SOP-10-008

1




Standard Operating Procedures for Adult Suction


NICE GUIDANCE
Once NICE guidance is published, health professionals are expected to take it fully
into account when exercising their clinical judgment. However, NICE guidance does
not override the individual responsibility of health professionals to make appropriate
decisions according to the circumstances of the individual patient in consultation with
the patient and/or their guardian or carer.

Sop Number

SOP-10-008
Title of SOP SUCTION GUIDELINES FOR ADULT PATIENTS IN
A COMMUNITY SETTING
Author

Helen Green
Consultation with
stakeholders






Anne Cerchione
Caroline Summers
Catherine Smyth
Tina Quinn
Catherine Gibbs
Gwen Ruddlesdin
Janice Boucher
Joan Booth
June Watson
Pam Lumb
Mark Marshall
Linda Meeson
Sandie Bunyard
Sheena Kelly
Approved at SOP
Development Group
27 May 2010
Responsible
Directorate:

Kirklees Community Health Services
Responsible Director:

Robert Flack
Date Ratified: 27 July 2010

Ratified by: KCHS Governance Committee
Review Date: July 2012
SOP-10-008
2



Contents


Section Page
1. Target staff group 3
2. Aim of Guidelines 3
3. Introduction 3
4. Associated Policies/ Procedures 4
5. Accountabilities/ Responsibilities 4
6. Patient Discharge from Hospital 5
7. Indications for Suctioning 5
8. Contra-indications for Suctioning 6
9. Complications of Suctioning 6
10. Infection control 7
11. Equality Impact Assessment 7
12. Training Needs Assessment 7
13. Monitoring Compliance with this Policy/ procedure 7
14. References 8
Appendices


A Key Stakeholders consulted/involved in the
development of the policy/procedure
9
B Equality Impact Assessment Tool 10
C Procedure for Performing Suction, Outcomes 11
D Infection Control and the Equipment 16
E Flow chart for the management of respiratory tract
secretions in terminally ill patients

18
F Flow Chart Suctioning Patients with a Tracheostomy

19
G Flow Chart for Suctioning Oro-pharyngeal Secretions

20


3
1. Target staff group

This procedure relates to the services provided directly by Kirklees Community
Healthcare Services, but may be utilised as evidence of good practice by
independent contractors.

2. Aim of the guidelines

Policy Statement
KCHS will deliver assessment, appropriate equipment and education to people (and
carers) who are unable through their own mechanism to clear secretions from their
airway.
Treatment for individual patients can involve several provider units, therefore strong
links with other providers will be maintained to promote seamless care.

2.1 To ensure all patients are able to access suction equipment, utilise it
safely and appropriately by themselves or by their carers, or by staff working
for Kirklees Community Healthcare Services (KCHS).

The objectives are to:

Provide a framework for standardised suctioning practice
Provide healthcare professionals with the support, knowledge and
evidence of good practice necessary to enable them to perform
suctioning techniques.
Enable staff to give education to patients, carers and other laypersons
by using these guidelines.

2.2 The guidelines only apply to suctioning of the adult patient in their own home
and other community settings, for example a day centre.

3. Introduction

3.1 This procedure has been written as a guide to best practice for use by health
professionals within KCHS to clear patients airway using a safe, evidence-
based approach. When it is appropriate for patients or carers to be instructed
in the technique of suctioning, the guidelines can be used for this.

3.2 Suctioning involves the mechanical aspiration of secretions from the
nasopharynx, oro-pharynx and trachea. It is a necessary procedure to maintain
the patency of the airway and is performed on people who are unable to clear
their chest with coughing or other chest clearance techniques.

3.3 The procedure may be performed through airways in their natural state, or
through an artificial airway such as tracheostomy tube or through a surgically
modified airway such as a laryngectomy stoma.



4
3.4 Suctioning is potentially a hazardous procedure and should therefore only be
performed when there are clear indications that excessive secretions are
affecting the patency of the airway. Where possible the patient should be
encouraged to expectorate secretions to avoid unnecessary suction (Bennett
2008).

