The use of nasopharyngeal and oropharyngeal suctioning in physiotherapy practice in the United Kingdom: a preliminary survey of current practice

Introduction: Nasopharyngeal (NP) and oropharyngeal (OP) suctioning are airway clearance techniques (ACTs) used to maintain airway patency and enhance gas exchange by removing secretions in an acutely unwell self-ventilating patient. Data on the current use of NP and OP suctioning by physiotherapists are scarce. Aim and objectives: To investigate the use of NP and OP suctioning by physiotherapists in the UK. Methods: An anonymous online questionnaire was developed in Microsoft Forms. UK-registered physiotherapists working in respiratory practice were invited to complete the survey via professional organisations and social media between May and June 2021. Data were analysed descriptively. Results: Respondents (N=134) mainly worked in the National Health Service (99%) in England (89%) across various clinical speciality levels. The median (IQR) frequency of treatment involving either NP or OP suctioning was 3 (1,5) in the preceding month. Suctioning was usually reported as being successful (92%) and most commonly administered following manual airway clearance techniques (78%), mechanical in/exsufflation (61%), and/or positioning and postural drainage (52%). The majority of respondents reported they performed suctioning with a lubricant (98%) and a nasal pharyngeal airway in situ (95%). Respondents reported experience of a number of adverse effects in relation to NP or OP suction, most notably bleeding (80%), hypoxaemia (63%), and tachycardia (58%). Conclusions: Although NP/OP suctioning is an important ACT in UK physiotherapy practice, it is highly invasive and carries the risk of adverse effects and negative patient experience. Further research and development of adaptations and less invasive alternatives to the technique are warranted. Contribution of the Paper: • This is the first study to identify how frequently and in what type of situations nasopharyngeal and oropharyngeal suctioning is used by physiotherapists in the UK. • The main modalities used prior to suctioning were manual techniques, mechanical insufflation-exsufflation, positioning, and the active cycle of breathing technique depending on patient's needs. • Suctioning was reported to be highly successful, although it carries a considerable risk of adverse effects such as bleeding, tachycardia and hypoxaemia.