Chapter 5. Oxygen Therapy Oral suctioning involves the mouth. Oropharyngeal involves the mouth and the pharynx and sometimes the trachea. The pharynx and trachea can also be reached through the nose. Suctioning via all of these routes are indicated when the patient has secretions in the pharynx and upper airway that they cannot clear independently. The choice of route will depend on patient factors like facial trauma, presence of airways, and the urgency of the situation. Symptoms to suggest the patient may need tracheal suctioning include visible secretions in the airway, coarse gurgling breath sounds, diminished breath sounds, suspected aspiration of gastric or upper airway secretions, increased work of breathing, deteriorating SaO2 or SpO2, restlessness (AARC, 2004). Because the suctioning occurs deeper into the respiratory tract, there is increased risk of respiratory infection. As such the procedure must be sterile and thus observe principles of asepsis. Other risks associated with oropharyngeal / tracheal suctioning include hypoxia, trauma, laryngospasm, increased intracranial pressure for persons with head injury, cardiac dysrhythmias, and death (Strickland et al., 2013). Respiratory assessment should always include underlying pathology including respiratory, neuromuscular, musculoskeletal factors influencing respiratory status. Recent surgery, or trauma to face or nose may influence the need and/or ability to insert suction catheters (Perry et al., 2018). Consider reasons why the patient is unable to clear secretions independently and consider strategies that may reduce the need for tracheal suctioning (i.e., humidity may help to liquefy secretions, sitting in chair and/or ambulation may help the patient to clear secretions independently) (Strickland et al., 2013). Checklist 44 describes the procedure for oropharyngeal suctioning.
To better understand oropharyngeal and tracheal suctioning, watch the following video. Watch the videos Oropharyngeal Suctioning developed by Renée Anderson and Wendy McKenzie, Thompson Rivers University (2018). Figure 5.6. Structures of the mouth & pharynx by Blausen.com staff is used under a CC BY 3.0 license. |