4. Associated Policies, Procedures and Guidance

This policy/procedure should be read in accordance with the following PCT
policies, procedures and guidance:

Consent Policy
Clinical Record keeping Policy
Hand Decontamination Policy
Infection Control Policy
Standard Universal Precautions Policy
Health and Safety Policies
Asceptic Technique Policy
Decontamination of Reusable Medical Devices Policy
Waste Management Guidelines
Medical Devices Policy
The Royal Marsden Manual of Clinical Procedures (7
th
Edition)
Mental Capacity Act Policy (MCA)

5. Accountabilities & Responsibilities

5.1 Director of KCHS

The Director of KCHS has overall responsibility for ensuring staff work towards
these guidelines. This responsibility is normally delegated to Locality and
Service Managers.

5.2 Service Managers

The responsibility of managers is to:
Ensure that their staff are aware of their personal responsibilities for the
management of medical devices

5
Ensure that their staff undertake procurement, maintenance, repair and
decontamination of medical devices in line with NHS Kirklees and KCHS
policies and procedures
Ensure that their staff report incidents about medical devices
Ensure that their staff are adequately trained and supervised in the use
of medical devices, and that records are maintained of local training
Ensure that their staff give appropriate information and training about the
use of medical devices to clients, and maintain adequate records of the
training given
5.3 Health Professionals

Health professionals undertaking these procedures are accountable for
ensuring they have received the appropriate training and are competent to
carry them out. They should inform their line manager if they feel they are not
competent and identify their training needs relating to this area of practice.

5.4 They are reminded that they should at all times adhere to:

The Code: Standards of conduct, performance and ethics for nurses and
midwives (NMC 2008)
The Chartered Society of Physiotherapists Rules of Professional
Conduct (2002)


6. Patient Discharge from Hospital

6.1 The hospital is responsible for teaching patients and carers the procedure for
suctioning before transfer of care to the community. The discharging hospital
must make contact or liaise with all community teams.

6.2 If patients with learning disabilities and mental health needs are referred to the
community service for tracheostomy suctioning, community staff should seek
the additional support of the mental health and learning disabilities services.

7. Indications for Suctioning

The primary indication for suctioning the patient cared for at home is the
patients inability to adequately clear the airway by coughing.
The patient may exhibit some or all of the following signs. The suctioning
technique will depend on the patients needs:

More frequent or congested sounding cough
Bubbly, gurgly voice
Rattling or coarse expiratory crackles
Visible secretions

6
Indication by the patient that suctioning is necessary
Suspected aspiration of gastric or upper airway secretions
Dyspnoea
Decreased oxygen saturations thought to be related to mucus plugging
where oxygen saturations are monitored
Terminal care patient who is distressed by upper respiratory secretions
and is unable to self- expectorate
An increased inspiratory pressure on the ventilator
The need to obtain a sputum specimen to identify pneumonia, other
pulmonary infection or for sputum cytology.

8. Contra-indications for Suctioning

Suctioning is a necessary procedure for patients unable to maintain a
patent airway. Most contraindications are relative to the risks of a
worsening clinical condition. There is no absolute contraindication to
suctioning as the benefits almost always outweigh the risk to the patient.

The decision to abstain from suctioning in order to avoid a possible
adverse reaction may worsen the condition of the patient considerably.
However, routine or scheduled suctioning, with no indication of need is
not recommended.

The patient may refuse the procedure,

For terminally ill patients drug treatment plus oropharyngeal suction
should preferably be used, and only then in unconscious people, as it
may be uncomfortable ( Twycross 2001)

See appendix C for patient preparation, consent and the procedure including
suction tube size

9. Complications of Suctioning

Hypoxia
Trauma to the nasal, oropharyngeal or tracheal mucosa
Cardiac arrest / Respiratory arrest
Bronchoconstriction / Bronchospasm
Pneumothorax
Pulmonary haemorrhage
Incomplete secretion clearance
Micro-atelectasis, (Atelectasis Definition- collapse of lung tissue
preventing the exchange of carbon dioxide and oxygen as part of normal
respiration)
Raised intra-cranial pressure
Hypotension / Hypertension
Laryngospasm
9.1

7
Sepsis
Cardiac arrhythmias


9.2 Patients should always be observed following suctioning for signs of the
complications listed and for signs of a successful clearance.

