THE NORTH CAROLINA BOARD OF PHYSICAL THERAPY EXAMINERS
PTBoard@NCPTBoard.org
RegulatorySpotlight
в
Is it appropriate for a PT to delegate suctioning, either
oropharyngeal or tracheal, to
а РТЛ?
Recent meetings of both the Public Protection Task
Force (February 28, 2024) and the Board (March 6,
2024) considered this question. Research into the
topic included:
• Review of Commission on Accreditation in
Physical Therapy Education (CAPTE) curriculum
requirements for PTA Education Programs
(Standard 7 and more specifically 7A2, 7D1-8);
• Discussion with CAPTE accredited PTA programs
in NC, along with Board-Certified Cardiovascular
and Pulmonary Clinical Specialists in NC who are
subject matter experts;
• Examination of the 2022 Academy of
Cardiovascular & Pulmonary Physical Therapy
publication: Entry-Level Physical Therapist
Competencies in Cardiovascular & Pulmonary
Physical Therapy ; and
• Consultation with rehab managers in long-term
acute care settings regarding current practice.
Since this question incorporates the appropriate
delegation and supervision of the PTA by the PT, a
scope of practice analysis is necessary. As with all
scope of practice considerations, the Board
reviewed and applied NC Physical Therapy Board
Rule 21 NCAC 48C .0101 PERMITTED PRACTICE (a)
Physical therapy is presumed to include any acts,
tests, procedures, modalities, treatments, or
interventions that are routinely taught in educational
programs or in continuing education programs for
physical therapists and are routinely performed in
practice settings.
The APTA Academy of Cardiovascular & Pulmonary
Physical Therapy publication, Entry-Level Physical
Therapist Competencies in Cardiovascular &
Pulmonary Physical Therapy , differentiates
oropharyngeal suctioning (airway suctioning) and
tracheal suctioning (deep, inline suctioning) when
defining entry-level physical therapist competencies.
Since the opinions of the NC Board-Certified
Cardiovascular and Pulmonary Clinical Specialists
and the experiences of the rehab managers
surveyed in long-term acute care settings aligned
with these categories of suctioning, oropharyngeal
and tracheal suctioning were the operational
definitions utilized by the Board.
After review, the Board determined both
oropharyngeal and tracheal suctioning fall within the
scope of practice for PTs who have the requisite
training, education, and competency. The skill and
knowledge required of PTs performing tracheal
suctioning are considered advanced and would not
be appropriate for an entry-level licensee to
perform. Additionally, levels of complexity (both
patient and the setting), as highlighted in the
Academy of Cardiovascular & Pulmonary Physical
Therapy 2022 publication noted above, should be
considered as PTs assess their own personal level
of proficiency and competence when practicing
suctioning. Advanced training may be required for
more complex patients and settings. The Board
defines “advanced training” as “beyond entry-level”
for the skill level or training required.
Since the clinical skills required to perform
oropharyngeal and tracheal suctioning range from
entry-level to advanced, a PT student should only
perform these skills under the supervision of a
trained, educated, and competent PT.
Similarly, PTAs always work under the supervision of
a PT. The supervising PT is responsible for
determining the competence of a PTA to perform
any delegated activity. Delegated activities must be
deemed safe and effective for the patient and within
the PT patient care plan. It is the responsibility of the
PTA to perform only those delegated activities
within their scope of practice, and for which the
individual PTA has the education and training to
perform, ensuring compliance with Board Rule 21
NCAC 48C .0101.
