Name:_______________________________Date:_____________Section/Group:_____

Oropharyngeal and Nasopharyngeal and Nasotracheal

Suctioning CHECKLIST
Legend:
3-Very Satisfactory 0- Did not perform the procedure
2- Satisfactory 1- Needs Improvement
PREPARATION 3 2 1 0

PURPOSES
• To remove secretions that obstruct the airway

• To facilitate ventilation

• To obtain secretions for diagnostic purposes

• To prevent infection that may result from accumulated

secretions

1 ASSESSMENT
Assess for clinical signs indicating the need for
suctioning: • Restlessness, anxiety

• Noisy respirations

• Adventitious (abnormal) breath sounds when the chest is

auscultated
• Change in mental status

• Skin color

• Rate and pattern of respirations

• Pulse rate and rhythm

• Decreased oxygen saturation

2 Assemble Equipment:
For Oral and Nasopharyngeal/Nasotracheal Suctioning
(Using Sterile Technique):
• Towel or moisture-resistant pad

• Portable or wall suction machine with tubing, collection

receptacle, and suction pressure gauge
• Sterile disposable container for fluids

• Sterile normal saline or water

• Goggles or face shield, if appropriate

• Moisture-resistant disposal bag

• Sputum trap, if specimen is to be collected

For Oral and Oropharyngeal Suctioning (Using

Clean Technique):
• Yankauer suction catheter or suction catheter kit

• Clean gloves

Nasopharyngeal or Nasotracheal Suctioning (Using

Sterile Technique):
• Sterile gloves

• Sterile suction catheter kit (#12 to #18 Fr for adults, #8 to

#10 Fr for children, and #5 to #8 Fr for infants)
• Water-soluble lubricant

• Y-connector

PROCEDURE

1 Introduce self and verify the client’s identity using agency

protocol. Explain to the client what you are going to do, why
it is necessary, and how he or she can participate. Inform the
client that suctioning will relieve breathing difficulty and that
the

procedure is painless but may be uncomfortable and

stimulate the cough, gag, or sneeze reflex.

2 Perform hand hygiene and observe other appropriate

infection prevention procedures.

3 Provide for client privacy.

4 Prepare the client:

Position a conscious person who has a functional gag reflex in the

semi-Fowler’s position with the head turned to one side for oral
 suctioning or with the neck hyperextended for nasal suctioning.

Position an unconscious client in the lateral position, facing you.

Place the towel or moisture-resistant pad over the pillow or under

the chin.

5 Prepare the equipment

Turn the suction device on and set to appropriate negative

pressure on the suction gauge.

For Oral and Oropharyngeal Suction

Apply clean gloves.

Moisten the tip of the Yankauer or suction catheter with sterile

water or saline.

Pull the tongue forward, if necessary, using gauze.

Do not apply suction (that is, leave your finger off the port) during
insertion.

Advance the catheter about 10 to 15 cm (4 to 6 in.) along one side

of the mouth into the oropharynx.

It may be necessary during oropharyngeal suctioning to apply

suction to secretions that collect in the mouth and beneath the
tongue.

Remove and discard gloves.

Perform hand hygiene.

For Nasopharyngeal and Nasotracheal Suction

Open the lubricant.

Open the sterile suction package.

a. Set up the cup or container, touching only the
outside. b. Pour sterile water or saline into the
container.
c. Apply the sterile gloves, or apply an unsterile glove on
the nondominant hand and then a sterile glove on the
dominant hand.

With your sterile gloved hand, pick up the catheter and attach it to
the suction unit

6 Make an appropriate measure of the depth for the insertion of the catheter,
and test the equipment.

Measure the distance between the tip of the client’s nose and
earlobe.

Mark the position on the tube with the fingers of the sterile-gloved
hand.
 Test the pressure of the suction and the patency of the catheter by
applying your sterile gloved finger or thumb to the port or open
branch of the Y-connector (the suction control) to create suction.

If needed, apply or increase supplemental oxygen

7 Lubricate and introduce the catheter.

Lubricate the catheter tip with sterile water, saline, or water-

soluble lubricant. Rationale: This reduces friction and eases
insertion.

Remove oxygen with the nondominant hand, if appropriate.

Without applying suction, insert the catheter into either naris and
advance it along the floor of the nasal cavity.

Never force the catheter against an obstruction. If one nostril is

obstructed, try the other

8 Perform suctioning.

Apply your finger to the suction control port to start suction, and
gently rotate the catheter.

Apply suction for 5 to 10 seconds while slowly withdrawing the

catheter, then remove your finger from the control and remove the
catheter.

A suction attempt should last only 10 to 15 seconds. During this

time, the catheter is inserted, the suction applied and
discontinued, and the catheter removed.

9 Rinse the catheter and repeat suctioning as above.

Rinse and flush the catheter and tubing with sterile water or saline.

