Nasal suction guidelines

[AbearsdenRNC]

We have a BIG problem in our NICU. It seems that nurses were "altering" the neosuckers by cutting the bulb tip off and then suctioning the nares with it. Also, nurses were using 8 french catheters in the nares to suction. We have had lots of nasal trauma as a result. One of our Nurse practitioners was so fed up that she threatened to call Risk Management if the Neo suckers weren't pulled immediately. The kicker is that I am the "Whistle blower" and the other nurses are really not happy with me, but I am not willing to stand by and watch these infants be traumatized. My nurse manager asked me to write a suctioning guideline. My delimma is there are limited resources and I am hoping there are others in my situation that can point me in the direction of some resources or share policies/ guidelines/ help/ ANYTHING with me.

Thanks a BILLION!

[BittyBabyGrower, MSN, RN]

Wow! We don't have a guideline for nasal suctioning at all, but maybe try Springhouse or Lippencott manuals, they may have something. And as for pulling the neosuckers, that won't do anything as they are a standard of care in most places and unless they are causing harm to the infant in their unaltered state, then risk management will say there is nothing they can do. Also, go to your CNS, she should be able, and should be in on, making this policy/procedure with you as anything you are going to institute most likely has to go thru a standards committee. Sounds like the NM is passing the buck to me.

[Sweeper933]

Why in the world would they be cutting the end off of the neosuckers??? We use those on my unit, and none of us have ever had a problem getting all of the (thick) secretions out of the nares...

[dawngloves, BSN, RN]

Why don't write a policy that neosucker are the only thing to be used for suctioning? And that any modification is not within the manufactures guidlines and not permitted?

If you elimintate them, people will just use TB syringes, like we did back in the day.

[TiffyRN, BSN, PhD]

I think your unit must be using the neo-sucker that has a bulb or flare at the end and that's what they are cutting off. We use the kind that is just straight, not much motivation to be chopping on it. There is a higher likelihood of causing trauma the the bulb ended ones but no cut ends to traumatize tissues. We very infrequently see nasal bleeding from those alone. Straight suctioning with 8f catheters though almost always causes some bleeding if it happens more than once or twice a day.

My only suggestion is that you use the the straight tip neo-suckers but the truth is that the nares can be traumatized with any suctioning device.

[prmenrs, RN]

I would suggest switching to the "olive tip" type instead of the "bebeonkers" which, I think, is the kind you're using.

http://bbgnasalaspirator.respironics.com/

Anytime you alter a medical device, you are opening yourself and the hospital to a risk management (read lawsuit) situation. If you discover an "altered" device or a suction catheter used inappropriately, it's important to document (incident report/quality variance/whatever report) the occurence.

If your NM chooses to pass the buck, maybe the NP needs to go ahead and call Risk Management. It's a risk.

[AbearsdenRNC]

I want to thank-you all for your responses. I did find some great resources on the web for developing a best practice for our unit. I am saddened by what our nurses were doing with the equipment, and embarassed by it, too.

What I have found in my lit search is basically to suction the mouth first with bulb syringe or cath, then the nose with either a bulb syringe or cath. Saline drops will help to mobilize the secretions. We are going to make our practice that an 8FR is good for the mouth and a 6 FR is good for the nose. We'll see how that flies.

THANKS for all the responses!!

:redbeathe

[elizabells, BSN, RN]

My unit is the suction capital of the world - most kids get a full NP/OP job with a 6 or 8 Fr q3h. My personal experience is that I actually get MORE nasal bleeding with the 6Fr because the end of the catheter isn't as smooth on the edges as the 8Fr. Just my 0.02.

[prmenrs, RN]

You can get a great lavage w/the baby on his/her side, an olive tip and one of those pink NSS bullets. Olive tip goes in the down side, NSS in the up side.

IMO, it works even better than the suction catheters which really go too far and make the nose worse.

[dawngloves, BSN, RN]

You can get a great lavage w/the baby on his/her side, an olive tip and one of those pink NSS bullets. Olive tip goes in the down side, NSS in the up side.

I tried this and couldn't get the sailine out of the nostril opposite of the saline insertion, so I just ended up suctioning the side I dropped the saline down.

I know it should work. What am I doing wrong??

[ScammRNC]

We use the nasal aspirators you are speaking of, but no one has ever "cut" it down. We suction our high flow nasal cannula and CPAP kids q 6 hours & PRN and low flow cannula q 12 hours & prn.

[dawngloves, BSN, RN]

We use the nasal aspirators you are speaking of, but no one has ever "cut" it down. We suction our high flow nasal cannula and CPAP kids q 6 hours & PRN and low flow cannula q 12 hours & prn.

You routinely suction, even if they don't need it?