Oral suction training for parents and carers

1. Carer skills passport Oral suction training for parents and carers Leanne Turner Physiotherapist Jenny Bayliss Specialist Nurse

2. Aims • To understand what oral suction is • To understand why, when and how oral suction is carried out • To know how to use a suction machine • To know how to look after and clean a suction machine

3. What is suction? • ‘Suction’ is the term used for removing secretions from a child’s airway using negative pressure (or vacuum) • It is like a hoover but you can set the pressure yourself

4. Why suction? • When children have problems clearing their own secretions • To remove the secretions in the oral space (mouth) that can block the airway • To help the child breath more easily • It can sometimes help to promote a cough • Comfort

5. When to suction? • Child will tell you by: • Being distressed/upset/ coughing/ work of breathing • Looks like something in their mouth • Vomiting • Change in colour • Change in saturations

6. Suction plan

7. Will it hurt? • NO as long as it is done properly by a trained person • Suctioning is an invasive procedure that can have side effects and dangers • IT MUST ONLY BE DONE BY TRAINED PEOPLE! • If done properly then side effects are rare

8. Side effects and Dangers • Trauma • Pain • Vomiting • Gagging • Loosen teeth • Distress • Infection • All of these can be avoided if the right procedure is used

9. How to suction orally ? • Suction in the mouth area from the back teeth forward • NO further than the back teeth or end of the buccal space in babies with no teeth

10. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

11. What to use to suction? Usually decided by the hospital or physiotherapist YankeurSuction catheter

12. Things to know • Yankauers are wider and are firmer so a risk of trauma to the mouth • Small Yankauers have holes and large ones don’t • Temptation to go further with a suction catheter than you will be competent to do • Yankauers need a cover on them whenever they are not being used

13. Typical suction machine

14. Checking the suction machine • This is a very important part of your care • Failure to check the machine correctly means you are putting the child/young person at risk • You will be working out of your competency and will carry the responsibility yourself

15. Suction machine checks • Charge Level • Charger present • Pressure is Correct • Adequate supply of suction catheters / yankauers • Suction Circuit is intact • Lid of bottle • Connector on top • Tubing • Supply of clean water for flushing of tube • Suction machine and all components clean and appropriate for use • Disposal bags • Hand cleaning gel • Gloves • Bag is safe to use

16. Lights on machine • External charge (plugged in) • Charged light • Warning light – flashes and then stays on - approx 30 minute charge

17. Cleaning and caring for the suction machine • Wipe down suction machine weekly • Suction bags machine wash at 40 degrees Consumables • Yankaeur change daily (more often if blocked) • Suction tubing change weekly • Filter, Pot and Lid change 3 monthly

18. Care & Cleaning continued • Flush the suction tubing after every use • Empty the pot when half full • Charge overnight • Serviced by manufacturer • Report any problems

19. Troubleshooting • Cracks • Seal • Battery • Wet filter

20. Suction pressures • The pressure for suction is always 150Hg or 20KPa • Check your pressures each time you are preparing to suction • Older machines pressure valve can easily be pushed and put pressure up!!

21. Check your child - before, during and after • Responsive • Colour • Respiratory rate • Increased work of breathing • Sound of breathing • Chest movement • Saturations

22. Holistic approach • How does she look? • Does she need a position change? • Is she trying to tell you something? What is her environment like? • Is she too hot or too cold? • Are her clothes rubbing her? • Is she uncomfortable? • Is she bored? • Is it too noisy? • Is she unwell?

23. How is suction done? • Wash your hands or alcogel before you suction, except in an emergency • Put on gloves • Have all equipment together and ready to use • The suction machine should be set at a pressure of less than 20kpa/150mmHg. Check the machine to make sure it is adjusted correctly • Attach the catheter to the tubing

24. How is suction done? • Remove the catheter with the gloved hand (clean hand/dirty hand) • Insert the yankauer no further than the hard pallet (back teeth) • Suction by blocking the finger hole (if small one) - side to side and out - moving the catheter slowly. • Allow the child to take at least three breaths if you need to repeat the procedure. • Stop suctioning when mucus cannot be seen or heard.

25. How is suction done? • Remove the glove by pulling the glove inside out. Throw in the bin • Rinse the yankauer and tubing in sterile water by suctioning a small amount through the catheter • Turn the suction machine off and make sure new supplies are ready for the next time (don’t open catheters) • Wash hands

26. What if it doesn’t work and the child is struggling to breathe? • SHOUT FOR HELP! • Consider giving the child oxygen if colour has changed • Consider re-suctioning or repositioning • Try to reassure the child • Dial 999 and follow resus protocol

27. Practical • Putting the suction machine together • Setting pressures • Attaching the yankeur and suction catheter • What parts to clean • Common trouble shooting areas • Practice oral suction technique

28. Any questions?