College of Nursing

Learning Material 4

Module: Newborn Infant

Suctioning

Module Description:

This module will help supports the students to produce and develop their skills
and knowledge in infant suctioning. They will acquire and gain understanding in
proper oropharyngeal and nasopharyngeal suctioning in infant.

Course Learning Outcome

At the end of this module the students will be able to learn:

The purpose of suctioning administration.
They will learn the method and procedure.
They will identify the different types of suctioning devices and equipment's.
They will learn the indication, complication and nursing responsibilities, in
infant suctioning

Topic
Breathing in a healthy newborn

Normally, a healthy baby starts to breath spontaneously immediately after delivery If the
breathing started spontaneously and is sustained by the baby without assistance, it
indicates that:
The fetus was not asphyxiated while in the uterus
The respiratory system is functioning well
The cardiovascular system (heart and blood vessels) is functioning well
There is coordination by the brain of the movements required for sustained rhythmical
breathing (brain is functioning well).
Suctioning is removing mucus and fluids from the nose, mouth or back of the throat with a bulb
syringe or a catheter (thin flexible tube).

Suctioning are used to clear secretions from the airway which inhibit normal respiratory functions

The procedure involves inserting a catheter into an infant's nose and advancing it to the back of
the throat (pharynx) approximately 4-8 cm

The transition from fetus to newborn involves the clearing of lung fluid and expansion of the
lungs with air. Traditionally suctioning at birth has been used routinely to remove fluids in
vigorous infants at birth. While suctioning can be successful in clearing the airway immediately
after birth, the procedure can have serious consequences that may outweigh the potential
benefits of suctioning.

According to WHO( Word Health Organization) now advises against routine bulb suctioning of
neonates in the minutes following birth. If the baby is born through clear amniotic fluid and
begins breathing on their own shortly after birth, do not suction. However, if the baby struggles
with signs of respiratory distress, do not delay suctioning. Aspirated meconium can be
especially lethal to newborns, and the faster you are able to suction them, the greater their
likelihood of survival. ( updates May 2020)

5 Types of newborn suctioning:

a. Oropharyngeal Suctioning
- as soon the baby's head is delivered, the mouth or
oropharynx and hypopharynx should be thoroughly
suction using flexible suction catheter or syringe bulb.

Attach catheter end to connection tubing from the

suction apparatus. Adjust wall suction. Recommended
pressures should not exceed 80 – 120 mmHg for
pediatrics and 80 - 100 mmHg for neonates.

b. Nasopharyngeal Suctioning- Suctioning in the nose

- remove mucus from your child's airway. This method

is usually done with an artificial airway such as a
tracheostomy tube. It removes mucus between the
end of the tube and the carina (the part where the
trachea splits into the bronchi, the tubes that go into
the lungs)
Indication of Oropharyngeal and Nasopharyngeal suctioning

Patient who undergone head and neck surgery.

Signs of respiratory distress.
Evidence of unable to cough and expectorate secretions.
Obtain sample for diagnostic test purposes.
Prevent infection.

c. Nasal Suctioning
- suctioning of the nose

d. Oral Suctioning

-suctioning of the mouth

Indication of oral suctioning

Audible secretions from the mouth with inability to cough independently.

Aspiration
Reduced oxygen saturations
Increased airway pressure when ventilated could be due to airway
occlusion by secretions.

e. Deep suctioning
remove mucus from your child's airway. This method is usually done with an
artificial airway such as a tracheostomy tube. It removes mucus between the end of
the tube and the carina (the part where the trachea splits into the bronchi, the
tubes that go into the lungs)
Bulb Syringe

A bulb syringe is used to remove mucus from your baby’s mouth or nose. A stuffy nose
can make it hard for your baby to breathe. This can make your baby fussy, especially
when he/she tries to eat or sleep. Suctioning makes it easier for your baby to breathe
and eat.

If needed, it is best to suction your baby’s nose before a feeding or bedtime. Avoid
suctioning after feeding. This may cause your baby to vomit.

Indication of Suctioning

Only suction a neonate who shows clear signs that suctioning is appropriate.
An increase in CO2
Increased oxygen needs
Bradycardia and apnea
Audible breathing, gasping, or wheezing
Visible secretions, or obvious difficulty clearing the airway
A "gurgle" sound of secretions
hard time breathing
blue or gray color around eyes, mouth, fingernails, or toenails
you feel "rattling" on the child's chest or back
child seems anxious or restless, or cries and cannot be comforted
breathing rate or heart rate increases
nostrils flare (open wider when breathing in)
retracting (chest or neck skin pulls in with each breath)

Monitor the baby’s vital signs before and after suctioning, because no procedure is
without risk. Airway trauma, hypoxia, infection, and increased intracranial pressure
are especially dangerous to neonates, so weigh the risks and benefits and know the
baby’s health history before proceeding.

Precautions in Suctioning Newborn Infant

Contraindications
Do Not Suction Too Long.
Avoid Forcing the Catheter.
Monitor for Complications.
Choose the Right Equipment.
Contraindication

Some patients face a higher risk of suctioning-related morbidity. They include:

Patients with a recent head or neck injury

Geriatric and pediatric patients, who have more fragile airways
People with cognitive or mental health conditions that make it more difficult for them to
understand the procedure and cooperate
Patients with loose dental hardware
Patients with a difficult airway or a history of suctioning complications
Patients with bradycardia
Patients with hypoxia

Do Not Suction Too Long

Prolonged suctioning increases the risk of hypoxia and other complications. Never suction
a patient for longer than 15 seconds. Rather than prolong suctioning, withdraw the
catheter, re-oxygenate the patient, and suction again.

