There are two main types of suctioning used in healthcare – nasopharyngeal suctioning and endotracheal suctioning. Nasopharyngeal suctioning is used to clear secretions from the nose and throat while endotracheal suctioning is used to clear secretions from the airway in patients who are intubated. Understanding the differences between these two types of suctioning is important for providing safe and effective respiratory care.
Nasopharyngeal Suctioning
Nasopharyngeal suctioning, also sometimes called nasal suctioning, is used to remove excess mucus and secretions from the nasal passages and pharynx. It is a common procedure performed on patients who are having difficulty managing secretions in their upper airways due to illness, allergies, or other medical conditions.
Some key facts about nasopharyngeal suctioning:
- Used for patients who are awake and breathing on their own
- Performed by inserting a suction catheter into either nostril
- Catheters range in size from 12F to 18F typically
- Suction is applied as catheter is gently inserted and rotated to vacuum secretions
- Often instill sterile saline first to thin secretions and ease removal
- Usually only suction for 10-15 seconds at a time
The purpose of nasopharyngeal suctioning is to keep the upper airways clear and allow for comfortable breathing. It is often done for conditions like:
- Rhinitis
- Sinus congestion
- Allergic reactions
- Excessive secretions from colds or flu
- Remove blood or mucus after surgery
Nasopharyngeal suction is generally very safe but can cause some irritation or discomfort. Proper technique is important to limit trauma to nasal passages.
Endotracheal Suctioning
Endotracheal suctioning is the removal of secretions from the airway in patients who have an artificial airway in place, such as an endotracheal tube or tracheostomy tube. Patients on ventilators will require regular endotracheal suctioning to maintain a patent airway.
Key facts about endotracheal suctioning:
- Performed on intubated or tracheostomy patients
- Uses sterile suction catheters sized 6-14F typically
- Catheter inserted into artificial airway without suction
- Suction applied for 5-15 seconds as catheter removed
- Pre-oxygenation and hyperoxygenation often done
Endotracheal suctioning is primarily done to:
- Keep airway clear of secretions
- Promote gas exchange
- Improve alveolar ventilation
- Prevent infection
- Avoid tube occlusion
Suctioning is generally done routinely every 1-4 hours, as well as when secretions are audible or ventilation becomes impeded. Endotracheal suctioning is more invasive than nasopharyngeal suction so strict sterile technique must be adhered to.
Similarities Between Endotracheal and Nasopharyngeal Suctioning
While there are many differences between nasopharyngeal and endotracheal suctioning, there are also some key similarities between the two procedures:
- Purpose is to remove excess secretions interfering with breathing
- Sterile catheters attached to suction apparatus used
- Suction only applied intermittently for short periods
- Saline instillation can be used to aid secretion removal
- Size of catheter selected based on patient size/age
- Suction pressure adjusted to avoid trauma
Both procedures require training on proper techniques to avoid adverse effects like hypoxemia or arrhythmias. Suctioning is also contraindicated if there are concerns for increased intracranial pressure.
Key Differences Between Endotracheal and Nasopharyngeal Suctioning
While there are some similarities between the two types of suctioning, there are also important key differences:
| Endotracheal Suctioning | Nasopharyngeal Suctioning |
|---|---|
| Performed on intubated/tracheostomy patients only | Done on non-intubated patients |
| Requires sterile gloves and equipment | Clean (but not necessarily sterile) technique |
| Suctions artificial airway directly | Only suctions nasal/oral passages |
| Higher infection risks | Lower risk of infection |
| Can cause deep suctioning of lungs | Only removes secretions from upper airways |
Risks and Complications
While generally safe when performed correctly, both types of suctioning do carry some risks of adverse effects or complications:
- Hypoxemia from loss of lung volume or suctioning too long
- Arrhythmias or cardiac ischemia from vagal stimulation
- Mucosal trauma or bleeding from too high suction pressure
- Infection from improper sterile technique (more risk with endotracheal suction)
- Bronchospasm or airway constriction
- Patient discomfort, coughing, or gagging
- Increased intracranial pressure
Careful monitoring, proper technique, and precautions can help reduce these risks when suctioning.
Conclusion
Nasopharyngeal and endotracheal suctioning are two important techniques for maintaining a patient’s airway and breathing. While there are some similarities, the key differences lie in the patient population and invasiveness of the procedure. Endotracheal suction requires sterile technique due to its higher risk. However, when properly performed, both types of suctioning can help provide comfort and optimize respiratory function in patients with excessive secretions.