10. Infection Control

10.1 The care environment where aseptic procedures are carried out is not always
ideal, so adaptation and creativity are required (Lawrence et al 2003).
Suctioning in the community should continue to be carried out in as aseptic a
manner as possible to prevent the introduction of infection, (Lawrence et al
2003) especially when suctioning via ET tube or tracheostomy. This may be
achieved either by using a non-touch technique or sterile gloves to introduce
the single use suction catheter.

10.2 Hands must be washed prior to suctioning and appropriate personal protective
equipment used. (NICE 2003), (KCHS 2009 Standard Universal Precautions)

11. Equality Impact Assessment

This policy has been assessed for the potential adverse impact as set out in
Appendix C. On initial screening the policy has not identified an impact. .

12. Training Needs Analysis

The Clinical governance team will ensure that all staff within KCHS have an
awareness of this procedure.

13. Monitoring Compliance with this policy/procedure

KCHS Internal Governance arrangements are accountable for monitoring the
implementation and effectiveness of the procedure, and acting on any concerns
raised to ensure the delivery of safe care.

All health care professionals who perform suctioning techniques on a patient in
a community setting should be aware of the content of these guidelines.







8

14. References
Barnett, M. (1998) Tracheostomy management and care. Journal of Community
Nursing, 19(1):4-8.
Barnett, M. (2008) A practical guide to the management of a tracheostomy.
Journal of Community Nursing, Vol 22(12):
Damani, N.N. (2003) Manual of infection control procedures. 2
nd
Edition GMM:
London
Donald, K.J. et al (2000) Safe setting and effective suction pressure. Intensive
care medicine. 26, 15-19.
Kirklees PCT ( 2007) Consent Policy
Lawrence, J. & May, D. (2003) Infection control in the community. Churchill
Livingstone: Edingburgh
McKenzie, S. et al (2008) Standards for the care of adult patients with a
temporary tracheostomy Standards and guidelines, Council of the intensive
care society www.evidence.nhs.uk Accessed on 05/03/2010
NHS (2007), Caring for the patient with a tracheostomy Quality improvement
Scotland, Best practice statement www.evidence.nhs.uk Accessed on
09/03/2010
NICE ( 2003) Infection control in the community. National Institute for Health
and Clinical Excellence. www.nice.org.uk Accessed on 15/03/2010
NMC (2008) The Code. Standards of conduct, performance and ethics for
nurses and midwives. NMC, London.
Odell, A. et al (1993) Endotracheal suction for adult, non-head injured patients:
a review of the literature. Intensive critical care nurse 9(4), 274-278.
Royal Marsden Hospital Manual of Clinical Nursing Procedures (2008) 7th
Edition
Twycross, R. & Wilcock, A. (2001) Symptom management in advanced cancer.
Abingdon: Radcliffe Medical Press.
















SOP-10-008
9

Appendix A
Key Stakeholder Consultation

Stakeholders name and
designation
Date
feedback
requested
Detail of feedback
received
Date
feedback
received
Action taken
Sandie Bunyard 09.04.2010
Suggested
grammatical
amendments
09.04.2010 Taken on board
Pam Lumb 09.04.2010 None 09.04.2010 None
Barbara Lockwood 09.04.2010 None 11.04.2010 None
Donna Roberts 09.04.2010 Algorithms Used. 12.04.2010 Included algorithms.
Joan Booth 09.04.2010
Suggestions about
length of document
12.04.2010 Taken on board
Catherine Smyth 09.04.2010
Numbering sections,
This wouldnt be the
Records
Management Policy
rather the Clinical
Record Keeping
Policy in section,
Change to consent
section page 7,
Monitoring
compliance (page
14) perhaps the bit
about the
Governance
responsibilities (
page 5) needs to be
here page .

