My First Suctioning Experience

Mr X is 88y.o/M admitted to hospital for decreasing consciousness and dehydration. He lives at home with his sister who is the main carer and is able to ambulate with a ZF with x1 assist from the bed to the toilet. He has no relevant respiratory history.

After admission to the hospital, Mr X is diagnosed with ?aspiration pneumonia and hence referred for physiotherapy management. On objective assessment, Mr X’s Cough: very delayed and ineffective, very moist and non-productive; Ausc: quiet BS throughout lungs, no added sounds and his SpO2 is 92 % RA.

After assessment, I determined that his cardiorespiratory problem is impaired airway clearance. Due to unable to produce an effective cough, other treatment ideas will be tracheal rub, catheter tickle and UL movements. However, all of the above failed and the last resort was suctioning. After advice from my supervisor, we decided to have suctioning via a Guedel as it is an easier method. The first suction was done by my supervisor and the process seems easy. Next was my turn. The first suction had triggered a very good cough and it was just the right time for me to do a second suction.

My first suctioning experience was horrible. I forgot to turn on the suction, the catheter was at the other end of the bed and I just can’t get the catheter down the patient’s AW! It must have been a very uncomfortable experience as the patient started to tear and struggle. Before I could do an effective suctioning, the patient had swallowed all the secretions.

My second session with Mr X: things are better the second time round. I got all the suctioning equipment prepared and now ready to go. Everything went on smoothly and amazingly, the SpO2 increase from 92 to 100% RA. This shows that patient also had impaired gas exchange which was not reflected in the ABGs.

On the first suction, I was very excited and too focus on just wanting to do suctioning. And forgot the importance of the preparation prior to that. On the second session, I learnt from my mistake, I got everything prepared (prepared equipment not only for one but two suctions-just in case). Mr X later commented that he felt more at ease the second time as I was more confident and prepared. That gave him the impression that I would ‘take good care of him’.

I was really glad that I had such a feedback. It is not all about giving the treatment but also giving the patient confidence and that will definitely help to relax the patient during the horrible suctioning treatment.