Relubricate the catheter, and repeat suctioning until the air

passage is clear.

Allow sufficient time between each suction for ventilation and

oxygenation. Limit suctioning to 5 minutes in total.

Encourage the client to breathe deeply and to cough between

suctions. Use supplemental oxygen, if appropriate

10 Obtain a specimen if required. Use a sputum trap as follows:

a. Attach the suction catheter to the tubing of the sputum trap

b. Attach the suction tubing to the sputum trap air vent.

. c. Suction the client. The sputum trap will collect the mucus
during suctioning.

d. Remove the catheter from the client. Disconnect the sputum

trap tubing from the suction catheter. Remove the suction tubing
from the trap air vent.
 e. Connect the tubing of the sputum trap to the air vent.

Connect the suction catheter to the tubing.

Flush the catheter to remove secretions from the tubing.

11 Promote client comfort

Offer to assist the client with oral or nasal hygiene.

Assist the client to a position that facilitates breathing.

12 Dispose of equipment and ensure availability for the next suction.

Dispose of the catheter, gloves, water and waste container. Wrap

the catheter around your sterile gloved hand and hold the
catheter as the glove is removed over it for disposal.

Rinse the suction tubing as needed by inserting the end of the

tubing into the used water container. Empty and rinse the suction
collection container as needed or indicated by protocol. Change
the suction tubing and container daily.

Perform hand hygiene.

Ensure that supplies are available for the next suctioning.

13 Assess the effectiveness of suctioning

Auscultate the client’s breath sounds to ensure they are clear of

secretions.

Observe skin color, dyspnea, level of anxiety, and oxygen

saturation levels.

14 Document relevant data.

Record the procedure:

• The amount, consistency, color, and odor of sputum (e.g.,

foamy, white mucus; thick, greentinged mucus; or blood
flecked mucus) and the client’s respiratory status before
and after the procedure.
• This may include lung sounds, rate and character of
breathing, and oxygen saturation.
• The frequency of the suctioning must be recorded.

For the next items, evaluate the students in general according to the criteria. (5 as
the highest score)
5 4 3 2 1

Mastery
 Orderliness

Proper attitude in assessing the client followed.

Ability to answer questions

Proper reporting observed.

Student’s Name and Signature:

_____________________________________________ Evaluator’s Name and

Signature: ___________________________________________

Comments:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Name:_______________________________Date:_____________Section/Group:_____

Suctioning a Tracheostomy or Endotracheal Tube

CHECKLIST
Legend:
3-Very Satisfactory 0- Did not perform the procedure
2- Satisfactory 1- Needs Improvement
PREPARATION 3 2 1 0

PURPOSES
• To maintain a patent airway and prevent airway obstructions

• To promote respiratory function (optimal exchange of oxygen

and carbon dioxide into and out of the lungs)
• To prevent pneumonia that may result from accumulated
secretions

1 ASSESS:
• Assess the client for the presence of adventitious (abnormal)
breath sounds.
• Assess the client’s cough reflex and note the client’s ability
or inability to remove the secretions through coughing.

2 Assemble Equipment:
• Resuscitation bag (bag valve mask) connected to 100%
oxygen
• Sterile towel (optional)

• Equipment for suctioning

• Goggles and mask (if necessary)

• Gown (if necessary)

• Sterile gloves
 • Moisture-resistant bag

PROCEDURE

1 Introduce self and verify the client’s identity using agency

protocol. Explain to the client what you are going to do, why
it is necessary, and how he or she can participate. Inform the
client that suctioning usually causes some intermittent
coughing and that this assists in removing the secretions.

2 Perform hand hygiene and observe other appropriate

infection prevention procedures.

3 Provide for client privacy.

4 Prepare the client.

If not contraindicated, place the client in the semi-Fowler’s
position to promote deep breathing, maximum lung expansion,
and productive coughing.

If necessary, provide analgesia before suctioning.

5 Prepare the equipment

Attach the resuscitation apparatus to the oxygen source. Adjust

the oxygen flow to 100%.

Open the sterile supplies:

a. Suction kit or catheter
b. Sterile basin/container.

Pour sterile normal saline or water into sterile basin.

Place the sterile towel, if used, across the client’s chest below the
tracheostomy.

Turn on the suction, and set the pressure in accordance with

agency policy.

Apply goggles, mask, and gown if necessary.

Apply sterile gloves

Holding the catheter in the dominant hand and the connector in

the nondominant hand, attach the suction catheter to the suction
tubing.

6 Flush and lubricate the catheter

Using the dominant hand, place the catheter tip in the sterile
saline solution.

Using the thumb of the nondominant hand, occlude the thumb

control and suction a small amount of the sterile solution through
the catheter.

7 If the client does not have copious secretions, hyperventilate the lungs with
 a resuscitation bag before suctioning.

Summon an assistant, if one is available, for this step.