13.04.2010
Christina Quinn 09.04.2010
Grammatical
changes
13.04.2010 Taken on board
Mark Marshall 09.04.2010 None 28.04.2010 None
Sarah Cowdell 09.04.2010
in appendix 3,
unable to clear
secretions
checking the
equipment and the
technique used
should be first with
nebulised saline at
the bottom of the list
especially given the
difficulty in obtaining
compressors in
community.
19.04.2010 Altered wording

10
Appendix B

Equality Impact Assessment Tool

Insert Name of Policy / Procedure
Yes/No Comments
1. Does the policy/guidance affect one
group less or more favourably than
another on the basis of:


Race
No

Ethnic origins (including gypsies and
travellers)
No

Nationality
No

Gender
No

Culture
No

Religion or belief
No

Sexual orientation including lesbian, gay
and bisexual people
No

Age
No

Disability - learning disabilities, physical
disability, sensory impairment and
mental health problems
No
2. Is there any evidence that some groups
are affected differently?
No
3. If you have identified potential
discrimination, are any exceptions valid,
legal and/or justifiable?
N/A
4. Is the impact of the policy/guidance
likely to be negative?
No
5. If so can the impact be avoided?
N/A
6. What alternatives are there to achieving
the policy/guidance without the impact?
N/A
7. Can we reduce the impact by taking
different action?
N/A

SOP-10-008
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Appendix C

Patient Preparation

Airway suction is an unpleasant experience for the patient and adequate preparation
and explanation must be given. Wherever possible, the patient should be encouraged
to clear the airway by directed cough or other airway clearance techniques. Help from
another member of staff or a carer may be required to prevent any sudden movement
from the patient.

Consent

Explanation of the procedure should always be given prior to suctioning commencing
and informed consent should be obtained in line with the NHS Kirklees Consent
Policy unless the patient is unconscious or in the terminal/dying phase.

Where ever possible the patient should be taught to perform the procedure for
him/herself, by hospital staff or the D/N. This reduces the risk of the transmission of
organisms and the introduction of cutaneous infections from the care giver.

The Procedure

Always inform the patient of the proposed procedure, whatever their conscious
level.
Always explain the procedure to the patient to reassure, increase cooperation,
aid relaxation and to gain consent.
Position the patient appropriately.
Staff must be adhering to Standard Universal Precautions, which includes
hand hygiene and Personal Protective Equipment (PPE).
The use of an FFP2 mask may be required if the patient has a communicable
infection such as Pulmonary Tuberculosis or during a pandemic of influenza -
this does not include MRSA.
Pre-oxygenate the patient if appropriate (see page 10).
For a clean technique; either, a) individually packaged sterile gloves should be
worn or if using a non touch technique, b) non sterile gloves, latex-free,
powder-free should be worn and a strict no-touch technique should be
employed ensuring that the catheter has no direct contact with the gloves.
For suction of oral secretions using a yankeur catheter, non sterile gloves may
be worn.
When suctioning, staff should ideally stand to one side to minimize potential for
contamination during coughing.
Patients requiring pre-oxygenation should also receive oxygen after the
suctioning event has been completed.
Ensure the suction unit is set to the suggested level of pressure (80- 120
mmHg or 10.7-16kPa).
Open the end of the suction catheter packet and attach to the suction tubing.
Keep the catheter itself inside the packet.
Cleanse hands and place an appropriate clean glove on the dominant hand and
adopt either the no-touch technique or clean technique as detailed above.

12
Introduce the catheter via the chosen route, (see Specific Route Procedures).
Ensure suction port on the catheter remains open. Insert catheter
approximately 10-15cm (or less in tracheostomy tube depending on length of
tube, McKenzie et al. 2008). Enter until a cough is stimulated or a measured
distance to be just above the carina (this is the point at which the trachea
bifurcates into the right and left main bronchus). It is not considered good
practice to insert the catheter until resistance is felt, as this will increase
mucosal damage.
Commence suction by covering Y-connector with thumb at the end of
inspiration (to ensure suction occurs during expiration).
Withdraw the catheter slowly and gently with the suction applied (keep thumb
over the vacuum port). It is not necessary to use a rotating motion whilst
applying suction as catheters have circumferential holes.
Suction time should ideally not exceed 10 seconds, (NHS Quality Improvement
Scotland. 2007; McKenzie et al. 2008). Never use a tromboning action to
remove secretions.
The suction catheter should be inserted and withdrawn once only to minimise
the potential for cross contamination. Suction catheters are designed to be
single use devices and therefore must not be reprocessed or re-used.
Wrap the suction catheter around the gloved hand, remove the glove and
dispose of in appropriate waste bag.
Repeat as necessary with a clean catheter and glove for each suction, with
time in between each insertion to monitor adverse effects and reassess
whether further suction is required.
The suction tubing should be flushed by suctioning recently boiled water or
sterile water (to rinse secretions away) from a clean receptacle that is left clean
and dry in between use. The container must be designed for this purpose. Then
aspirate air to clean and dry the internal surface of the tubing.
Protective clothing should be removed and hands decontaminated preferably
with soap and water or, if physically clean, alcohol gel is acceptable.

