5.9 Oropharyngeal Suctioning

Critical Thinking Exercises: Questions, Answers, and Sources / References

1. Name 4 potential complications of oropharyngeal suctioning.

Answer: laryngospasm, hypoxia, trauma, increased intracranial pressure for persons with head injury, cardiac dysrhythmias and death

Sources: Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical nursing skills & techniques (9th ed.). St. Louis: Elsevier-Mosby.

Strickland, S et al. (2013). American Association of Respiratory Care (AARC) clinical practice guideline: effectiveness of nonpharmacologic airway clearance therapies in hospitalized patients. https://www.aarc.org/wp-content/uploads/2014/08/nonpharmacologic_2013.pdf

2. Why is oropharyngeal suctioning treated as a sterile procedure?

Answer: because the suction catheter is being inserted into the trachea there is risk of introducing microorganisms into the lungs. Sterile procedure reduces the risk.

Source: Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical nursing skills & techniques (9th ed.). St. Louis: Elsevier-Mosby.

1. The difference(s) between oral and oropharyngeal suctioning is / are: Select all that apply

• Depth of suctioning Answer: yes. Oral suctioning involves the mouth. Oropharyngeal suctioning involves suctioning at the back of the mouth into the pharynx and sometimes in to the trachea. 
• Risk of respiratory infection. Answer: yes. Oral suctioning only involves the mouth therefore there is no increased risk of respiratory infection. 
• Risk of bradycardia Answer: yes. Oropharyngeal suctioning may result in stimulating a vasovagal response resulting in bradycardia. 
• One is a clean procedure one is sterile Answer: yes. Oral suctioning is a clean procedure. Oropharyngeal suctioning is considered sterile because sometimes the suction catheter enters the trachea. 
• Risk of hypoxia Answer: yes. Oral suctioning considerations do not involve risk of hypoxia. Oropharyngeal suctioning considerations do involve risk of hypoxia 

Source: Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical nursing skills & techniques (9th ed.). St. Louis: Elsevier-Mosby.

2. Baljit, age 89 has had a stroke. She is non responsive, drooling and has audible course breath sounds. She is unable to clear her secretions. The nurse makes the decision to perform oral pharyngeal suctioning. What are the risks associated with this procedure? Select all that apply.

• Laryngospasm Answer: true. Introduction of a suction catheter into the trachea can induce laryngospasm.
• Trauma to the nasal mucosa Answer: false. The route chosen is the oral tracheal route.
• Hypoxia Answer: true. Suctioning can result in removing oxygen out of the airway leaving less available to the patient . continual monitoring with pulse oximetry may be indicated.
• Bradycardia: Answer: true. Introduction of a suction catheter into the trachea can induce a vasovagal response resulting in bradycardia. Extreme: cardiac arrest

Source: Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical nursing skills & techniques (9th ed.). St. Louis: Elsevier-Mosby.

AARC. (2004). Nasotracheal suctioning—2004 revision and update. Respiratory Care, 49(9), 1080-1084.  https://www.aarc.org/wp-content/uploads/2014/08/09.04.1080.pdf.

3. Laryngospasm can be characterized by all of the following except: Select all that apply.

• Coughing Answer: incorrect. Laryngospasm can result in airway obstruction
• Dyspnea Answer: incorrect. Laryngospasm can result in airway obstruction
• Increased secretions Answer: Correct. Increased secretions are not a characteristic of laryngospasm
• Hypoxia Answer: incorrect. Laryngospasm can result in airway obstruction
• Anxiety Answer: incorrect. Laryngospasm can result in airway obstruction

Source: Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical nursing skills & techniques (9th ed.). St. Louis: Elsevier-Mosby.

4. Discuss the following statement: suctioning should be done as rarely as possible and as frequently as needed.

Answer: suctioning has risks associated with it ( laryngospasm, hypoxia, trauma, increased intracranial pressure for persons with head injury, cardiac dysrhythmias and death) but to not suction someone who cannot clear their own secretions puts them at risk for impaired oxygenation which also has risks including hypoxia, cellular death

Source: Cordero, L. Sananes, M. and Ayers, L.W. (2001) A comparison of two airway suctioning frequencies in mechanically ventilated, very low-birthweight infants. Respiratory Care, 46(8): 783-788. Cited in http://www.olchc.ie/Healthcare-Professionals/Nursing-Practice-Guidelines/Suctioning-Guideline-Sept-2017.pdf