Oxy SL
3yr - 1st sem, Midterms
SUCTIONING
Introduction
➢ Suction can be used to remove secretions from
intubated patients and from infants and
children who are unable to cough and
expectorate
General Principle
➢ The technique should be as quick, clean and
gentle as possible
➢ Suction is very traumatic to delicate mucosal
tissue and it is very easy to introduce infection,
especially in intubated patients
Suction Trolley
➢ Suction should only be carried out as and when
➢ All the equipment needed for airway suction
necessary, rather than on a routine basis
should be set out on a trolley for ease of access:
1. Sterile plastic gloves - disposable
Equipments
2. Suction catheters - appropriate sizes for the
patients
3. Lubricating jelly water based only, not oil based
- for use in nasopharyngeal suction
4. Sterile gauze swabs - to transfer jelly to tip of
catheter
5. Sterile water - to flush the secretions through
the catheter and tubing. Sodium bicarbonate
acts as a solvent of the secretions
6. Forceps (if used)
7. Plastic bag - collection of disposables
Indication
1. Whenever secretions can be heard in an
intubated patient
2. For retained secretions in the spontaneously
breathing patient who is unable to cough and
expectorate efficiently
3. Before and during the release of the cuff on a
tracheostomy tube
4. If the inflation pressure of the ventilator
suddenly rises. This may indicate the presence
of a large plug of mucus in one of the larger
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bronchi or even within the endotracheal or
tracheostomy tube Types
5. If the minute volume (MV) drops, this may ❖ Depending on site of suctioning
indicate retained secretions a. Nasotracheal suctioning (NT)
b. Oropharyngeal suctioning
Risks and Complications of Suction c. Tracheostomy suctioning (TT)
❑ Trauma d. Endotracheal suctioning
⬝ Mucosal hemorrhage and erosion frequently
occur in the patient who has been suctioned, ❖ Depending upon circuit
leading eventually to the formation of a. Open circuit
granulation tissue b. Closed circuit
⬝ The amount of trauma depends upon the
frequency of suction, the amount of negative Procedure
pressure applied, the size and type of catheter ❖ Intubated Patients
used and the vigor of insertion 1. Wash hands
❑ Hypoxia 2. Prepare equipment : - turn on vacuum, check
⬝ This can occur following suction pressure → attach suction catheter → prepare
⬝ To avoid this the suctioning time should be saline or mucolytic solution → prepare
kept to a minimum, particularly in patients gloves/forceps
who are dependent on a ventilator, and the 3. Prepare patient - if conscious the patient should
inspired oxygen and/or ventilation may be be swaddled in a blanket being aware if
increased prior to suction providing there are infusions, drains, tubes, etc. or he should be
no contraindications held firmly by an assistant. The procedure
❑ Cardiovascular effects should be explained to the child and constant
⬝ Cardiac arrhythmias and hypotension can occur reassurance given while suctioning is taking
during suction due to hypoxia and/or vagal place
stimulation from direct pharyngeal and tracheal 4. Physiotherapy may be carried out at this point
irritation if indicated
⬝ Particular care should be taken within neonates 5. Place glove on the hand that is to hold suction
as bradycardia and apnoea can follow catheter
nasopharyngeal suction in these patients 6. Withdraw catheter from its sterile pack with the
❑ Atelectasis gloved hand
⬝ Too large a suction catheter in too small an 7. Disconnect ventilated patient from ventilator
airway will prevent room air from entering 8. Insert catheter into tube without applying
around the catheter during suctioning and suction
atelectasis, in varying degrees may occur 9. Push catheter gently and quickly down tube
⬝ Too high a negative suction pressure may also until a slight resistance is met
cause atelectasis and airway collapse 10. Withdraw catheter 0.5cm
❑ Pneumothorax 11. Apply suction
⬝ This can occur primarily in premature infants 12. Withdraw catheter quickly, rotating gently
with severe underlying lung disease due to between thumb and first finger and
perforation of segmental bronchi by a suction interrupting the suction pressure every few
catheter seconds
13. Reconnect patient to ventilator
