Oral suctioning

Welcome to this oral suction training video, this presentation will cover oral suctioning. The objectives of the session is to recognize and select appropriate equipment; to understand the risks of suctioning and not doing suction and to demonstrate good technique. It's also important to recognize and maintain a child or young person's dignity throughout the procedure.

The aims of the session are to provide safe suctioning, to lessen the risks to the child and young person and prevent the introduction of infection, to lessen the discomfort of the procedure and to recognize when suction is and is not appropriate.

What is your suction? Oral suction is suction that is applied to the mouth only. The suction catheter should not go further back than the teeth in children or the end of the buckle space in babies. The purpose of oral suctioning is to maintain a patent airway and to improve oxygenation by removing mucus secretions and foreign material, such as vomit or gastric secretions, from the mouth.

So who might need or suction? Children and young people who have an inability to clear their secretions, my need to have oral suctioning. They may be unable to clear their secretions due to having an ineffective cough. They may be fatigued or have an acute illness, have muscular weakness or an impaired swallowing, or may be agitated due to cerebral irritation.

There are different types of suction machine, and this is dependent on your child's provider as to which one your child will have. It's important to know how to use your child's specific device.

The equipment: handwashing facilities, a suction machine in good working order, suction tubing, suction catheters and a yankauer sucker if necessary, charges, both the mains and a transducer, gloves and apron, cooled boiled water and a waste bag.

Suction machines: They need to have a PAT test number, this is a portable appliance test, and this evidences that the equipment has been tested for electrical safety. This must be in date. A pressure gauge or dial, an intact collection jar and suction liner if needed, a charger, suction tubing and a carrier bag should all be present. Checking the suction machine. This is a really important step to ensure the safety of the child. Check the charge levels by turning on the machine and if the battery light is on, make sure the machine is placed on charge immediately. The child must not be taken out without a charge suction machine if they require suctioning as part of their routine care. It must be ready for use at all times. Inspect the machine, are all the parts clean and intact? Check the tubing and the yankauer sucker. The tubing can be replaced weekly or when dirty and yankauer suckers are replaced daily. Ensure the charger and transducer are available. If using a Clario machine set the pressure to a minimum. If using a Leardal machine, turn the dial to the required pressure.

Here are some appropriate suction pressures to set your machine to depending on the age of your child. 

Catheter or yankauer sucker. This is usually decided by the child's Physiotherapist and hospital. Yankauers have a wide bore and are firmer, but there is more risk of trauma to the mucosa of the mouth because of this. Suction catheters are soft and flexible, so there's less risk of trauma, but there may be a risk that these can be passed further into the mouth and you are competent to do so. If using a yankauer sucker, the same one can be used as long as it is kept clean and dry. Renew the yankauer every 24 hours to reduce the risk of infection.

We need to assess the need for suction. We need to check the child's care plan as this is very individualized. But some common signs and symptoms are excessive secretions; the child having a weak or ineffective cough; drooling or gastric secretions in the mouth, you might hear a gurgling sound; the child might have decreased oxygen levels with increased secretions; you might hear bubbling sounds, or the child may have trouble breathing, so they might become pale or cyanosed; have an increased breathing rate, or become restless. Here's a picture of the mouth.

Draw an imaginary line across the back of the teeth from left to right. This is as far as you can safely pass a suction catheter or yankauer. 

Suction guide. Use equipment from the care plan only. Keep the child and young person informed about what you're going to do. Explain what's happening to the child in a language that they understand. This is to help reduce anxiety and distress and prepare them for the procedure. We need to always gain consent for the procedure. We're going to use long strokes for the suctioning, and this shouldn't take more than a few seconds for each suction.

We need to allow time for the child to have some breaths in between each suction, and then we're going to reassess with the need for further suctioning. The suction must only be applied when removing the suction, if using a suction catheter. Be aware of the gag reflex. This can cause a child or young person to vomit if the catheter or yankauer pass too far. Vomit will need to be cleared in order to maintain the young person's airway. 

Suctioning procedure. This is a practical skill, so please follow the procedure shown. Wash your hands and put on gloves and an apron, attach the suction catheter or yankauer sucker to the suction tubing. Make sure the suction catheter does not touch anything to reduce the risk of infection. Turn on the machine. Holding your catheter in the dominant hand, gently insert into the oral cavity. Include the section port and steadily withdraw the catheter. Do not exceed ten seconds in doing this to reduce discomfort and minimize desaturation. Stop if the child or young person shows any signs of distress. Work from the back of the mouth to the front.

Assess if suctioning has been successful at removing secretions. Repeat if necessary. Dip the tip of the suction catheter or yankauer into water, include the suction port and suction, to flush the tube. Turn off the machine. Remove the suction catheter into a gloved hand. Remove gloves and aprons. And dispose into the waste. Signs of successful suctioning. The child or young person would appear more comfortable, their breathing pattern has returned to normal and they might have improved oxygen saturations if you're monitoring them. They would have had an improved colour and breath sounds and their chest movement will have normalized. The audible secretions that we can hear will have gone. If you have any questions, please contact us. Thank you for listening.