Nasotracheal Suctioning - An Overview

Introduction

Nasotracheal suctioning is a unique technique where the catheter is inserted through the nasal cavity as a route into the trachea through the larynx. The suction catheter used in this method is a straight and round distal tip that does not cause trauma. It is a basic skill but also a life-saving technique. This procedure can bring a difference in an individual’s outcome who is affected.

What Is Nasotracheal Suctioning?

Secretions of the bronchi are usually transported through the mucociliary transport mechanism. When this mechanism does not work, the only mechanism left to send secretions out is the cough reflex.

In the ICU setting, individuals generally have more secretions and a depressed cough reflex. Various methods like postural, vibrating, breathing, and tracheobronchial suctioning are used to mobilize secretions. Tracheobronchial suctioning is an invasive method to remove secretions in conditions like physical distress or physiological impairment.

NTS is a blind technique used to remove secretions similar to a difficult airway management technique in which a gum elastic bougie (tracheal tube introducer) with coude (curved tip distally round bougie introducer) angled tip is blindly inserted into the trachea.

What Are the Indications of NTS?

NTS is used to clear the secretions when an individual cannot use the cough reflex to remove the secretions. Indications of NTS include

• When there is an audible secretion present in the upper airway.

• Signs showing inadequate ventilation.

• To maintain the routine airway.

• Individuals with difficulty in breathing, restlessness, and discomfort.

• Individuals with changes in respiratory rate, heart rate, oxygen saturation, skin color, and perfusion.

What Are the Contraindications of NTS?

Contraindications of NTS include

• Occlusions present in nasal passages.

• Bleeding or trauma to the nose.

• Fractures and surgeries of the nose occurred recently.

• If coagulation time is increased due to blood thinners.

• In the case of bleeding disorders.

• Coiling of catheters due to frequent insertion.

• In the case of epiglottitis or croup (inflammation of the larynx and trachea in children).

• Injuries to head and neck.

• Bronchospasm.

How Is NTS Performed?

When an individual cannot remove secretions through a cough reflex, suctioning is required to clear the airway. The method of suctioning depends on the area to be cleared and whether an individual has artificial ventilation.

Materials Required For NTS:

In-wall or portable suction ( vacuum source), regulator ( to adjust suction strength), collection vessel, suction tubing, flexible catheter, sterile gloves, normal saline, sterile water, and local anesthetic is used.

Procedure:

• The procedure should be carried out in a sterile environment.

• Examine the individual, explain the procedure and why it is being performed, and position the patient in a semi-Fowler’s position.

• Take the catheter and sterile it with saline and hold it in a sterile gloved hand and connect it to the suction supply tubing using a sterile technique.

• Ventilate an individual with oxygen using a manual resuscitator or a ventilator. Ventilate an individual for about 10 breaths or 15 seconds with 100 percent oxygen.

• Disconnect the manual resuscitator.

• Hold the catheter in such a way that the natural curve is aligned with the artificial airway. Gently insert the catheter into the airway till the slight obstruction is felt without suction. Then withdraw 0.5 centimeters, and apply suction at irregular intervals, rotating the catheter between the thumb and forefinger. Suction for no more than five seconds.

• Repeat the procedure as required.

How to Monitor the Individual Undergoing NTS During and After the Procedure?

Special care should be taken for an individual undergoing this procedure.

• Vital signs should be monitored before and after the procedure.

• Attention must be given to the breath sounds.

• Observe the amount of secretion, changes in color, consistency, signs of mucosal trauma, or blood after the suctioning procedure.

• Observe for the changes with a pulse oximeter and intracranial pressure during and after the procedure also.

• Evaluate the pain level in an individual.

• Observe for adverse reactions like bradycardia and laryngospasm.

What Are the Complications of NTS?

NTS is considered a routine procedure that saves lives, but it is not devoid of risks or complications.

1. Hypoxia: It is one of the important risks expected in suctioning procedure. This occurs due to

• Stimulation of vagus nerve by suctioning equipment.

• When the suction is not effective and does not remove any obstruction in the airway.

• Airway trauma may be caused due to suctioning machine.

• Blockage of the airway due to suctioning equipment or long suctioning.

The risk of hypoxia can be reduced by preoxygenation of an individual before doing suctioning.

Should not be suctioned for longer than 15 seconds. In case of suction failure, before suctioning again, preoxygenate an individual.

2. Airway Trauma: Damage to the airway may occur very easily.

• Use of inappropriate size of the catheters.

• Hurriedly conducted procedure.

• While performing the procedure on children and old aged people.

This risk can be overcome by making use of smaller types of equipment and taking enough time to perform the procedure.

3. Psychological Trauma: Individuals may experience psychological trauma, especially children, individuals with dementia, mental health issues, and those with difficult airways.

This risk can be avoided by keeping calm, being gentle, and reassuring the individuals and by gaining the trust of the individual undergoing the procedure.

4. Infection: The airway is prone to a wide variety of contaminants. Hence suctioning machine should be kept neat, and personnel with infection should not do suctioning. Before and after the procedure, all members of the operating team must wash their hands.

5. Bradycardia (Slow Heart Rate): During suctioning, there may be stimulation of the vagus nerve, which results in fainting of an individual or loss of consciousness.

To overcome the risk, history is to be asked, and vital signs are to be maintained during the procedure.

Conclusion:

The airway is important for one to breathe. Without breathing, life cannot exist. Hence one should take care of their airway and know about the disorders related to the airway and procedures to treat these diseases. If airway discomfort occurs, quality of life also gets affected. Hence knowing about this becomes important, and taking action to resolve the problems at the earliest.