Using your nondominant hand, turn on the oxygen to 12 to 15

L/min.

If the client is receiving oxygen, disconnect the oxygen source

from the tracheostomy tube using your nondominant hand.

Attach the resuscitator to the tracheostomy or endotracheal tube

(ETT).

Compress the Ambu bag three to five times, as the client inhales.

Observe the rise and fall of the client’s chest to assess the
adequacy of each ventilation.

Remove the resuscitation device and place it on the bed or the

client’s chest with the connector facing up.

Variation: Using a Ventilator to Provide Hyperventilation

If the client is on a ventilator, use the ventilator for hyperventilation

and hyperoxygenation.

8 If the client has copious secretions, do not hyperventilate with a

resuscitator. Instead:

Keep the regular oxygen delivery device on and increase the liter
flow or adjust the FiO2 to 100% for several breaths before
suctioning.

9 Quickly but gently insert the catheter without applying any suction.

With your nondominant thumb off the suction port, quickly but
gently insert the catheter into the trachea through the
tracheostomy tube.

Insert the catheter about 0.5 to 1 cm past the distal end of the
tube for an open system, and 1 to 2 cm past the distal end for a
closed system (Nance-Floyd, 2011) or until the client coughs. If
you feel resistance, withdraw the catheter about 1 to 2 cm (0.4 to
0.8 in.) before applying suction

10 Perform suctioning.

Apply suction for 5 to 10 seconds by placing the nondominant

thumb over the thumb port.

Rotate the catheter by rolling it between your thumb and

forefinger while slowly withdrawing it.

Withdraw the catheter completely, and release the suction.

Hyperventilate the client.

Suction again, if needed.

11 Reassess the client’s oxygenation status and repeat suctioning.

 Observe the client’s respirations and skin color. Check the client’s
pulse if necessary, using your nondominant hand. If the client is
on a cardiac monitor, assess the rate and rhythm.

Encourage the client to breathe deeply and to cough between

suctions.

Allow 2 to 3 minutes with oxygen, as appropriate between

suctions when possible.

Flush the catheter and repeat suctioning until the air passage is
clear and the breathing is relatively effortless and quiet.

After each suction, pick up the resuscitation bag with your

nondominant hand and ventilate the client with no more than three
breaths.

12 Dispose of equipment and ensure availability for the next suction.

Flush the catheter and suction tubing.

Turn off the suction and disconnect the catheter from the suction
tubing.

Wrap the catheter around your sterile hand and peel the glove off
so that it turns inside out over the catheter. Remove the other
glove.

Discard the gloves and the catheter in the moisture- resistant bag.

Perform hand hygiene.

Replenish the sterile fluid and supplies so that the suction is ready
for use again.

Be sure that the ventilator and oxygen settings are returned to

presuctioning settings.

13 Provide for client comfort and safety.

Assist the client to a comfortable, safe position that aids breathing.

If the person is conscious, a semi-Fowler’s position is frequently
indicated. If the person is unconscious, Sims’ position aids in the
drainage of secretions from the mouth.

14 Document relevant data.

Record the suctioning, including the amount and description of

suction returns and any other relevant assessments.

Variation: Closed Airway/Tracheal Suction System (In-Line Catheter)

PROCEDURE

If a catheter is not already attached, apply clean gloves,

aseptically open a new closed catheter set, and attach the
ventilator connection on the T piece to the ventilator tubing.
Attach the client connection to the ETT or tracheostomy.
 Attach one end of the suction connecting tubing to the suction
connection port of the closed system and the other end of the
connecting tubing to the suction device.

Turn suction on, occlude or kink tubing, and depress the suction
control valve (on the closed catheter system) to set suction to the
appropriate level. Release the suction control valve.

Use the ventilator to hyperoxygenate and hyperinflate the client’s

lungs.

Unlock the suction control mechanism if required by the

manufacturer.

Advance the suction catheter enclosed in its plastic sheath with

the dominant hand. Steady the T piece with the nondominant
hand.

Depress the suction control valve and apply continuous suction

for no more than 10 seconds and gently withdraw the catheter.

Repeat as needed remembering to provide hyperoxygenation and

hyperinflation as needed.

When completed suctioning, withdraw the catheter into its sleeve

and close the access valve, if appropriate.

Flush the catheter by instilling normal saline into the irrigation port
and applying suction. Repeat until the catheter is clear.

Close the irrigation port and close the suction valve.

Remove and discard gloves.

Perform hand hygiene.

For the next items, evaluate the students in general according to the criteria.
(5 as the highest score)
5 4 3 2 1

Mastery

Orderliness

Proper attitude in assessing the client followed.

Ability to answer questions

Proper reporting observed.

Student’s Name and Signature:

_____________________________________________ Evaluator’s Name and

Signature: ___________________________________________

Comments:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________