Nasopharyngeal suctioning is a skill added to NMC OSCE from November 2022. The time limit for this station is 8 minutes. We will explain in this article about how to perform this skill in NMC OSCE.

Nasopharyngeal Suctioning Skill in NMC OSCE

Articles required

Nasopharyngeal suction catheter (size 10 or 12), tubing to suction canister, unsterile gloves, apron, sterile water (for lubrication and clearing the tube), mask and goggles.

We will explain this skill in four phases which are Introduction phase, Pre Procedural phase, Procedural phase and Post Procedural Phase.

Introduction Phase

In this phase candidate need to

• Clean hands with alcohol hand rub, or washes with soap and water and dries with paper towels, following WHO guidelines.
• Introduces self. Identify the patient using 3 checks. Explains the procedure to be carried out and the rationale for this. Gain consent for the procedure.

(Introduce yourself as Miss. X who is nurse caring for the patient, today. How to explain the procedure? Explain to the patient that you are there to perform a Nasopharyngeal suctioning procedure to remove mucus or saliva from the back of the throat so that the patient can cough or swallow better. )

• Arrange a signal with the patient so that they can communicate if they wish to halt/stop, e.g. raising hand.
• Candidate also need to say that he/she will monitor the patient’s condition throughout the intervention especially colour, breathing pattern, respiratory rate, heart rate, secretions, and evidence of trauma and distress, using pre-suction baseline observations as a guideline.
• Assist the patient to sit in a semi-upright position in chair/bed, supporting head with pillows and ensuring no head tilt forwards or backwards.

Pre – Procedural Phase

In this phase, candidate,

• Do a hand rub using who guidelines.
• Dons a disposable plastic apron, non-sterile gloves, mask and goggles.
• Selects an appropriate type and size of catheter for the task and size of the patient (size 10 or 12 accepted).
• Sets suction to 12–20 kPa/100–150 mmHg, and checks suction is working.
• Assembles equipment using non-touch technique, and attaches tubing to the wall suction canister and suction catheter to the tubing.
• Check that the nostrils are patent by asking the patient to sniff with one nostril closed. Repeats with the other nostril.
• Lubricates the tip of the catheter with sterile water and gently inserts the catheter into the nostril as the patient inhales until the patient coughs or resistance is felt.
• States that if resistance is felt or distress caused, such as uncontrolled coughing, the catheter will be withdrawn 1cm before applying suction.

Procedural Phase

In this phase candidate do the procedure by

• Applying suction by placing thumb over valve. Slowly withdraw, maintaining the vacuum, applying intermittent suctioning (10-second intervals). Rotating, the catheter is withdrawn to avoid damaging structures. State that i would repeat the procedure 2 to 3 times as required/tolerated.
• Flushes the suction tubing with sterile water.
• Ensures that the patient’s face is clean and that they are safe and comfortable post procedure.

Post Procedural Phase

• Dispose all equipment, including apron and gloves, appropriately – verbalisation accepted.
• Cean hands with alcohol hand rub, or washes with soap and water and dries with paper towels, following WHO guidelines – verbalization accepted.

Conclusion

As nurses, most of us will be performing nasopharyngeal suctioning in our work settings. There are a few things to note in this skill demonstration which i feel is different from what we regularly practice. One of them is use of sterile water instead of lubricant gel. Anyway, in order to be successful in this station, you need to be demonstrating according to NMC recommendations.