Which client assessment should the nurse perform during nasopharyngeal suctioning?
Introduction Show
Aim Definition of Terms Indications for insertion of NPA (Medical Patients) Indications for insertion of NPA (Surgical Patients) Contraindications for insertion Assessment Management Insertion / Re-insertion of a NPA (ward setting only) Insertion and Securing of NPA Securement of a NPA (all settings) Ongoing Assessment and Management Documentation Removal of NPA Discharge Planning for patients requiring an NPA at home Complications associated with NPA insertion Special Considerations Evidence Table IntroductionA nasopharyngeal airway (NPA) is a thin, clear, flexible tube that is inserted into a patient’s nostril. The purpose of the NPA is to bypass upper airway obstruction at the level of the nose, nasopharynx
or base of the tongue. It also prevents the tongue falling backward on the pharyngeal wall to prevent obstruction. NPA’s maintain airway patency in patients who are conscious or semi-conscious, they can be used in neonates to adults. AimThe aim of this Clinical Guideline (CG) is to provide a framework for the insertion and management of NPA’s to relieve airway obstruction, in a self-ventilating patient within a medical ward setting and/or for surgical patients postoperatively in the Post Anaesthetic Care Unit (PACU) and surgical ward. Definition of TermsNPA: Nasopharyngeal airway; is a soft, anatomically designed airway adjunct inserted into the nasal passageway to provide airway patency. Upper Airway Obstruction: Upper airway obstruction above the level of the larynx results in a failure of airflow into the lungs, despite adequate inspiratory effort. Increasing respiratory effort can worsen the obstruction, as increased intra-thoracic pressure collapses the soft tissue structures inwards. OSA: Obstructive Sleep Apnoea PACU: Post Anaesthetic Care Unit OT: Operating Theatre EMR: Electronic Medical Record ENT: Ear, Nose, Throat Micrognathia: is a condition in which the jaw is undersized. It is a symptom of a variety of craniofacial conditions. Sometimes called mandibular hypoplasia Glossoptosis: An abnormal posterior placement of the tongue, which may occlude the airway WOB: work of breathing PPE: Personal Protective Equipment Stertor: noisy, snoring-like breathing resulting from obstruction in the naso- or oropharynx Indications for insertion of NPA (Medical Patients)MEDICAL PATIENTS: A patient’s bed card team should determine whether a NPA is required and order accordingly, ensuring the appropriate size and length are included. Common indications for patient’s in a ward setting:
Indications for insertion of NPA (Surgical Patients)Elective Nasopharyngeal Airway Insertion: NPA’s are inserted at the end of surgery when the patient is anaesthetised. This enables the NPA to be inserted under direct vision to the correct length. NPA’s are commonly inserted electively at the end of surgery to prevent problems with postoperative airway obstruction, including:
Children who have a NPA inserted intra/postoperatively, generally only require it for the first postoperative night. It is then removed the next day as directed by the bed card team. Insertion postoperatively in PACU:
If an NPA is accidentally removed, reinsertion should only be done after consultation with surgical team, to avoid damaging the operative site. Contraindications for insertion:(ward setting only, does not inc lude NPA’s inserted in surgical patients in OT/Recovery)
Assessment
ManagementInsertion / Re-insertion of a NPA (ward setting only)A patient’s bed card team should determine whether a NPA is required and order accordingly, ensuring the appropriate size and length are included. Insertion and Securing of NPA :
The tube should pass to just below the level of the soft palate and should be checked with a light and tongue depressor - in case it is too long (causes gagging) or too short (may not bypass the obstruction). If you are unable to insert the NPA, STOP, do not force, and escalate to medical/senior nursing team for assistance.
Securement of a NPA (all settings)
Figure 1:
Ongoing Assessment and Management:Initially after insertion of the NPA the child may need to be suctioned more than normal, as there will be mucus in the nose and pharynx. This should settle, if it does not seek medical review.
Suctioning of the NPA tube is necessary to remove excess mucous, secretions (and blood for postoperative patients) to maintain a patent airway and avoid tube blockage.
Additional Indications for suctioning:
* follow local medical emergency response procedure, if clinically indicated (signs of respiratory distress). For further assessment information please see the Nursing Assessment guideline. Documentation
Removal of NPAPrior to removing NPA assess and document vital signs including a full respiratory assessment Respiratory Assessment in the Nursing Assessment Guideline. A patient who has had an NPA inserted postoperatively will require a surgical team review prior to removal.
Discharge Planning for patients requiring an NPA at home
Table 1: Recommended suction catheter sizes:
Complications associated with NPA insertion:
Special Considerations
Evidence TableThe evidence table for this guideline can be viewed here. Please remember to read the disclaimer. The development of this nursing guideline was coordinated by Lauren Jorgensen, CNS, and Casey Clarke, CSN, Sugar Glider, and approved by the Nursing Clinical Effectiveness Committee. First published August 2022. When preparing a patient for nasopharyngeal suctioning which steps should be performed?Moisten the catheter by dipping it into the container of sterile saline. Occlude the suction valve on the catheter to check for suction. Encourage the patient to take several deep breaths. Apply lubricant to the first 2 to 3 inches of the catheter, using the lubricant that was placed on the sterile field.
How can you perform an assessment of the need for suctioning?Prior to suctioning, a baseline assessment for indications of respiratory distress and the need for suctioning should be obtained and documented, including, but not limited to, the following: Secretions from the mouth and/or tracheal stoma. Auscultation of lung sounds. Heart rate.
What should be monitored while suctioning?Vitals should be monitored continuously, including heart rate, oxygen saturation, and intracranial pressure if transduced. Each pass should be less than 15 seconds in duration, and the patient should be allowed to recover between suction passes.
When suctioning What should the assessment of outcome be?The adequacy of suctioning can be assessed by the clearance of secretions, improved breath sounds, improved air entry, good pulse oximetry readings, and improvement in respiratory distress in a patient.
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