Deep Suction: Oropharyngeal and Nasopharyngeal Suctioning

Source: Deep Suction Presentation, SR.pptx (11 slides) Author: Sammy Reed, Paediatric Physiotherapist Date: April 2021 Learning Level: Primarily 🟢 Foundation / 🟡 Intermediate

1. Overview and Scope

This module addresses the key question:

How do we address the fear, risks, training needs, care package requirements and expectations on the physiotherapy service when a child requires regular oropharyngeal and nasopharyngeal suction?

Key References Underpinning This Module

• Association of Paediatric Chartered Physiotherapy (APCP), 2019
• Wolff et al., 2015

2. Definitions and Types of Suction

🟢 Foundation

2.1 What Is “Deep Suction”?

The term “deep suction” is used as an umbrella term encompassing:

Key Distinction: “Deep suction” refers to nasopharyngeal and oropharyngeal suction techniques, as distinct from simple oral suctioning (e.g. Yankauer) or inline suction of an artificial airway (ETT/tracheostomy).

2.2 The Broader Suctioning Landscape

[The source presentation includes a comprehensive mind-map diagram on Slide 4 showing the interconnected aspects of suctioning. The diagram maps out the following domains:]

Types of Suction

• Soft tip catheter
• Oropharyngeal
• Nasopharyngeal
• Guedel airway suction
• NP airway suction
• ETT suction
• Tracheostomy suction
• Inline suction
• Yankauer (oral hygiene)
• Sterile technique

Settings Where Suctioning Occurs

• Inpatient: Tertiary Hospitals, District General Hospitals, Intensive Care
• Community: School, Transport, Outpatient
• Home/Social Care

People Involved in Suctioning

• Physiotherapists
• Nursing Staff
• Doctors
• Clinical Nurse Specialists
• Children’s Community Nursing Teams
• School Nurses
• Care Agencies
• Families

Practicalities

• Equipment servicing
• Consumables
• Escalation plan
• Bacterial growth management
• Oral hygiene
• MDT coordination

Care Package Stakeholders

• Social Care
• Continuing Healthcare
• Families
• School Nurses
• Care Agencies

3. Indications, Precautions and Contraindications

🟢 Foundation

Critical Clinical Reference — this table must be committed to practice knowledge.

References for this section:

• American Association for Respiratory Care (AARC), 2004
• Moore, 2003

4. Fears and Risks

🟢 Foundation / 🟡 Intermediate

Understanding the fears associated with suctioning is essential for effective training and patient care.

4.1 MDT Fears and Risks

• Inadequate knowledge and skills set
• Inadequate training
• Unfamiliar with protocols and guidelines
• Time constraints
• Fear of causing harm or instability
• Consistency of technique across team members
• Invasive procedure causing visible distress to the child

4.2 Family Fears and Risks

• Inadequate knowledge about the procedure
• Time and high treatment burden
• Acceptance of a child’s condition
• Psychological implications of suction for the family

5. Training Needs

🟡 Intermediate

Addressing fears and risks requires a structured training approach:

5.1 For the MDT

• MDT awareness of roles and responsibilities
• Awareness of relevant guidelines and policies
• Provide education, guidance and reassurance
• 1:1 joint sessions with nurses, junior physiotherapists and students
• Self-confidence questionnaires to track learning progression
• Effective teaching sessions (both theoretical and practical)

5.2 Training Content Must Cover

5.3 Training Audiences

• MDT members (medical, nursing, therapy staff)
• Families and carers
• Care agencies providing home/community support

Barts Health NHS Trust Suction Guideline (2020): Referenced as a key local policy document. [Slide 8 references this guideline, likely containing an image or table from the guideline document.]

References for this section:

• Association of Paediatric Chartered Physiotherapy (APCP), 2019
• Association of Paediatric Chartered Physiotherapy (APCP), 2020

6. Physiotherapy Expectations and Role

🟡 Intermediate / 🔴 Advanced

[Slide 9 references the physiotherapy role in suctioning, likely containing a diagram or table from APCP 2019 and Wolff et al. 2015 guidelines. The specific expectations relate to the physiotherapist’s role in assessment, training, care planning and ongoing review of children requiring regular suctioning.]

Key references:

• Association of Paediatric Chartered Physiotherapy (APCP), 2019 — Recommendations for Paediatric Respiratory Physiotherapy Care of the Complex Child in the Community
• Wolff et al., 2015 — Development and evaluation of a community respiratory physiotherapy service for children with severe neurodisability

7. Cross-References to Other Modules

• Tracheostomy care (see 02-tracheostomy.md): Tracheostomy patients require specific suctioning protocols, including inline suction and sterile technique considerations
• Nebulisers and saline instillation (see 03-nebulisers-and-saline-instillation.md): Secretion management in ventilated patients often combines suctioning with nebulised therapies and saline instillation

8. References

1. American Association for Respiratory Care. 2004. Clinical Practice Guideline Nasotracheal Suctioning. Respiratory Care 49(9), pp. 1080-1084.

2. Association of Paediatric Chartered Physiotherapy. 2020. Guidelines for Nasopharyngeal Suction of a Child or Young Adult. London: Association of Paediatric Chartered Physiotherapy.

3. Association of Paediatric Chartered Physiotherapy. 2019. Recommendations for Paediatric Respiratory Physiotherapy Care of the Complex Child in the Community. London: Association of Paediatric Chartered Physiotherapy.

4. Barts Health NHS Trust. 2020. Paediatric Suction Guideline. London: Barts Health NHS Trust.

5. Moore, T. 2003. Suctioning techniques for the removal of respiratory secretions. Nursing Standards 18(9), pp. 47-55.

6. Wolff, A. et al. 2015. Development and evaluation of a community respiratory physiotherapy service for children with severe neurodisability. British Medical Journal 4.