,
absence of cough, aspiration of
gastric contents).
ACTION
12. Apply suction continuously (not
intermittently) throughout
catheter removal. Withdraw
catheter smoothly (without
rotation). Ensure that this
period of suction application
does not exceed 15 seconds
(Pedersen et al., 2008 &
AARC, 2010). The catheter
must be withdrawn cleanly and
not reinserted during
withdrawal.
13. Monitor patient’s condition
during and following treatment,
e.g. colour, breathing pattern,
evidence of trauma (bleeding),
distress, cough secretions
(colour, tenacity, quantity). The
patients Sp02 should be
monitored throughout the
procedure and heart rate and
BP monitoring should be
undertaken where available.
RATIONALE
Continuous suction minimises adverse
effects / hazards associated with
suction, e.g. hypoxia / hypoxaemia,
cardiac dysrhythmias, blood pressure
fluctuations, pain, apnoea, atelectasis,
raised intra-cerebral pressure etc
(Czarnik et al., 1991, Stenqvist et al.,
2001, Day et al., 2002, Celik & Elbas,
2000, Wood, 1998b)
Ensures patient safety and assesses
improvement in patient condition.
Detects deterioration quickly.
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14.
15.
16.
17.
Seek urgent help in the event
of patient deterioration.
Remove sterile glove inverting
it over the used catheter and
dispose in clinical waste bin.
After the final episode of
suction, remove airway adjunct,
provided the patient is able to
maintain a safe airway. If the
patient has been preoxygenated prior to the
procedure turn the Fi02 back to
the previous level and monitor
the patients Sp02 for at least 5
minutes (see CLMM032 Inpatient Oxygen Therapy
Guidelines) to ensure the
patient’s oxygen saturations
are within the target saturation
level
Where possible encourage
deep breathing. The patient
should be allowed to recover
between subsequent suction if
further airway suction is
indicated their Sp02 and
cardiovascular status should be
allowed to recover to presuction levels. The patients
should be allowed to take at
least 8 breaths between
subsequent suctions.
Once treatment is completed,
rinse suction connector tubing
using a small amount of sterile
water decanted from the bottle
into a container. Ensure
opening date and time has
been marked on bottled water
in order that it may be
discarded after 24 hours. Turn
suction off. Ensure suction
tubing is supported well clear of
the floor.
Maximises effectiveness of procedure
and minimises risk of cross infection.
Ensures patient safety and comfort.
Minimise atelectasis. Avoids patient
distress and fatigue, and quick
repeated suctions. Reduces the risk of
an adverse event.
Maintain safe, clean environment.
Minimise risk of cross infection.
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ACTION
18. Wash hands.
Discard any disposable items
in appropriate clinical waste
bins and change suction bottle
if necessary.
19. Reassess patient and report
any adverse effects or changes
in patient’s overall condition to
senior nursing
and/or medical personnel.
Return oxygen to pre suction
levels if the patient’s
saturations are within their
target range.
20
Consider further management
if the patient is going to require
further /regular suction. For
example if the secretions are
thick consider hydration,
humidification of oxygen (see
Guideline for Humidification of
Oxygen for adult self-ventilating
and
temporary tracheostomy
patients) and/or regular saline
nebulisation. If the patient has
copious secretions consider if
further airway management is
indicated e.g. formal
tracheostomy. Consider
referring the patient to the ward
physiotherapist and/or the
critical care outreach
team(CCOT) for further
management
21. Document procedure, effects
and response as per
RATIONALE
Maintain safe, clean environment.
Guedel airways are single use products
and therefore must be discarded after
use. Nasal airways can remain in situ
but should be changed every 48 hours
or sooner if indicated to prevent
occlusion by dried secretions.
To ensure patient safety.
To ensure the patients secretions are
correctly managed and ensure airway
management is considered in the
situations of tenacious or copious
secretion production
Allows ongoing multidisciplinary team
assessment and evaluation of patient’s
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documentation policies.
condition.
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Further Reading & References
Acute Illness Management (AIMs) Manual (2011). Greater Manchester
Critical Care Network. www.gmcriticalcareskillsinstitute.org.uk
American Association of Respiratory Care (1992) Clinical Practice Guideline –
Nasotracheal Suctioning Respiratory Care Vol. 37, pp. 898-901
American Association of Respiratory Care (2010) Clinical Practice Guideline –
Endotracheal suctioning of mechanically ventilated patients with artificial
airways Respiratory Care Vol. 38, pp. 500-504.
Branson RD, Cambell RS, Chatburn RL, Covington J (1993) AARC clinical
practice guideline: Endotracheal suctioning of mechanically ventilated adults
and children with artificial airways. Respiratory Care; 38 (5): 500-4
Celik SS, Elbas NO (2000) The standard of suction for patients undergoing
endotracheal intubation. Intensive critical care Nursing; 16 (3) 191-8
Chartered Society of Physiotherapy (2002) Rules of Professional Conduct.
