Aspiration of nasopharyngeal secretions

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Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

• Create the right moment: integrate the care in a routine.
• Alert your child to the needed care and communicate together.
• Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

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Summary:

• Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
• Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
• Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

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Summary 3 key concepts:

• Safety: Carefully follow the care practice steps as you have been taught.
• Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
• Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

• Use a flat work surface that has been properly cleaned.
• Gather the material required.
• Leave the catheter in its envelope. Open one end of the envelope if using a new catheter.
• Pour cooled boiled water or sterile water into a clean container.
• Check that the canister for collecting secretions is correctly installed on the suction device and that it is less than ¾ full.
• Connect the suction tubing to the suction device.
• If you are using a water-soluble lubricant, then open the pouch and squeeze a small amount onto a non-sterile compress, as recommended by your healthcare team.

This step ensures the safety and the continuity of the procedure.

• Switch on the suction device.
• Adjust the pressure setting, following the directions of the healthcare team.

This step ensures that the correct pressure setting is used.

An excessively high pressure may damage the fragile lining of the mouth.

A pressure that is too low may be ineffective in suctioning secretions.

• Take the free end of the suction tubing in one hand.
• With the other hand, connect the tip of the catheter to the suction tubing, taking care to keep the catheter in its protective envelope.

By connecting the catheter in this way, the tip stays clean, reducing contamination with bacteria.

• Place your child in a comfortable position that easily allows you to perform this care.
• If your child is in a sitting or semi-sitting, gently extend your child’s head, with the chin in a slightly raised position.
• The procedure can also be done with your child in the lying position.

The semi-seated position is preferred, if possible.

With the head slightly extended, the catheter can be more easily inserted.

• Remove the suction catheter from the protective envelope without touching the tip of the catheter (the portion of the catheter that will go in the nose).
• Holding the catheter in the middle, dip the tip of the catheter into the lubrication solution (either cooled boiled water or sterile water) in order to aspirate a small amount of water.
• At the same time as you dip the catheter into the solution, close the valve with your thumb to create a vacuum effect and then remove your thumb to release the suction.

• Check that the water has been sucked into the catheter.
• Confirm that the pressure level indicated on the device is matched to the values recommended by the healthcare team.
• Remove the tip of the catheter from the water container.
• If you are using a water-soluble lubricant: dip the tip of the catheter in the lubricant that you squeezed out onto a compress; follow the recommendations of your healthcare team.
• Keep the catheter in your hand, taking care that the tip does not touch anything.

This step ensures that the catheter works and is lubricated.

This also verifies that there is no air leak in the aspiration device and that the pressure is correctly set.

Avoid contamination of the catheter by not touching the tip of the catheter with your hands.

Lubricating the catheter facilitates insertion in the nose and reduces irritation.

• Identify the maximal insertion length point on the catheter, using your previous measurements for the reference point.
• Ask your child to take slow deep breaths, if possible.
• Without blocking the suction valve, quickly but gently insert the catheter into one of your child’s nostrils, ideally when your child takes a breath in.
• Continue to gently insert the catheter, following the inside wall of the nose.
• Without blocking the suction valve, insert the catheter to the reference point as previously determined; this number on the catheter should align with the outside edge of the nostril.
  
• Ask your child to cough, if possible.
• If you experience resistance while attempting to insert the catheter:
  • Do not force insertion; remove the catheter and gently re-insert either in the same nostril or the other one.
  • Make sure that the catheter does not go into the mouth; if this happens, remove the catheter and re-insert it, directing it towards the back of the throat.

This method minimizes the risk of injury to the lining of the nose and pharynx.

Taking a deep breath during the insertion of the catheter can help your child stay calm, facilitate insertion of the catheter and the passage of air into the lungs.

Coughing helps secretions move upwards in the airways towards the pharynx, facilitating removal.

• While withdrawing the catheter gently but quickly with one hand, intermittently close the suction valve with the thumb of your other hand.
• Rotating the catheter during withdrawal (by rolling it between your thumb and index finger) can be helpful in aspirating secretions; check with your healthcare team to see if this recommended for your child.
• Each aspiration session should not last more than 15 seconds or as tolerated by your child.
• After the aspiration, ask your child to take regular breaths to recover from the procedure.
• Wipe excess secretions from the mouth and nose with a paper tissue, if required.

Intermittent suction avoids injury to the lining of the pharynx and nose.

Aspiration of secretions from the nasopharynx should be brief as it removes air from the airways at the same time.

• Wipe the outside of the catheter using a non sterile gauze or compress to remove secretions.
• Dip the tip of the catheter into the cooled boiled water or sterile water container and aspirate a small quantity of water to clean the inside of the catheter (closing the suction valve of the catheter with your thumb).
• Remove the catheter from the water container.

By wiping clean the outside of the catheter first, you avoid contaminating the water solution before rinsing the inside of the catheter.

Aspirating water into the catheter helps to remove and residual secretions from the inside the catheter.

• Let your child rest for at least 30 seconds between each aspiration.
• Repeat the process 2 to 3 times if secretions are still present in the throat, alternating nostrils.
• Between each aspiration, rinse the catheter with water (cooled boiled water or sterile water).
• At the end of the procedure, have your child breath deeply.
• Advise your healthcare team if you notice a change in the colour, quantity or consistency of secretions.

This step optimizes removal of secretions from the nose and throat.

A rest period between each aspiration allows your child to catch his breath.

Breathing deeply at the end allows your child to relax and recover.

A change in the secretions may indicate a change in the health status of your child (eg, beginning of a respiratory tract infection).

Keeping the suction valve closed with your thumb:

• Thoroughly rinse the catheter one last time by aspirating water (boiled or sterile) until no more secretions are visible inside the catheter and the suction tubing.
• If secretions remain inside the catheter, aspirate a small amount of 3% hydrogen peroxide (previously poured into a small clean container) until the secretions are removed.
• Aspirate water (boiled or sterile) and air into the catheter to rinse and dry the inside of the catheter.
• Wipe the outside of the catheter with an alcohol swab.
• Let the catheter air dry.
• Disconnect the catheter from the suction tubing.

This step is needed to keep the catheter clean and ready for next use and to limit contamination that might cause infections.

• Turn off the suction device.
• Place the catheter back into the envelope or a clean, sealed container.
• If necessary, empty the secretions from the canister into the toilet.
• Discard the rinsing and lubricating solutions used during the aspiration procedure.
• Rinse the containers used to hold the solutions with water and let air dry.
• Store the containers with the rest of the aspiration equipment.

This step ensures that the equipment is clean, in good condition and ready to use for the next episode of aspiration.

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Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

• Listen to what your child says about the parts of the procedure that were difficult or painful.
• Comfort your child and recognize your child’s collaboration with positive feedback.
• Highlight your child’s  specific strengths that helped make the procedure positive.
• Discuss with your child what might be done the same or differently the next time the care is needed.
• Keep your promises if you have promised a reward, follow through.
• Reward yourself too.