| Knowledge |
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States Contraindications and Relative Contraindications of procedure.
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| Preparation |
| Clinical Standards for Procedures and Interventions. |
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| Assessment |
| Confirms a clinical indication for secretion removal after assessing cough effectiveness, audible or visible secretions, coarse breath sounds, oxygenation, ventilation, and response to less invasive airway-clearance measures. |
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| Screens for active epistaxis, nasal obstruction or trauma, recent nasal surgery, suspected skull-base or severe midface fracture, coagulopathy, and physiologic instability before selecting the route. |
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| Preparation |
| Obtains baseline respiratory rate, heart rate and rhythm, oxygen saturation, breath sounds, work of breathing, and patient tolerance and explains the procedure. |
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| Prepares sterile catheter and gloves, regulated suction, sterile water if required for equipment clearing, oxygen, water-soluble lubricant, monitoring, and rescue ventilation equipment. |
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| Selects the smallest effective catheter and the lowest effective suction pressure within the age-specific institutional protocol and verifies suction function. |
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| Implementation |
| Preoxygenates patients at risk of suction-related desaturation and positions the head and neck to facilitate atraumatic passage while maintaining spinal precautions when applicable. |
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| Selects the more patent nostril, lubricates the catheter or approved nasal airway, and advances gently along the floor of the nose without applying suction and without forcing resistance. |
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| Advances during inspiration to the depth needed to stimulate cough or enter the trachea according to the trained technique, then applies suction only while withdrawing with gentle rotation. |
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| Limits each suction application to no more than 15 seconds, allows full recovery between passes, and uses the fewest passes needed to meet the clinical goal. |
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| Monitoring & Modifications |
| Does not instill normal saline routinely; considers any exceptional use only under a specific evidence-based order or protocol. |
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| Continuously observes oxygen saturation, heart rate and rhythm, respiratory distress, bleeding, bronchospasm, and tolerance; stops for severe desaturation, bradycardia, arrhythmia, significant bleeding, or clinical deterioration. |
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| Post-Intervention |
| Reassesses breath sounds, secretion burden, respiratory rate and effort, oxygen saturation, heart rate, and patient comfort and provides oxygen or other support as needed. |
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| Documents indication, route and nostril, catheter and pressure, number and duration of passes, secretion characteristics, physiologic response, complications, and recommendations. |
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| Post-Intervention Management Steps. |
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