Oropharyngeal Suctioning: Nursing Procedure, Pressures, and Safety

Oropharyngeal suctioning is a core airway-management skill used when a patient can cough but cannot fully clear secretions on their own. This note reviews when and how to suction safely, the equipment to choose, correct pressures, and the complications and exam traps you must recognize.

Definition

• Oropharyngeal suctioning removes secretions from the mouth and throat using a suction catheter.
• Used when the patient can cough but cannot clear secretions independently.
• Purposes: prevent aspiration, maintain airway patency, and allow visualization of the oral cavity.

Indications

• Audible secretions — gurgling or rattling sounds in the mouth or throat.
• Visible secretions — pooling of secretions in the mouth.
• Ineffective cough — patient coughs but cannot expectorate.
• Decreased SpO₂ — oxygen saturation drops, often from airway blockage.

Audible gurgling is a hallmark sign of secretions in the upper airway.

Types of Suction Catheters

• Yankauer (tonsil tip): rigid plastic with a bulbous tip; the standard choice for oropharyngeal suctioning. The bulbous tip helps prevent mucosal damage.
• Whistle tip: soft, flexible, single-hole; used for nasopharyngeal or endotracheal suctioning.
• French catheter: soft, flexible, with multiple side holes; used for deep oral or nasal suctioning.

Soft catheters are needed for nasopharyngeal or deep oral suctioning because the rigid Yankauer cannot reach those areas.

Procedure

Preparation

• Perform hand hygiene and apply clean gloves; wear a face shield because splashing is likely.
• Set suction pressure to 100–120 mmHg for adults.
• Test pressure by occluding the tubing.

Patient Positioning

• Place the patient in Fowler's position (HOB elevated 45–90°).
• If the patient cannot sit upright, turn the head to the side.

Suctioning Technique

• Insert the catheter along the side of the mouth toward the pharynx. Do not insert straight down the center — this triggers the gag reflex.
• Apply suction only during withdrawal, for 5–10 seconds per pass.
• Use a twisting/rotating motion as you withdraw.
• Allow the patient to rest and breathe between passes.
• Limit to 3 passes or fewer to prevent hypoxia.

Suction Pressure Guidelines

• Adults: 100–120 mmHg
• Children: 80–100 mmHg
• Infants: 60–80 mmHg

Higher pressures cause mucosal damage and bleeding. Always test pressure by occluding the tubing before suctioning.

Complications

• Hypoxia (most common) — suctioning removes oxygen along with secretions. Prevent by limiting suction to 5–10 seconds and pre-oxygenating as needed.
• Mucosal trauma — from excessive pressure or force. Use correct pressure and insert along the side of the mouth.
• Gagging or vomiting — from stimulating the gag reflex. Avoid the center of the throat.
• Bradycardia — from vagal stimulation. Stop suctioning immediately if it occurs.
• Infection — from contaminated equipment. Use sterile or clean technique per facility policy.

Assessment Before Suctioning

• Auscultate lung sounds to identify secretion location.
• Check SpO₂ before and after suctioning.
• Assess cough effectiveness — a weak, non-productive cough indicates need for suctioning.
• Assess level of consciousness — sedated patients cannot protect their airway.

Comparing Suctioning Routes

• Oropharyngeal — mouth and throat only; Yankauer (rigid); for secretions in the mouth or visible in the throat. Least invasive; can be done with clean technique.
• Nasopharyngeal — through the nose into the pharynx; soft, flexible catheter; when the oral route is ineffective. Requires sterile technique.
• Endotracheal — into the trachea through an ET tube; sterile soft catheter; for patients with an artificial airway. Requires sterile technique.

Common Exam Traps

• Do not apply suction during insertion — only during withdrawal.
• Do not suction longer than 10 seconds per pass.
• Do not insert the catheter straight down the center of the throat — triggers the gag reflex.
• Do not exceed 120 mmHg in adults.
• Do not perform more than 3 passes without rest.
• Do not ignore bradycardia or desaturation — stop suctioning immediately.

Key takeaways

• Use a Yankauer catheter at 100–120 mmHg for adult oropharyngeal suctioning.
• Position the patient in Fowler's, insert along the side of the mouth, and apply suction only on withdrawal for 5–10 seconds.
• Limit suctioning to ≤3 passes and allow rest between passes to prevent hypoxia.
• Stop immediately for bradycardia (vagal response) or significant SpO₂ drop.
• Oropharyngeal suctioning uses clean technique; nasopharyngeal and endotracheal suctioning require sterile technique.
• Key indications: audible gurgling, visible secretions, ineffective cough, or falling SpO₂.