Nasopharyneal Suctioning Policies

[Inquisitivewon]

I was trained as a student that maintaining a clear airway is one of the most primary of all nursing priorities. It has come to my attention that some facilities require an MD order for suctioning via the NP route. I have two questions to contemplate. 1.) Does your institution require and MD order to suction by NP route? 2.) Was nursing involved in drafting your

Institutional policy on NP suctioning?

Please feel free to add what type of institution you work in.

Thanks,

carrmichael3:argue:

[NotReady4PrimeTime, RN]

In our facility (a university hospital with attached children's hospital) nasopharyngeal suctioning is a nursing or respiratory therapy responsibility and the assessment of the need for it is based on nursing or RT judgment. We do not need an order and if the patient needs it and doesn't get it, then later has an airway patency issue, we'd be chewed a new one.

[PICNICRN, BSN, RN]

I have been reading and hearing a lot about this recently, I think we are getting away from NT suctioning and the new trend,(from what I understand) is going to be using oral/trach suction. We have a new VAP(ventilator acquired pneumonia) protocol that states we are no longer to use NG tubes for gastric decompression of ventilated patients and we are using OG instead because of the risk of sinusitis from the NGs. I think the suctioning rational is the same.

Now, there is no order NOT to suction NT, nor do you NEED an order to do it... and it is still done. I think that evidence based practice is going to swing the way of the oral route soon.

[Inquisitivewon]

I understand the concern for patients with regard to sinusitis, but oral suctioning can only get the upper airway. Deep suctioning by the oral

route is contraindicated because of the risk of introducing the oral flora

to the lungs. My concern is for non-intubated patients who require deep suctioning.

The benefit should always outweigh the risks. What about your policy?

Does it call for an MD order?