NB. Health Professionals employed by the PCT and staff working on behalf of
the PCT should follow the above procedure at all times.

Equipment

Checking that the suction machine is set to an appropriate level <120mmHg in adults
(aim for 80-120 mmHg or 10.7-16kPa) (NHS Quality Improvement Scotland 2007)

N.B for more tenacious secretions, attempts should be made to increase the flow rate
first, by using a slightly wider diameter catheter before increasing the negative
pressure. However, it is not recommended to exceed 200mmHg or 27kPa due to the
high risk of mucoid trauma. (NHS Quality Improvement Scotland 2007; Donaldson
2000)






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Specific Route Procedures

Oro-Pharyngeal Suction

Patients requiring oro-pharyngeal suction generally have difficulty swallowing,
coughing and/or clearing thick secretions.

Technique:

A Yankeur sucker [ clear plastic, angled sucker] is usually sufficient to clear such
secretions and rarely will deeper suction be required. The technique involves gentle
insertion of the Yankeur to the back of the throat, as far as the soft palate, then
occluding the opening in the Yankeur device. This will produce a negative pressure to
facilitate suction. Care should be taken that this procedure does not induce vomiting.
Avoid the end of the yankeur catheter coming into direct contact with the soft tissues
of the oral cavity to reduce the risk of trauma.

Naso-Pharyngeal Suction

In patients who are unable to cough, deep suction via the nasal route may be carried
out to remove secretions. A naso-pharyngeal airway (i.e. Portex or Robertazzi tube)
should be inserted to facilitate the introduction of a suction catheter. This technique
should only be performed by staff and carers who have been trained in the procedure.

Technique:

A naso-pharyngeal airway should be inserted by a trained, competent practitioner,
which then allows for the smooth passage of a suction catheter. Suction catheters
should be sized according to the diameter of the naso-pharyngeal airway. As only one
nostril is occluded, the airway should remain patent at all times. The suction technique
is as described in Endotracheal and/or Tracheal Suctioning.

Endotracheal and/or Tracheal Suction

The technique used to suction a patients airway depends upon the route to be used
but all have common indications, contra-indications and risks associated with them.















14
Technique:

The placement of a suction catheter through the nose, mouth or artificial airway, into
the trachea, to remove secretions by using negative pressure (or suction) as the
catheter is withdrawn. Aseptic technique should be employed and each suction pass
should not last longer than 10 seconds. Suction pressure should be set as low as
possible but be effective to remove secretions.

Catheter type: Large end hole with 2 small opposing side holes ( Odell
et al. 1993), in-built thumb control, centimetre
graduations.

Catheter size: Less than half the diameter of the airway in situ or a size
bigger for oral suction. It is recommended that catheters
used should be vacuum controlled (those with Y-
connector for thumb control).

To calculate the correct suction catheter for the
lumen of the tracheostomy tube, multiply the
tracheostomy tube size by 3 and then divide by 2.

See table 1below.

If for example, a size 8 tracheostomy tube is used,
multiply this by 3 = 24. This total should then be divided
by 2 given a total of 12. Therefore the appropriate
catheter is a size 12. N.B The suction catheter should
have a diameter no greater than half internal diameter of
the tracheostomy tube.

Suction Pressure: 60-120 mm Hg (8-16 kPa), up to 200mm Hg (20 kPa)
may be used for adults, if secretions are very thick.

