The use of nasopharyngeal and oropharyngeal suctioning in physiotherapy practice in the United Kingdom

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 current use of NP and OP suctioning by physiotherapists (PTs) are scarce.
Aim and objectives: To investigate the use of NP and OP suctioning by PTs in the UK.
Methods: An anonymous online questionnaire including open and closed questions was developed in Microsoft Forms. UK-registered PTs in respiratory practice were invited to respond between May and June 2021. Quantitative data were analysed descriptively and qualitative underwent thematic content analysis.
Results: Respondents (N=134) mainly worked in the National Health Service (99%) in England (89%) across various clinical specialty levels. Median (IQR) monthly frequency of suctioning was 3 (1,5). Suctioning was usually successful (92%) and administered following manual airway clearance techniques
(76%), mechanical in/exsufflation (59%), and/or positioning and postural drainage (51%). Majority use suctioning with lubricant (98%) and NP airway (95%). The most common observed adverse effects were bleeding (80%), hypoxaemia (63%), and tachycardia (58%). Major qualitative themes included ethical challenges related to patient discomfort during suctioning, inappropriate requests for suctioning, and communication with patient, next of kin and other clinicians regarding the (non)use of suctioning.
Conclusions: NP/OP suctioning is an important ACT used by the UK PTs. Negative patient experience and appropriate indications for suctioning identify implications for education and training of PTs.