To suction or not to suction?

[texasheat]

Hello everyone,

I am in need of some clarification. Our night nurse had a situation with one of our residents. She was in need of oral suctioning, when he went to suction her, she had her mouth tightly shut and would not open for suctioning. After much coaxing and with assist of the CNA, he was able to suction a little but on the third try she clench her jaw and would not let go of the yaunker. After she did let go, he noticed some redness to her jawline and was later reported by the CNA that a bruise was forming to her left cheek. He did give her a svn tx after suctioning, made incident report, called MD, RP. Family requested resident be sent to ER for further evaluation. Came back to facility 2 hrs later after labs, xray, another svn tx with no orders. This morning our Administration decided it should be reported to the state, due to excessive force to remove yaunker. Some of us agree. The other half disagree. Have any of you come across something like this? What has been your experience with difficulties during suctioning?

[SuesquatchRN, BSN, RN]

She was correct to report it.

I've never come acoss this particular situation.

[Lissacheer87]

I think she is right to report this

[JulieCVICURN, BSN, RN]

It seems like no force should have been necessary to remove the yankauer. Eventually the resident would have let go of it on her own. Forcing her jaw open does seem excessive. I don't know if it's reportable as abuse, but it seems like some retraining might be in order.

[texasheat]

It seems like no force should have been necessary to remove the yankauer. Eventually the resident would have let go of it on her own. Forcing her jaw open does seem excessive. I don't know if it's reportable as abuse, but it seems like some retraining might be in order.

Thank you all for your comments. He stated he was worried she would break off the tip, which I have seen happen, or break a tooth. And yes we're having an inservice to discuss this, among other things. I'll keep you posted.

[netglow, ASN, RN]

I have. But just the jaw clenching "till lightning strikes" part.

I knew the patient could not control this and also was unable to communicate, although conscious and aware of those treating. Watched RT and other nurses wrestle with it, and worried about roughness. When it was up to me to suction, I spent a little time with the patient first, and said, I know this is hard for you. But you and I can work things out. I'll wait, and you give me a sign and try not to bite. I do believe the patient gave their best effort, it was hard, but we got it done. I think, in this particular case, people were just going in and forcing the situation. This patient was vented/trached/suctioned in-line as well. The patient had become afraid of RT, which made me want to cry once I realized it. Talking about being totally at the mercy of others.

[Hospice Nurse LPN, BSN, RN]

I would report the incident. How about getting an order for transderm scpolamine patch? Place behind the ear and change it Q 3 days. We use the in hospice to help dry the secretions and it eliminates (or at least lessens) the need for suctioning.

[NotFlo]

I like the scope patch idea.

Would it have been completely crazy to try using a soft suction catheter (the king for deep suctioning or trache suctioning) instead of the hard yankaur? I have used it to suction people's mouths before, sometimes even if you can just get the tip in the corner of the mouth you can remove a lot of secretions. Of course, then the issue becomes the patient actually biting a piece of the catheter off, I guess.

[systoly]

Sometimes you have to open a pt.'s mouth and there are a few techniques that work well and don't cause injury. I don't know if suctioning was needed or not, but the issue is technique. If the inservice doesn't teach you how to open a pt.'s mouth without using a crow bar, get a hold of a speech therapist/pathologist. They can teach you in just a few minutes.

[realnursealso/LPN, LPN]

I learned to not put the yankauer in between the person's teeth. Suctioning in the sides of their cheeks usually works just as well. It's hard, and doesn't always work, but I've done this lots of times with cerebal palsy kids who constantly grind their teeth. Usually after cleaning out the cheeks the yuck from the back of their throat will come out too. Just my Too bad the patient ended up with a bruise. I agree, a bruise has to be reported.

[JulieCVICURN, BSN, RN]

If we have problems with people clenching their jaws and the need for suction becomes an airway management issue, we'll use the soft catheter and go in through the nose. It's not fun, but sometimes you don't have much of a choice.

[NickICU-RN, ADN, BSN]

I've been an ICU RN for 15 years and worked all ICU specialties. I have seen patients actually broken Yankauers and green swabs, etc.. At our facility we use the No-Bite V Suction to help stop patients from biting down and then insert a suction catheter to do subglottic suctioning. That pretty much solves the problems of patients biting down and other suctioning problems.

I do question the nurse and how hard of force had to of been used to create a ecchymosis on the cheek and unfortunately, it has to be reported. And I am not super fond of scpolamine patch as the end all solution to not having to suction. Yes it can help sometimes, but definitely not all the time, nurses still have to suction. Basically anybody with pneumonia it is not going to work on!