Pre-oxygenation: If patient is known to be hypoxic please check saturation
levels prior to procedure and consider pre-oxygenation.

Increase inspired oxygen by 10-20% for 1-2 minutes or
for the duration of the procedure.

Depth of catheter insertion: Insert catheter approximately 10-15cm (or less in
tracheostomy tube depending on length of tube,
McKenzie et al. 2008). Enter until a cough is stimulated
or a measured distance 1cm below tip of airway or until
cough is initiated, then withdraw by 1/2cm before suction
applied.

Duration of suctioning: Less than 10 seconds.




15
Table 1

Recommended Size of suction catheter

Endotracheal or
tracheostomy Tube Size
(I.D.)
Recommended
Catheter Size
Catheter
Size (O.D.)
Silver Tube
Size
4.0 4.5 mm 06 CH

2.0 mm
5.0 6.0 mm 08 CH

2.7 mm
6.5 7.0 mm 10 CH

3.3 mm 32
7.5 8.0 mm 12 CH

4.0 mm 34
8.5 9.0 mm 14 CH

4.6 mm 36

N.B. The suction catheter should have a diameter no greater than half internal
diameter of the tracheostomy tube.

Signs of successful outcome/ Assessment of outcome

Results and observations should be recorded in the care plan to inform and alert other
caregivers. The suctioning procedure can be considered successful and the need for
suctioning affirmed by:

Reduced airway secretions
Improvement in breath sounds
Clearing of cough
Improved oxygen saturations reflected in pulse oximetry
Subjective improvement as reported by patient
Decreased respiratory effort
Decreased shortness of breath
Decreased in airway pressure
Clear voice quality

If Unable to Clear Secretions, Consider:

Check efficiency of suction machine
Increase suction vacuum pressure, do not exceed maximum.
Increase suction catheter size
Increase depth of catheter insertion
Increase frequency of suctioning
Repeat postural drainage (and manual techniques if trained)
Saline nebulisers
Seek further advise see appendix D, page 20 for how to contact health
professionals.


16

Appendix D

Equipment

Suction tubing should be flushed by suctioning recently boiled water or sterile water
(to rinse secretions away) from a clean receptacle that is left clean and dry in between
use.
Suction tubing should be changed every 7 days if all secretions can be flushed out. If
the tubing cannot be cleared then it must be changed as appropriately, daily if
required.
Frequency of change should be based on a risk assessment dependent upon usage
and nature of secretions.
Then aspirate air to clean and dry the internal surface of the tubing. The tubing should
always be left free from visible soiling.

Catheters (Wilson 2002)

Yankeur suction catheters can be re-used on the same patient/client provided they are
flushed through after use, thoroughly cleaned using hot water and a general purpose
detergent, rinsed and dried using disposable paper towel, the inside of the catheter
can be dried by aspirating air.
They should be stored clean and dry and protected from any environmental
contamination.
Frequency of change should be based on a risk assessment dependent upon usage
and nature of secretions. In the community this should be on a weekly basis as a
minimum requirement but more often if required.
All other catheters should be single use and used in accordance with manufacturers
guidance.

For Kirklees CHS it is the responsibility of the appropriate District Nursing Team to
ensure that disposables (catheters and tubing) are supplied and replenished.

Suction machine

It is expected that in most circumstances where health care professionals are carrying
out suctioning techniques on patients in the community setting, the suction equipment
will be provided by the Kirklees Integrated Community Equipment Store (KICES).
Only District Nurses can request suction machines from KICES, therefore it is
expected that other health professionals will liaise with the appropriate D/N team for
provision of a suction machine. In the unlikely event that a suction machine is obtained
from another source e.g. MND society then the health professional who has organized
this will ensure the D/N is fully aware of the situation. This may require joint visit by
both health professionals and/ or contact to explain any delay in equipment arriving.
In these circumstances the health care professional who arranges the provision of
such equipment is responsible for:

Checking that the equipment is service and maintained regularly, KICES use
the CarryVax suction Machine.