Avoid Forcing the Catheter

A difficult airway can be stressful and upsetting, particularly if the patient requires
emergency suctioning. Yet forcing the catheter can cause serious airway trauma. Never
force the catheter, and do not attempt to insert it into an airway you cannot see.

Monitor for Complications

During and after suctioning, monitor the infant for common complications. Take their vital
signs before and after the procedure .

Hypoxia
Bradycardia and arrhythmias
Airway trauma, which may increase the risk of infection
Higher blood flow in the cerebrum and increased intracranial pressure
Pneumothorax or lung perforation
Atelectasis (lung collapse)
 Choose the right equipment

Without the right equipment, even a flawless suctioning technique may prove inadequate.
The right catheter size is key. In most cases, the suction catheter should have an external
diameter that is less than half the internal diameter of the endotracheal tube. Geriatric and
pediatric populations often require smaller suction catheters. Children have smaller airways,
and elders may have more difficult airways due to loss of muscle tone.

Avoid Forcing the Catheter

A difficult airway can be stressful and upsetting, particularly if the patient requires emergency
suctioning. Yet forcing the catheter can cause serious airway trauma. Never force the catheter,
and do not attempt to insert it into an airway you cannot see.

Minimize the risk of the Newborn

As with any other patient, hyperoxygenate the neonate before and after suctioning.
Minimize the length of suctioning to 10 seconds or less. If the first pass does not fully clear
the airway, reoxygenate the neonate and try again. Some other strategies that can reduce
risk include:
Choosing smaller equipment. Neonates have fragile airways that are easily damaged.
Being mindful of differences in the neonate’s airway. Babies have smaller, more
narrow airways, a larger tongue and epiglottis, and a shorter trachea. Adapt your
technique and your equipment accordingly.
Supporting the infant’s head. A newborn cannot support the weight of their own head,
increasing the risk of injury during suctioning if they are not well supported.
Reducing the risk of infection. Pathogens that are only mildly annoying to an adult can
be lethal to neonates, especially those with compromised immune systems. Thoroughly
wash hands in hot water. Always wear gloves and a mask, and change gloves before
changing equipment or after touching anything that might be contaminated.
 Reducing the risk of Suctioning

Minimizing suctioning time. Suctioning a baby for too long greatly increases the

likelihood of hypoxia.
Monitoring the baby’s vital signs. Log all data in the infant’s log, and take the baby’s
vitals and oxygen saturation levels before and after suctioning.
Treating suctioning as a two-person procedure. One person performs the suctioning
while the other physically supports and reassures the baby while monitoring the
baby’s condition.
Delaying suctioning until at least eight hours after the administration of a surfactant.
Preoxygenating the baby prior to suctioning and reoxygenating the baby again after
suctioning.

Methods in Suctioning

Suctioning with a bulb syringe

A bulb syringe is used to clean the nose or to remove mucus that has been coughed up.
Most suctioning can be done this way. You may use this method as often as needed.

1. Wash your hands

2. Squeeze the bulb until it is collapsed.
3. Place the tip in the nose or mouth and release the bulb. This will create suction and
bring the mucus into the bulb.
4. Remove the bulb syringe from the nose or mouth and squeeze it into a tissue to get
the mucus out.
5. After use, wash the bulb syringe in hot soapy water, squeezing the bulb several
times. Squeeze in clear hot water to rinse.
6. Wash your hands again.
Suctioning with a catheter

1. Wash your hands.

2. Gather equipment:
3. • water-soluble lubricant
4. • suction catheter kit
5. • suction machine
6. • normal saline for lavage
7. • sterile water
8. Turn on the suction machine.
9. Open the suction catheter kit, keeping everything inside the kit sterile as you open it.
10. Put some sterile water in the cup.
11. Using sterile technique, put on the glove(s). Avoid touching anything that is not sterile.
12. Pick up the suction catheter with your "suctioning hand" and the suction tubing with your
other hand. Connect the two ends.
13. Apply a water-soluble lubricant to the end of the suction catheter.
14. Keep your thumb off the thumbport while you gently pass the catheter into the nostril to the
back of the throat. This may or may not stimulate a cough.
15. • If more than gentle pressure is needed to put the catheter in, stop and take it out.
16. To suction, block the thumbport with the thumb of your non-sterile hand and withdraw the
catheter. Do not suction longer than 5 to 10 seconds.
17. Let your child rest for 15 to 20 seconds before suctioning again.
18. If mucus is thick, lavage with 3 to 5 drops of normal saline into the nostril before suctioning.
19. You may need to rinse the catheter by suctioning some water through it.
20. After suctioning the nose, you can use the catheter to suction the back of the mouth if needed.
If you do this, do not use the catheter to suction the nose again.
21. Throw away the used catheter kit.
22. Suctioning some water through the suction tubing.
23. Turn off the suction machine.
24. Wash your hands again.

When should I call the doctor?

child coughs up fresh blood
fresh blood is in the mucus you suctioned
hard time breathing even after suctioning
increased mucus
mucus changes color
mucus becomes thicker and does not thin after putting a few drops of sterile salt water in the
nose
fever
lip or nail color becomes darker