Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [165], C).
2. 2.Show
   Position the patient upright in a chair or in a high semi‐Fowler position, supported as necessary with pillows.
   For comfort and to facilitate optimum specimen collection. E
3. 3.Show
   Wash hands with bactericidal soap, or decontaminate physically clean hands with alcohol rub. Put on apron and eye protection.
   To reduce the risk of cross‐infection and splash injury to the practitioner (NHS England and NHSI [155], C).

Procedure

1. 4.Show
   Attach suction tubing to the male adapter of the specimen trap and attach the rubber tubing on the trap to the end of the suction catheter, leaving the packaging on.
   To enable correct set‐up and to ensure the suction catheter remains sterile. E
2. 5.Show
   Turn suction on and adjust to correct pressure (see Table 13.12).
   To ensure suction pressure is high enough to clear secretions while avoiding trauma. E
3. 6.Show
   Put on sterile gloves and remove the suction catheter from the packaging aseptically.
   To prevent cross‐contamination of the specimen. E
4. 7.Show
   Ask the patient to tilt their head backwards slightly while sitting upright.
   To optimize recovery of specimen collection. E
5. 8.Show
   Dip the end of the catheter into the water‐soluble lubricant.
   To facilitate comfortable passing of the catheter. E
6. 9.Show
   Without applying suction, carefully insert the catheter into the nostril and direct it posteriorly towards the external ear (Action figure 13.27). Note: the depth of insertion necessary to reach the posterior pharynx is equivalent to the distance between the anterior naris and the external ear.
   To prevent damage to the nasopharynx and to minimize patient discomfort. E
7. 10.Show
   Apply suction. Using a rotating movement, slowly withdraw the catheter. Note: the catheter should remain in the nasopharynx for no longer than 10 seconds.
   To prevent damage to the nasopharynx and to obtain the desired nasopharyngeal specimen. E

   To reduce the risk of hypoxaemia, mucosal damage and atelectasis. E
8. 11.Show
   Hold the trap upright to prevent secretions being suctioned into the suction pump.
   To prevent loss of the specimen. E
9. 12.Show
   Rinse the catheter (if necessary) with approximately 10–20 mL of viral transport medium.
   To ensure maximum recovery of epithelial cells and to prevent cross‐contamination (Higgins [84], E).
10. 13.Show
    Disconnect suction. Depending on the sputum trap type, connect the tubing to the arm of the sputum trap to seal, or detach and apply the sealable lid.
    To ensure the specimen container is securely sealed and to prevent cross‐contamination. E

Post‐procedure

1. 14.Show
   Dispose of waste; remove apron, gloves and eye protection; and wash and/or decontaminate hands.
   To ensure correct clinical waste management and to reduce the risk of cross‐infection (DH [48], C).
2. 15.Show
   Label the sample immediately and complete the microbiology request form (including relevant information such as indication for sample and current or recent antimicrobial therapy).
   To maintain accurate records and provide accurate information for laboratory analysis (NMC [165], C; Weston [255], E).
3. 16.Show
   Dispatch the sample to the laboratory as soon as possible (within 4 hours).
   To increase the chance of accurate organism identification (Higgins [84], E).
4. 17.Show
   Document the procedure in the patient's records.
   To ensure timely and accurate record keeping (NMC [165], C).