Yankauer or NT suction

[zacarias, ASN, RN]

Hey all

I have a question. I am working on a unit where patients are much sicker than I've taken care of in several years. When do you just stick with Yankauer/oral suction or really do NT suction?

Last night I had a patient who was very sick, septic, and had rhonchi upper airway gurgly sounds most of the time he was awake. Yankauer gave little results. I guess RT has been NT suctioning a few times, but the family had refused one time because there was blood-tinged sputum suctioned out due to trama. What about using the Yankauer or preferibly a flexible cath (for less trauma) and going back towards the base of the tongue to cause the gag reflex and get phlegm that way. Is that advisable?

I've read several posts and it just seems that NT suction is risky and almost better not used for people who don't have trachs. I'm just wondering why some sick people have these gurgly sounds, and sound like they just need to cough, but don't...but will choke/gag if stimulated deep enough. Is it that their brains don't tell them to cough? Are they too weak? Would confusion have to do with it?

I'm just wondering what you're thoughts are on this and if there's any EBP guidelines that are newish on this stuff.

Me

[FLArn]

Not knowing your unit or the patient's diagnosis, it is hard to give constructive advice. I try to avoid deep suction and try not to overuse oral suction because as you know the mucus membranes' response to irritation is to produce mucus so you end up with more of what you were trying to get rid of in the first place.

We use several meds to control secretions: Levsin SL, Atropine drops SL, and lately are having really good results with Nitropaste applied to the mid upper chest.

[systoly]

Agree with the above. Sometimes positioning can help. BTW, good for the family.

[nrsang97, BSN, RN]

A scopalimine patch is also a good option. What about glycopyrulate? I hate to NT suction anyone, unless necessary. A nasal trumpet can help decrease trauma when it NT suction is necessary.

[ckh23, BSN, RN]

Be very careful about shoving that yankaur into the back of their throat. If not you will be dealing with aspiration.

[Maysa25]

From my experience of working on the medical unit, I really tell pts and family that I avoid NT suctioning unless absolutely necessary because it feels terrible and probably increases anxiety, pain, and discomfort much more than they were already coping w/ having the gurgles. Coughing and deep breathing is best w/ yankeur, and I usually stick it pretty far in the back of the throat to stimulate the gag/cough reflex. Depending on your pt's prognosis, it doesn't sound to good, so my guess is to suggest yankeur because pts can even do that on their own and it's definitely not as traumatic for the pt and the family that happens to see you do it.

[wooh, BSN, RN]

If it's oral secretions, I've gotten a fat suction catheter and used that at the back of the throat instead of a yankauer. The yankauer is hard and when they cough, which means their head jerks, it's just banging that yankauer into their throat. I had a patient that RT had gotten aggressive with the yankauer and the back of his throat looked like hamburger meat. But I agree with above, suction begets more secretions begets more suctioning. Keep the airway open, otherwise let it be.