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Endotracheal, oropharyngeal and oral suctioning -- what first, second and third?

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Dear colleagues

Just a naïve question.

Endotracheal, nasopharyngeal and oral suctioning in infants -- what first, second and third?

My idea was 1. Trachea 2. Oropharyngeal 3. Nose.

But some colleagues told that oropharyngeal suctioning first because we need to clean upper airways in order to avoid risk of microaspiration by ETT during the endotracheal suctioning. 

For example guidelines from Ireland https://www.olchc.ie/Healthcare-Professionals/Nursing-Practice-Guidelines/Suctioning-Guideline-Sept-2017.pdf support my opinion.

But the other opinion sounds reasonable too.

Where the truth? Many thanks! 

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Hi I am Ismail,

I agree with Lionel.

1.Oral 2 Oropharyngeal and 3 Nasopharyngeal.

If nose is done first it might trigger a choking/sneezing or inhalation effect and possible aspiration. Once mouth and pharynax is done most secretion will have been cleared, than would be safe to try the nose. 

Just my thoughts 


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