17
Suction machines must always be serviced according to the manufacturers
instructions. The responsibility for maintenance lies with the department
that has supplied the equipment.
Instructions are sent from KICES for each suction machine at time of delivery.
Machines that are on loan from KICES are on a 6 week, short term loan, thus if
the machine is required for a longer period a request needs to be put to KICES
for Joint Contingency Funding via a proforma for the use of a machine long
term.
The filter requires changing according to the frequency of usage please check
for each patient according to the CarryVax manual (this could be every 12
months) - see page 11 of CarryVax instruction manual. This will be the D/N
responsibility to manage this by liaising with KICES.
If a machine is faulty then KICES need to be made aware as soon as possible, there
is no access to emergency OOH suction machines.

Suction pumps require a weekly clean and should be unplugged prior to the outside of
the machine being cleaned with a well wrung out cloth (do not drench the equipment)
of warm, clean, soapy water. Pumps must not be immersed in water.

When the suction unit is not in use, the bottle must be kept clean and dry and the
catheter should not be connected until it is required. Patients/carers should be
encouraged to cover the machine with a dust proof cover if not in use e.g. clean tea
towel.

When emptying a non-disposable (suction jar) reservoir the following
precautions should be taken.

A disposable plastic apron and disposable non-sterile gloves must be used for
emptying the jar. Eye protection should be used if splashing to the face is an
actual or potential risk and if the patient has a communicable respiratory spread
infection a high filtration FFP2 mask must be worn (this does not include
MRSA).
The jar must be disconnected from the vacuum system, carried carefully to a
toilet and poured gently to minimize splashing to the surrounding environment.
Secretions should be flushed away with copious amounts of water.
The jar should be rinsed and then washed with a General Purpose Detergent
and hot water solution. It must be rinsed again in fresh water and dried with a
disposable paper towel.
A weak solution of sodium bicarbonate may be used to help remove mucous
material.
The bottle should be emptied when 2/3 full. In the community setting,
patients/carers should be encouraged to clean the bottle on a daily basis
irrespective of the amount of aspirate.
The routine use of disinfectants is unnecessary for cleaning suction jars. The
organic matter in the contents will readily inactivate disinfectants, therefore the
addition of disinfectants will only lengthen the process and will be of no
advantage. The only exception to this is when the patient/client has pulmonary
tuberculosis or another infectious diseases. In such cases please contact
Infection control Nurse and KICES to obtain instructions.

18


TRAINING OF HEALTHCARE ASSISTANTS/ LAY PERSON

Where appropriate, this procedure may be taught to lay persons/health care
assistants. Any training of laypersons needs to be undertaken by health care
professionals who deem themselves competent in this area of practice. Any registered
healthcare professional who delegates the task to an unregistered practitioner retains
the accountability for the delegated task, and takes responsibility for the training of a
lay person.

Training should follow these guidelines and should cover:
Indications for suctioning, page 5
Contraindications for suctioning, page 6
Patient preparation and Consent, appendix C, page 11
Signs of a successful outcome, If unable to clear secretions, appendix C page
15
Observation of the required technique, appendix C page 13
Preparation of equipment, Appendix D pages 16/ 17
Performance of the technique under supervision until the individual is
deemed competent




19
Instructions To Be Printed Out For Carers:


Home Oral (yankaeur) Suctioning Guidelines


Look at the machine and ensure all parts of the equipment are clean and intact

Ensure that the unit is charged if using it via the battery
Decide on pressure required normally up to 1250mmHg (20Kpa) is
appropriate although it can be increased up to 150
Wash your hands

Prepare the client:
Explanation of procedure
Obtain consent from the client
Position client appropriately (usually supported lying or sitting)
Plug in machine (if not using on battery)
Wash hands
Put on gloves (optional)
Attach yankauer or suction catheter to suction tubing
Switch on machine and recheck the pressure
Insert yankauer gently into mouth until it reaches the pouch of the cheek, close
over the hole on the yankauer, and then gently sweep over the arch of the
tongue to the pouch of the opposite cheek. See diagram below.
Only cover the hole in the circuit while removing the catheter this completes
the circuit and will then be the only time pressure is applied
Only apply suction through the yankauer for a short period of time
(no longer than 10 seconds) as this might result in tissue grab
causing damage to the sensitive lining of the mouth. Repeat again if
necessary.
Inform GP if secretions are green, thick or more copious





20
Information useful to teach carers or auxiallaries.
Draw an imaginary line from the back teeth on the left to the right and that is as
far as you can pass a yankaeur suction catheter. Oral suction is suction
applied to the mouth area from the back teeth forward. Oral suction should go
NO further than the back teeth.