14. The same catheter can then be used to clear
secretions from the mouth and nose
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15. Discard both the glove and the catheter 12. Discard both the glove and the catheter
16. Repeat until secretions are cleared 13. Repeat until secretions are cleared
◈ Contraindications
1. Frank haemoptysis ❖ Oral suction
2. Severe bronchospasm 1-7 same
3. Undrained pneumothorax 8. Pass suction catheter to the back of the throat until a
4. Compromised cardiovascular system cough has been stimulated. Ensure that the catheter is
not curling up in the mouth
❖ Non-intubated patients 9. Apply suction
⬩ Children and infants should always be 10. Withdraw catheter
suctioned in side lying to prevent aspiration of 11. Repeat until secretions are clear
vomit 12. Discard both the glove and the catheter
1. Wash hands
2. Prepare equipment : - turn on vacuum, check Closed-circuit suctioning
pressure → attach suction catheter → prepare ➢ Closed-circuit suction systems are available and
saline or mucolytic solution → prepare consist of a catheter in a protective closed
gloves/forceps sheath which remains attached to the
3. Prepare patients - if conscious the patient endotracheal or tracheostomy tube for 24 hours
should be swaddled in a blanket being aware of ➢ The indications for use are : immunosuppressed
infusions, drains, tubes, etc. or he should be patients, actively infectious patients (e.g. open
held firmly by an assistant. The procedure TB) and patients with severe refractory
should be explained to the child and constant hypoxemia on high levels of PEEP
reassurance given while suctioning is taking
place
4. Physiotherapy may be carried out at this point
if indicated
5. Place glove on the hand that is to hold suction
catheter
6. Withdraw catheter from its sterile pack with the
gloved hand
7. Gently insert catheter into the nose using an
upward motion until the nasal septum is passed,
then using a downward motion. If a slight
resistance is met, withdraw catheter slightly and
try again
8. Insert catheter to the back of the throat until a
cough has been stimulated. It is possible to pass
a catheter into the trachea by inserting the
catheter during inspiration, but an effective Precautions
cough can be elicited merely by stimulating the 1. 100-120mmHg is ideal for most patients
pharynx although pressure up to 200mmHg may be
9. Apply suction needed for thick secretions
10. Withdraw catheter, rotating slightly between 2. Nasopharyngeal suction
thumb and first finger and interrupting the a. When introducing a suction catheter
suction every few seconds via the nose it is helpful if the patient’
11. Repeat procedure via other nostril neck is extended so that the head is
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tilted backwards resting on a pillow. If
the patient can cooperate the tongue
should be protruded, as this helps when
attempting to pass the catheter between
the vocal cords and into the trachea
b. It must be remembered that
nasopharyngeal suction is a very
unpleasant experience for the conscious
patient and should only be used when
absolutely necessary
c. Nasopharyngeal suction should not be
used for patients with head injuries
where there is a leak of CSF into the
nasal passages
3. Oropharyngeal suction
a. A lubricated plastic airway is usually
tied to prevent the patient biting the
catheter and it is difficult to direct the
catheter accurately into the pharynx
and beyond
4. Suction via tube
a. Whatever the mode of entry, the
physiotherapist must ensure that no
suction pressure is applied while the
catheter is being introduced
b. If during nasopharyngeal suction, the
patient becomes cyanosed and the
catheter was difficult to insert, it is
acceptable to disconnect the suction,
leaving the catheter in situ, while
administering oxygen until the patient
recovers and suction can be resumed
c. No longer than 15 seconds should
elapsed between the disconnection and
reconnection of the patient to the
ventilator, more than adequate time for
effective removal of secretions by the
experienced operator. Where possible,
the patient should be suctioned in side
lying or with the head rotated to one
side to avoid aspiration of gastric
contents should vomiting occur
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