The following video is in Thai language that shows how phlegm suction is performed. The video is in Thai but the actions are self explanatory. I am not sure about other countries but in Thailand, the nurses are well versed with phlegm suction.
Phlegm suction for non tracheostomy (how it is done on a life patient):
The video is created by Awusotnc Net, mentioned in the video as a guide for caregivers who are caring for loved ones at home. I will include the timeline and what is explained by the narrator.
14.0 seconds– items required for phlegm suction
- 1. Cotton balls (soaked with alcohol)- these are sold widely in Thailand used in hospitals
- 2. Clean hand gloves
- 3. Suction catheter (for adults I recommend size 14. Size 12 would not be able to suction out some solidified mucus or phlegm). This is for single use only and must be disposed after each use.
- 4. Suction machine
0.33 seconds: Wear a face mask, wash hand clean and put on 2 layers of rubber gloves on each hand.
0.42seconds: Raise the patient’s bed to 30 degrees. Suction must be done before meal.
1.07min: Use the cotton ball (soaked in 70 percent alcohol solution) to wipe the tip of the suction tube that connects to the suction machine. Then attach to the suction catherer.
1.35min: On the suction machine and insert the suction catherer into the patient’s mouth. Slowly move it down the throat to do suction. At 1.43s, the nurse pressed with her left hand on the tip of the suction tube in order for suction to happen. Catherer tube should be inserted not more than 10s, then in between patient need to rest for about 20 to 30 seconds before doing again. When removing the suction catherer from the patient, gently rotate and pull up the catherer.
During rest time, administer oxygen for the patient (note: For me, my mom is on the oxygen concentrator set at 2.0, via a cannula that attached to her nostrils throughout the suction).
2.17min: Rinse the suction tube by placing in a bottle of cleaned water. Roll the suction catherer and then while taking off the first layer of glove with the catherer and then dispose it. Then use a cotton ball, soaked in 70 percent alcohol to wipe the tip of the suction catherer that attached to the machine.
My personal experience
I hope the video gives you a better picture on how suction is performed. In my case, I do suction daily for my mom at least 4 times before her meals. And if there is a need for suction to be done in between (due to a lot of secretions and mucus), I will wait for 2 hours after her meal. Suction cannot be done on a full stomach because sometimes the person will cough and it may cause the food to reflux upwards and aspirate into the lungs.
I also perform deep suction, ie I pass the tube deep into my mother’s trachea to do suction. Before passing the tube, I will wet her mouth with a little water soaked in cotton swab because it is uncomfortable and can be painful if her mouth is too dry when passing the tube. To identify the correct passage, ie whether it goes to trachea or throat (to stomach) would require practice and experience. Fortunately I was taught by a nurse on how to do deep suction, and to pass the tube gently.
Deep suction is required because hardened mucus deep within her trachea near her lungs had caused her to choke and unable to breathe a few times….severe until her lips actually turned dark blue and her eyes rolled upwards. After I learned to do deep suction, fortunately these episodes are very much reduced because I do my best to remove the obstructions to her throat passageway.
Additional in the video- oral care
2.53min: Brush the teeth twice, once during morning and second time at night. Head to be titled sideways as per video so that water does not get easily into the lungs. Place toothpaste on toothbrush. Brush the teeth but with suction activated using the other hand.
3.23 min: Using a syringe with water, pass gently in the mouth and do suction.
Note: Generally for my mom, she had no teeth (she lost all her teeth due to radiotherapy from her tonsil cancer treatment more than 20 years ago). She also had no saliva secretion. The GP advised using only water with either gauze or cotton swab to clean her mouth. I would soak the gauze in water, make sure it is not too wet but wet enough to provide moisture, wrap around my finger (with gloves on) and then pass the gauze into her mouth to clean. This was taught by a nurse to me when my mom was hospitalized. After that, I would do quick throat suction again to make sure no water gets into her lungs. At night, I would apply oral paste (a brand from Thailand) to her mouth.
