Nasotracheal Suctioning

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I find it very difficult to reach the trachea. My superior told me that hyperextension of the neck helps and timing suctioning while patients are coughing. However, in my experience, patients are swallowing way more than they are coughing and it's not ideal to wait. I've been reading this pdf file that I've googled and it has great tips to prevent swallowing for conscious clients. However a lot of our patients are disoriented.

How do I prevent swallowing? I supposed I can force neck flexion with a pillow but then how to I supress the tongue? Some clients won't even open their mouths? How do I get disoriented people to cough?

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Please clarify why you would be trying to manipulate the tongue or open the mouth for NT suctioning? Are you attempting to introduce the catheter through the mouth?

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I'm very confused. It sounds like your patients have dysphagia and shouldn't be eating or drinking?

How do you prevent swallowing? Don't give them food or water.

How do you get disoriented people to cough? I think coughing is a natural reflex? If a patient is so debilitated they have no cough reflex they have to be NPO?

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My bad. Sorry for suddenly inserting swallowing into my query. Let me rephrase. Basically my problem is that I can't reach the trachea during nasotracheal suctioning.

When I do nasotracheal suctioning I end up entering the esophagus because a lot of my disoriented patients react by swallowing instead of coughing when the suction catheter reaches their throat. I can't instruct them not to swallow the catheter and it's very frustrating especially when they have all these secretions. I tried my superior's advise to hyperextend the neck to lessen the risk of going to the esophagus but my patient's have really active swallowing reflexes despite being NPO for a very, very long time.

Thank you.

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I'm still confused. I need to know why, what type of, patient you're suctioning. Frail elderly, severely developmentally delayed, severely medically incapacitated?

I have never heard that reaching the trachea is required when suctioning. But I don't know who or why your suctioning.

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I would need to know why you NT suctioning an alert patient? It is horribly uncomfortable and painful for that patient. I've only ever seen it done on an alert patient one time and it was a very last resort and it was left up to the RT. I was not attempting it.

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That seems terribly uncomfortable. The only time we do nt suctioning is on semi conscious patients and we to use a trumpet in that case. Even then, we're not going as deep as you describe. In what country do you practice?

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I'm sorry I don't feel comfortable stating the country where I'm currently working. Reading your responses, I just realized that we don't have respiratory therapists in our hospital. And, I just did some googling and, RT doesn't even have it's own pie on the chart of therapist workforce percentages. And, the existing education program is more like a continuing education seminar (for nurses, OTs, PTs, and medical engineers) compared to the four year Bachelor's in my country of origin.

Most of the patient's we have aren't fully alert but we do have a lot of instances were we have to do nasotracheal suctioning of an awake, conscious, and coherent patient. If we don't reach deep enough, we can't remove the significant amount of secretions that will lead to death. Most of our patient's are frail elderly people. I guess I can say that they have poor coughing mechanisms.

Personally when I was first blamed for a patient desaturating because I didn't suction enough, I was like WTF. "Did I apparently slept sometime during nursing school and missed something very vital on suctioning?" Back then I never new nasotracheal suctioning existed and that it is what our patient's needed.

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I'm sorry I don't feel comfortable stating the country where I'm currently working. Reading your responses, I just realized that we don't have respiratory therapists in our hospital. And, I just did some googling and, RT doesn't even have it's own pie on the chart of therapist workforce percentages. And, the existing education program is more like a continuing education seminar (for nurses, OTs, PTs, and medical engineers) compared to the four year Bachelor's in my country of origin.

Most of the patient's we have aren't fully alert but we do have a lot of instances were we have to do nasotracheal suctioning of an awake, conscious, and coherent patient. If we don't reach deep enough, we can't remove the significant amount of secretions that will lead to death. Most of our patient's are frail elderly people. I guess I can say that they have poor coughing mechanisms.

Personally when I was first blamed for a patient desaturating because I didn't suction enough, I was like WTF. "Did I apparently slept sometime during nursing school and missed something very vital on suctioning?" Back then I never new nasotracheal suctioning existed and that it is what our patient's needed.

If you are not in the US, I guess it's a whole different ball game to which I cannot speak. In my experience here, people that can't cough and have issues swallowing would have trachs in if it was a long term thing. If they can't get those secretions up, that is a problem.

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Thank you very much guys for coming back and attempting to think of the answer. I appreciate it. Most of our cases are from pneumonia so I guess that's the reason why there's no need for trachs. It's just that they're really old (80+ years old) so, even if it's "only" pneumonia, their respiratory system isn't helping itself. I guess that too is another reason for the lack of trachs.

Thanks. If I ever find an effective method, I'll share here. In case your RTs aren't available. ;)

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Thanks. If I ever find an effective method, I'll share here. In case your RTs aren't available. ;)

I'm an RT (and an RN). I'd love to help you, but you never answered my first question (see the first reply to your question). Feel free to PM me if you don't want to do a back and forth on your thread.

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I'm not manipulating the mouth but, if it will help, I would like to know how. The tongue "maneuver" to prevent the client from swallowing the catheter during Nasotracheal Suctioning is posted in the link in my OP...

...Unfortunately, the posted link only address cooperative clients.

Please clarify why you would be trying to manipulate the tongue or open the mouth for NT suctioning?

I want to stop the client's swallowing reflex as advised by the link. The advise involves protruding the tongue out. If the patient can't actively do it, I'd like to try and help. However, I can't even open the mouths of most patients easily, let alone surpress their tongues.

Are you attempting to introduce the catheter through the mouth?

No. It's nasotracheal suctioning afterall.

Sorry, I assumed everyone will go read the linked pdf file. :o Oh, and please forgive my terrible sentencing and paragraphs. Thank you for coming back. :)

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