Cleaning:Once the procedure has been completed, suction through cold, previously
boiled water to flush the system. Then rewash hands.
after flushing the unit and tubing through with clean water empty the collection bottle
daily by disposing of the contents down a toilet
Rewash your hands
Please refer to the manufacturers guidelines for specific information on disassembling
the equipment and more detailed sanitation guidelines for the individual suction unit
model being used
Lisa Emmett, Senior Physiotherapist. Leeds Sleep & Ventilation Service Feb 2010
Contact telephone numbers for health professional advice

24 hour number for District nurses in North Kirklees: 01484 221600
24 hour number for District nurses in South Kirklees: 01484344335
West Yorkshire Urgent Care Direct: 03456059999

21

APPENDIX E

Flow chart for the management of respiratory tract secretions in terminally ill
patients





NO YES



NO








YES

YES NO




YES












YES NO


APPENDIX II

Patient has a life threatening illness and is being
managed palliatively
Patient has respiratory tract
secretions which are causing
distress to patient and/or
family.
Consider need for :
a) Antibiotics help with
thick secretions from actual
infection
b) Diuretics help with heart
failure
Patient at risk of
significant
respiratory tract
secretions.
eg patient with
lung cancer,
head & neck
cancer, heart
failure, etc
Follow suction
guidelines for
non terminally ill
patients
Re-position patient
on side head down
and re-assess
distress.
Distress persists


Observe
Administer hyoscine butylbromide 20 40 mg SC stat. This will
not remove existing secretions but will reduce the production of
more secretions
Re-assess
Distress persists
Consider:
a) Syringe driver with hyoscine
butylbromide 40-60 mg over
24 hours
b) Sedatives Midazolam 5
10 mg SC prn, then 20-30
mg SC over 24 hours
c) Need for suction
Observe and repeat injection
of hyoscine butylbromide 20-
40 mg SC as needed

22
APPENDIX F

Flow Chart Suctioning Patients with a Tracheostomy








Assess the Patient
Patient experiencing difficulty in breathing

Yes No
Obtain Consent

Clean/Change tracheostomy
inner tube if required
Eg Shiley, Trachle Twist Silver
Negus
Normal breathing
No further action
required
Not improved Obtain patient consent
to perform suctioning
Obtain Suctioning
Equipment and prepare
to suction, use
Universal precautions .
Check suction pressure
See Check List


Insert sterile suction catheter,
Withdraw catheter and apply suctioning
continuously for no longer than 15 seconds


Continue to monitor
patient
Unable to insert
suction catheter
If patients condition
deteriorates
Ensure patient comfort
Observe vital signs
Monitor patient to ensure they
return to pre suction status
Phone for ambulance
Tracheostomy may be
blocked/obstructed
Change tracheostomy tube
immediately if competent
Dispose of
clinical waste
Document colour,
amount and
consistency of
secretions
Inform GP if secretions green, thick or
more copious
Repeat if
necessary

23
APPENDIX G
Flow Chart for Suctioning Oro-pharyngeal Secretions









Assess the Patient
Obtain patient consent
Explain length and duration of procedure
Sit patient upright if possible
Obtain suction equipment and prepare to
suction.
Use universal precautions.
Check suction pressure
Gently insert Yankeur sucker into patients
mouth
Occlude hole on sucker to initiate suction
and remove oral secretions. Reduce
suction pressure if required
Stop suctioning and remove Yankeur if
patient is distressed, unless situation is life
threatening.
Document any change in secretions and
inform GP if they become green, thick or
more copious.
Repeat suctioning as per protocol but
ensure that the patient is able to return to
pre suctioning status before you continue.