Czarnic RE, Stone KS, Everhart CC Jr, Preusser BA. (1991) Differential
effects of continuous versus intermittent suction on tracheal tissue. Heart Lung
; 20 (2) :144-51
Day T, Farnell S, Wilson-Barnett J. (2002) Suctioning: a review of current
research recommendations. Intensive Critical Care Nursing 18 (2): 79-89
Department of Health (2007) Saving Lives: a delivery programme to reduce
healthcare associated infection including MRSA London
Frankell HL, Mathias CJ, Spalding JM (1975) Mechanisms of reflex cardiac
arrest in tetraplegic patients The Lancet Vol. 2, pp.1183-1185
Glass C, Grap MJ. Ten tips for safer suctioning American Journal of Nursing ;
95 (5): 51-53
Higgens, D; (2005) Tracheal suction. 22 February, Nursing TimesVOL: 101,
ISSUE: 08, P 36 -38
http://www.nursingtimes.net/nursing-practice-clinical-research/trachealsuction/203988.article
Nasal and Oral Suction March 2015 Review March 2020 Final
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Jones M and Moffatt F (2002) Cardiopulmonary Physiotherapy Oxford: Bios
Scientific Publishers
Jung RC, Gottlieb LS (1976) Comparison of tracheo-bronchial suction
catheters in humans. Chest Vol. 69, pp. 170-181
Kleiber C, Krutzfield N, Rose EF (1988) Acute histologic changes in the
tracheo-bronchial tree associated with different suction catheter insertion
techniques. Heart & Lung Vol. 17, pp. 10-14
Leith DE (1985) The development of cough. American Review of Respiratory
Disease Vol. 131, pp. S39-42
Mansell A, Bryan C, Levison H (1972) Airway closure in children. Journal of
Applied Physiology Vol. 33, pp. 711-714
Nottingham University Hospitals NHS Trust (2012) Consent to Examination or
Treatment policy, NUH, Nottingham
Nottingham University Hospitals NHS Trust (2013) Medicines Policy: Code Of
Practice Inpatient Oxygen Therapy NUH, Nottingham
Nursing and Midwifery Council (2015) The Code: Professional standards
of practice and behaviour for nurses and midwives (March 2015)
Pedersen C, Rosendahl-Nielsen M, Hjermind J and Egerod I (2008)
Endotracheal suctioning of the adult intubated patient – What is the Evidence?
Intensive and critical care Nursing (2009) 25, 21-30
Rosen M, Hillard EK (1962) The effects of negative pressure during tracheal
suction Anaesthesia and Analgesia Vol. 41, pp. 50-57
Stenqvist O, Lindgren S, Karason S, Sondergaard S, Lundin S (2001)
Warning ! Suctioning. A lung model evaluation of closed suctioning systems.
Acta Anaesthesiol Scand ; 45 (2): 167 – 72
Thomson L, Morton R, Cuthebertson S. (2000) Tracheal suctioning of adults
with an artificial airway. Best Practice; 4 (4): 1-6
Quirke S (1997) Closed circuit suction systems. Care of the Critically ill.
Vol.13, No. 6 Supplement.
Widdicombe JG (1980) Mechanism of cough and its regulation. European
Journal of Respiratory Disease Vol. 61: (Suppl 110) pp. 11-15
Nasal and Oral Suction March 2015 Review March 2020 Final
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Wood C J (1998b) Endotracheal suctioning: a literature review. Intensive
Critical care nursing 14 (3): 124-136
Young CS (1984) A review of the adverse effects of airway suction.
Physiotherapy Vol. 70, pp. 104-106
Original Author: Fiona Moffatt, Critical Care Outreach Team Physiotherapist,
NUH Queens Campus and Cheryl Crocker, Consultant Nurse Critical Care
Reviewer: Eleanor Douglas, Lecturer/Practitioner Physiotherapist
NPGG Link: Ellie Dring
For Review: 2020
Audit Points
1.
Have other less invasive techniques been attempted and proved
unsuccessful prior to naso or oral tracheal suction being attempted?
2.
Has the patient been prepared with explanation, reassurance, privacy &
dignity and analgesia (if necessary)?
3.
Has informed consent been obtained?
4.
Has the vacuum been set to a negative pressure no greater than 20kPa
/ 150mmHg?
5.
Has asepsis been maintained throughout the procedure?
6.
Has the patient’s condition during and following treatment been
monitored?
7.
Have any adverse effects or changes in patient’s overall condition been
reported to the relevant nursing or medical staff?
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Appendix 1
Selection and Insertion of an Oropharyngeal Airway
Resuscitation Council UK (20011) Advanced Life Support Course Provider
Manual 6th Edition London: Resuscitation Council UK (reference is incorrect)
http://www.resus.org.uk/pages/pub_ALS.htm
Selection:
 Most commonly used sizes are 2, 3 and 4.
 For small, medium and large adults respectively.
 The length of the airway should correspond to the vertical distance
between the patients incisors and angle of the jaw (see diagram).
