Oropharyngeal (OP) suctioning is a medical procedure performed to clear accumulated secretions from a patient’s mouth and throat (the oropharynx). The goal is to maintain a clear airway, support effective breathing, and prevent the aspiration of materials like mucus or vomit. Precision in the technique is necessary for patient safety, as improper application can lead to serious complications. The procedure requires a clear understanding of the tools and the exact timing for applying negative pressure to maximize secretion removal while minimizing tissue damage.
Purpose and Components of Oropharyngeal Suctioning
The equipment for oropharyngeal suctioning includes a catheter connected to a regulated vacuum source. The two main types are the rigid Yankauer, used for thick secretions in the mouth, and the flexible suction catheter, which reaches deeper into the pharynx. Both are tubes designed to draw materials out of the airway under negative pressure.
The side opening, also called the thumb port or control vent, controls the flow of negative pressure. When the port is left open, vacuum pressure vents to the atmosphere, preventing suction at the catheter tip. Covering the port closes the circuit, immediately diverting the full negative pressure to the catheter tip to initiate suction. This mechanism allows the operator to regulate the application of suction precisely.
The Timing of Suction Application
The rule for safe oropharyngeal suctioning is that the side opening must be occluded, and suction applied, only during the withdrawal of the catheter. The catheter is first inserted gently into the oropharynx without suction engaged. The operator advances the catheter until secretions are reached or until the patient demonstrates a gag reflex.
Once the desired depth is achieved, the operator occludes the thumb port to initiate suction. While maintaining occlusion, the catheter is slowly removed from the airway, often using a gentle rotational motion. This technique helps clear secretions from all sides of the mucosal lining and prevents the catheter tip from sticking to delicate tissues. Suction application should be brief and intermittent, lasting no longer than 10 to 15 seconds in total.
Physiological Rationale for Intermittent Suction
The intermittent application of suction protects the patient from known physiological risks. Continuous suction or applying suction during insertion can cause significant mucosal trauma by stripping the delicate airway lining. Strong negative pressure can adhere tissue to the catheter tip and side ports, leading to bleeding and inflammation.
Prolonged suctioning carries the risk of hypoxia, as the procedure removes both secretions and oxygen from the airway. Suctioning for more than the recommended 10 to 15 seconds can rapidly deplete the available oxygen supply, causing a significant drop in the patient’s oxygen saturation levels. Furthermore, stimulating the vagus nerve in the posterior pharynx can lead to a vagal response, resulting in a sudden drop in heart rate (bradycardia) or other cardiac arrhythmias.
Intermittent suctioning and allowing rest periods—typically 30 seconds to a full minute between passes—minimize these risks. This interval allows the patient time to reoxygenate and recover from the transient physiological stress. Limiting the total duration of suction pressure prevents excessive oxygen depletion and reduces the likelihood of stimulating the vagal nerve.
Pre- and Post-Procedure Assessment
Before initiating oropharyngeal suctioning, assess the patient’s respiratory status to establish a baseline. This pre-procedure check includes:
- Observing the patient’s color, respiratory rate, and effort.
- Confirming the current oxygen saturation level using a pulse oximeter.
- Verifying the suction unit is functioning correctly.
- Setting the pressure, which for adults is typically between 100 and 150 mm Hg.
Following the procedure, a reassessment is immediately performed to gauge the patient’s tolerance and the intervention’s effectiveness. The operator must check for signs of distress, monitor heart rate and oxygen saturation, and listen to breathing sounds. The characteristics of the cleared secretions—including amount, color, and consistency—are also noted to document the procedure’s success and the status of airway clearance.