What is nasopharyngeal (NP) suctioning?
It is the process of passing a suction catheter into the upper airway and applying negative pressure as it is withdrawn to remove secretions. The procedure is performed using a sterile technique.
What is the aim of NP suctioning?
To remove excess secretions from the upper respiratory tract in patients who cannot clear them independently.
Who requires NP suctioning?
Self-ventilating adult patients who are unable to clear their own secretions.
When should NP suctioning NOT be performed? (Contraindications)
- Tracheo/oesophageal fistulae
- Severe bronchospasm or stridor
- Acute head, facial, or neck injury
- Severe epistaxis
- Leakage of cerebrospinal fluid
- Occluded nasal passage
- Clotting problems (INR 1-1.2, platelets 120-500)
- Inhalation injury
- Cardiovascular instability
What conditions require caution before NP suctioning? (Precautions)
- Recent oesophageal or tracheal surgery
- Coagulopathy or bleeding disorders
- Upper airway lesions
- Irritable airways (e.g., wheeze, bronchospasm)
- Pulmonary oedema
- Latex allergy (use latex-free NP airway)
What checks should be done before NP suctioning?
- Assess the patient’s condition and attempt other sputum clearance techniques first
- Ensure cardiovascular stability
- Check INR is below 1.2
What equipment is needed for NP suctioning?
Functional suction unit
- Suction catheters (correct size)
- Oxygen source
- Sterile water and jug
- Personal Protective Equipment (PPE)
- Nasopharyngeal airway (correct size)
- Sterile gloves
- Sputum tap (if needed)
- Pulse oximeter
How should you prepare for NP suctioning?
- Wear PPE (visor/mask, goggles, gloves, apron).
- Position the patient (side-lying to reduce aspiration risk).
- Explain the procedure to the patient.
- Preoxygenate for 2 minutes if not contraindicated.
- Encourage the patient to take deep breaths for reassurance.
- Set suction pressure to a maximum of 20kPa.
- If using an NP airway, insert it with soluble lubricant under sterile conditions.
How do you choose the correct suction catheter size?
Multiply the NP airway size by 2, then subtract 2.
Example: NPA size 7 → 7 × 2 = 14, then 14 - 2 = size 12 catheter.
What is the step-by-step NP suctioning technique?
- Attach catheter to suction tubing while keeping it sterile.
- Wear a sterile glove on the dominant hand.
- Remove the catheter from the pack and lubricate it.
- Insert catheter parallel to the nasal floor, aiming towards the opposite eye.
- If resistance is met, rotate gently and advance slowly.
- To avoid oesophageal entry, have the patient tilt their head back, stick out their tongue, or cough.
- If the catheter enters the oesophagus (patient swallows), withdraw and reposition.
- When resistance is felt, withdraw slightly before applying suction to reduce trauma.
- If distress occurs, withdraw partially until the distress stops.
- Slowly remove the catheter within 10 seconds without rotating it.
- Reassess and repeat if necessary.
What should be monitored throughout the procedure?
- Patient response
- Oxygen saturation
- Signs of distress
- Effectiveness of secretion removal
What are the possible side effects of NP suctioning?
Arrhythmias (e.g., bradycardia)
- Hypoxia
- Trauma
- Patient distress
- Coughing
- Sputum plugging
How is the effectiveness of NP suctioning assessed?
Patient comfort and observation
- Auscultation
- Volume of secretions removed
- Oxygen saturation levels and arterial blood gases (ABGs)
What are the different types of suction catheters?
- In Line Suction Catheter
- Flexible Suction Catheter
- Yanker Suction Catheter
- Sputum Trap
What is an In Line Suction Catheter used for?
It is used for patients connected to a ventilator and is shorter when used via a tracheostomy.
What is a Flexible Suction Catheter?
A soft tubing catheter available in various sizes, used for nasopharyngeal (NP) suctioning and suctioning via an open tracheostomy or laryngectomy.
What is a Yanker Suction Catheter used for?
A solid tubing catheter used specifically for oral secretions.
What is a Sputum Trap used for?
It is used to collect sputum specimens for microbiology analysis.