Diagram A (http://www.haworth21.karoo.net/BASIC%20AIRWAY%20MANAGEMENT.htm
Insertion:
 Only used in patients with a reduced level of consciousness, as vomiting
and laryngospasm may occur if glossopharyngeal and laryngeal reflexes
are present.
 Open patient’s mouth and ensure that there is no foreign material that
could be pushed into the larynx.
 Introduce airway into the oral cavity in an upside-down position (as far
as the junction between the hard and soft palate), then rotate through
180. This rotation minimises the chances of pushing the tongue down
and back
Insert further until the airway lies in the oropharynx.
 Diagram B
http://www.haworth21.karoo.net/BASIC%20AIRWAY%20MANAGEMENT.htm
Remove airway immediately if any reflex responses are seen.
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Appendix 2
Selection and Insertion of a Nasopharyngeal Airway
Resuscitation Council UK (2011) Advanced Life Support Course Provider
Manual 6th Edition London: Resuscitation Council UK
http://www.resus.org.uk/pages/pub_ALS.htm
Selection:
The NPA should be sized according to the patient’s size, sex and race.
As a general guide a size 6 should be used for females and size 7 for
males (AIMS, 2011).
Insertion:
 Generally better tolerated than an oropharyngeal airway in patients
who have a higher level of consciousness.
 Not suitable for patients with actual or suspected basal skull fracture.
 Can cause damage to the mucosal lining, leading to bleeding. It is
essential to ensure that clotting is normal.
 If the tube is too long, it may stimulate laryngeal and glossophayngeal reflexes eliciting laryngospasm and vomiting (AIMS,
2011).
 Prepare the nasal airway by lubricating the airway with water-based
gel.
 Some nasal airways have a wide flange to prevent inhalation via the
nostril. Others have smaller flanges and these require the insertion of
the supplied safety pin through the flange to prevent inhalation.
 Slowly and gently insert the bevel end first along the floor of the nose,
with a slight twisting action. The curve of the airway should direct it
towards the patient’s feet.
 Once in place, establish the patency of the tube and adequacy of
ventilation (look, listen, feel).
 In patients with coagulopathies this will need to be performed under
platelet cover where there is significant risk of bleeding, and
consultation should be made with the medical team prior to insertion.
http://www.haworth21.karoo.net/BASIC%20AIRWAY%20MANAGEMENT.htm
Diagram C
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Appendix 3 - Checklist for the Review and Approval of Procedural
Documents (to be used by authors and at the Matron’s Forum)
This should be the very last Appendix following all the others in the document
Title of document being
reviewed:
1.
2.
4.
Comments
Yes/No Yes/No
Title
Is the title clear and
unambiguous?
YES
YES
Is it clear whether the
document is a guideline,
policy or protocol?
YES
YES
YES
YES
Is the method described in
brief?
YES
YES
Are individuals involved in
the development identified?
YES
YES
Do you feel a reasonable
attempt has been made to
ensure relevant expertise
has been used?
YES
YES
Is there evidence of
consultation with
stakeholders and users?
YES
YES
Is the objective of the
document clear?
YES
YES
Is the target population clear
and unambiguous?
YES
YES
Are the intended outcomes
YES
YES
Rationale
Are reasons for development
of the document stated?
3.
Author NPGG
Development Process
Content
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19
Title of document being
reviewed:
Author NPGG
Comments
Yes/No Yes/No
described?
Are the statements clear and
unambiguous?
5.
6.
7.
YES
YES
Is the type of evidence to
support the document
identified explicitly?
YES
YES
Are key references cited?
YES
YES
Are the references cited in
full?
YES
YES
Are local/organisational
supporting documents
referenced?
YES
YES
Does the document identify
which committee/group will
approve it?
YES
YES
If appropriate, have the Staff
Side committee been
consulted about the
document?
NO
N/A
Is there an outline/plan to
identify how this will be
done?
YES
YES
Does the plan include the
necessary training/support to
ensure compliance?
YES
YES
Evidence Base
Approval
Dissemination and
Implementation
Nasal and Oral Suction March 2015 Review March 2020 Final
e-mail to inform
staff of the update
20
8.
9.
10.
11.
12.
Document Control
Does the document
identify where it will be
held?
NO
YES
Have archiving
arrangements for
superseded documents
been addressed?
YES
YES
NPG intranet
page
Process for Monitoring
Compliance
Are there measurable
standards or KPIs to
support monitoring
compliance of the
document?
Local
YES
competencies/
Is there a plan to review or
audit compliance with the
document?
YES
YES
Is the review date
identified?
YES
YES
Is the frequency of review
identified? If so, is it
acceptable?
YES
YES
Is it clear who will be
YES
responsible for
coordinating the
dissemination,
implementation and review
of the documentation?
YES
Matron’s Forum
Approval Date
March
2015
Acute Care
Skills Course
Review Date
Overall Responsibility
for the Document
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