Basics of Suctioning
When patients are unable to mobilize their secretions, you may need to suction any secretions from the oropharynx and/or trachea to maintain a patent airway. Patients may be unable to clear their own airway due to a number of different problems, including neuromuscular disease, sedation or neurological deficits, such as a CVA. In addition, patients with an artificial airway, such as those who have been intubated, usually require suctioning while they are on a ventilator.
Suctioning may be done through an endotracheal tube, tracheostomy tube or through the nose or mouth into the trachea. Although each procedure is slightly different, indications, supplies, procedures and risks are similar.
Indications for Suctioning
Suctioning a patient’s lungs is not entirely without risk. As with all medical interventions healthcare workers need to use clinical judgment in order to determine if the benefits outweigh the risks.
Clinical indications for suctioning include respiratory distress due to increased copious, retained secretions. Signs of respiratory distress may include increased respiratory rate, tachycardia, gasping and difficulty talking. In the intubated patient, increased resistance, decreased SPO2, increased PEEP and an increasing FiO2 are indications that suctioning may be required. Patients who are not intubated and have coarse breath sounds should be encouraged to cough before suctioning is performed.
Patients with artificial airways, including those who are intubated, may routinely require suctioning. In some instances, mucus plugs or increased sputum production may cause a decrease in oxygen levels. If this occurs, suctioning will be required. In addition, there may be times when you need a sputum sample and the patient is unable to cough effectively enough to provide a sample. If this is the case, you may need to obtain a sample by suctioning.
There are closed suction catheters and open suction catheter systems. If you are suctioning an endotracheal tube or a patient with a tracheostomy, you can use either a closed suctioning system (in-line suctioning) or a regular suction catheter. Be sure to choose the correct size catheter.
If you are performing nasal-tracheal suctioning, a 12 or 14 Fr catheter is appropriate for most adults. You will also need saline, gloves, an ambu bag, a suction canister and connective tubing. If you are performing nasal-tracheal suctioning, you will also need a lubricant.
Before you begin, make sure the suction canister is hooked up correctly and set at an appropriate level. For adults, the suction vacuum should be set at 80 to 120 mmHG. For pediatric patients, suction vacuums should be between 60 and 80mmHG. Setting levels too high should be avoided and can lead to tissue damage.
After you have explained the procedure to the patient and have collected your supplies, you are ready to get started. Use personal protective equipment including an eye shield. Be sure to use sterile technique in order to reduce the risk of infection.
If you are suctioning an endotracheal tube, hyperoxygenate your patient by giving him a few breaths with 100 percent oxygen. If you will be suctioning through the nose, have supplemental oxygen ready in case it is needed. When suctioning through the nose, apply lubricate to the end of the catheter for easier insertion.
Insert the catheter through the nose, tracheostomy tube or endotracheal tube. Don’t be aggressive when inserting the tube through the nose. Once the catheter has been inserted to the appropriate depth, apply intermittent suction and slowly withdraw the catheter, using a twirling motion as you withdraw. If you will be suctioning more than once, allow the patient time to recover between suctioning attempts. As you suction, monitor oxygen levels and heart rate to make sure the patient is tolerating the procedure well. Suctioning attempts should be limited to 10 seconds.
Most invasive medical procedures carry some risk and suctioning is no different. Suctioning can stimulate the vagal nerve, causing bradycardia. It can also cause hypoxia. Hyperoxygenating the patient before suctioning and allowing them to rest in between suctioning attempts can reduce the chances of hypoxia.
Injury to the mucus membranes and bleeding can also occur. Using the appropriate vacuum level, a water-soluble lubricant and not forcing the catheter can decrease the risks of tissue injury.
- Apply suction for no longer than 10 seconds. Applying the suction longer can cause injury, hypoxia and bradycardia.
- Don’t apply suction while inserting the catheter. This can increase the chances of injuring the mucus membranes.
- If you are suctioning through the nose, do not force the catheter. In some instances, due to a person’s anatomy, it may be difficult to move the catheter through their nose into the trachea. Try different angles and reposition the patient’s head. In some instances, attempting to insert a catheter through the other nostril may work. Research has shown that the right nare is the largest in the majority of adults.
Farzan, Sattar, MD, FACP, FCCP A Concise Handbook of Respiratory Diseases. Prentice Hall 1997. Accessed July 2014
John Hopkins Medicine. Suctioning. http://www.hopkinsmedicine.org/tracheostomy/living/suctioning.html Accessed July 2014.