INTRODUCT

ION
• Suction can be used to
remove secretions from
intubated patients and from
infants and children who
are unable to cough and
expectorate.
 GENERAL
PRINCIPLES
• 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 should only be carried out as and when necessary, rather

than on a routine basis.
 SUCTION
TROLLEY:
• All the equipment needed for airway suction should be set out on a
trolley for ease of access:
1. Sterile plastic gloves - disposable.
2. Suction catheters - appropriate sizes for the patient.

3. Lubricating jelly water-based only, not oil-based, for use in

suction.
nasopharyngeal
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 for the collection of disposables
 INDICAT
ION
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
presence of a large
may indicate the plug of mucus in one of the larger bronchi or
endotracheal
even within theor tracheostomy tube.
5. If the minute volume (MV) drops, this may indicate
retained secretions
 RISKS AND
COMPLICATIONS OF
1. Trauma:
• Mucosal haemorrhage and erosion frequently occur in the patient
who has been suctioned, leading eventually to the formation of
granulation tissue.
• The amount of trauma depends upon the frequency of suction,
the amount of negative pressure applied, the size and type of
catheter used and the vigour of insertion.
2.
Hypoxi
• This can occur following suction.
a.
• To avoid this the suctioning time should be kept to a minimum,
particularly in tl](ose patients who are dependent on a ventilator,
and the inspired oxygen and/or ventilation may be increased prior to
suction providing there are no contra- indications.
• Cardiovascular effects.
• Cardiac arrhythmias and hypotension can occur during
suction due to hypoxia and/or vagal stimulation from direct
pharyngeal and tracheal irritation.

• Particular care should be taken with neonates as bradycardia and

apnoea can follow nasopharyngeal suction in these patients
• Atelectasis.

• Too large a suction catheter in too small an airway will prevent

entering
room airaround
from the catheter during suctioning and atelectasis, in
may occur.
varying degrees,
• Too high a negative suction pressure may also cause atelectasis and
airway collapse.
• Pneumothorax.

• This can occur primarily in premature infants with severe

underlying lung disease due to perforation of segmental bronchi
by a suction catheter
 TYPES

Depending on site of
Suctioning
A. Nasotracheal suctioning (NT)
B. Oropharyngeal suctioning
C. Tracheostomy suctioning (TT)
D. Endotracheal suctioning
 PROCEDURE:- INTUBATED
SUCTION FOR PATIENTS
1. Wash
hands.
2. Prepare equipment: - turn on vacuum, check pressure - attach
suction catheter -

3. Prepare patient - if conscious the patient should be swaddled in a

blanket being
prepare saline or mucolytic solution - prepare
gloves/forceps.
aware of infusions, drains, tubes, etc; or he should be held firmly
by an assistant.
The procedure should be explained to the child and constant
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. Disconnect ventilated patient from ventilator.
8. Insert catherter into tube without applying suction.
9. Push catheter gently and quickly down tube until a slight
resistance is met.
10. Withdraw catheter 0.5cm.
11. Apply suction.
12. Withdraw catheter quickly, rotating gently between thumb and
first finger and
interrupting the suction pressure every few seconds.
13. Reconnect patient to ventilator.
14. The same catheter can then be used to clear secretions from the
mouth and nose.
15. Discard both the glove and the catheter.
16. Repeat until secretions are cleared.
 SUCTION FOR NON-INTUBATED
PATIENTS
• Children and infants should always be suctioned in side lying to
prevent aspiration of vomit.

1. Wash hands.
2.Prepare equipment: - turn on vacuum, check pressure - attach
suction catheter - prepare saline or mucolytic solution - prepare
gloves/forceps.
3. Prepare patient - if conscious the patient should be swaddled in a
blanket being
procedure should be explained to the child and constant
aware of infusions, drains, tubes, etc; or he should be held firmly
suctioning
reassurance isgiven
takingwhile
place.
by an assistant. The
4. Physiotherapy may be carried out at this point if
indicated.
5. Place glove on the hand that is to hold suction
catheter.
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 slighdy
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
cough can be elicited merely by stimulating the pharynx.
9. Apply suction.
10. Withdraw catheter, rotating slightly between thumb and
first interrupting
finger and the suction every few
seconds.
11. Repeat procedure via other
nostril.
12. Discard both the glove and the
catheter.
13. Repeat until secretions are
cleared.
 ORAL
SUCTION
8. Pass suction catheter to the back of the throat until a cough has
been stimulated.
Ensure that the catheter is not curling
up in the mouth.
9.Apply suction.
10.Withdraw catheter.
11. Repeat until secretions are clear.
12.Discard both the glove and the
cathete
CONTRAINDICAT
IONS TO
THE INTUBATED
SUCTIONING
1. Frank haemoptysis
PATIENT
2. Severe bronchospasm
3. Undrained pneumothorax
4. Compromised cardiovascular
system.
 CLOSED-CIRCUIT
SUCTION
• Closed-circuit suction systems
are available and consist of a
catheter in a protective closed
sheath which remains
attached to the endotracheal
or tracheostomy tube for 24
hours.
• The indications for use are:
immuno- suppressed patients,
actively infectious patients
(e.g. open TB) and patients
with severe refractory
hypoxaemia on high levels of
PEEP.
 PRECAUTI
1.
ONS
100 — i20mmHg is ideal for most patients although pressure up
to —200mmHg may be needed for thick secretions.
2. Nasopharyngeal suction:
I. When introducing a suction catheter via the nose it is helpful if the
patient’s neck is extended so that the head is tilted backwards
resting on a pillow. If the patient can co-operate the tongue
should be protruded, as this helps when attempting to pass the
catheter between the vocal cords and into the trachea
II. It must be remembered that nasopharyngeal suction is a very
unpleasant experience for the conscious patient and should
only be used when absolutely necessary.
III. 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.
I. A lubricated plastic airway is usually tie eded 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

I. Whatever the mode of entry, the physiotherapist must ensure
that no suction
pressure is applied while the catheter is being introduced.
II. If, during nasopharyngeal suction, the patient becomes cyanosed
I and the catheter was difficult to insert, it is acceptable to
disconnect the suction, leaving the catheter in situ, while
administering oxygen J until the patient recovers and suction
can be resumed.
III. No longer than 15 seconds should elapse between the
disconnec - I tion and reconnection of the patient to the
ventilator, more than adequate time for
effective removal of secretions by the experienced I operator. j
Where possible, the patient should be suctioned in side lying
or 1 with the head rotated to one side to avoid aspiration of
gastric contents should
vomiting occur.
Suctioning
Procedure
 Oropharyngeal
 Nasopharyngeal
 STEP
 S
1. Assign signs and symptoms of upper and
including RR or adventitious sounds, nasal
lower airway obstruction requiring
secretions, drooling, gastric
nasotracheal secretions,
or orotracheal or
suctioning,
vomitus in mouth
• Rationale
• Physical signs and symptoms result from pooling
of secretions in upper and lower airways.
Step
2 signs and symptoms associated with
Assess
hypoxia and hypercapnia.
• Rationale
• Physical signs and symptoms
resulting from decreased oxygen to
tissues indicate need for suctioning.
Step
• Determine factors that normally • Rationale
3 influence upper or lower airway
functioning
• Fluid Status • Fluid overload may increase
amount of secretions. Dehydration
promotes thicker secretions
• Lack of Humidity
• The environment influences
secretion formation and gas
exchange, necessitation airway
suctioning when cannot clear
• Infection secretions effectively.
• Clients with respiratory infections
are prone to increased secretions
that are thicker and sometimes
more difficult to expectorate
• Anatomy • Abnormal anatomy can impair
normal drainage or secretions.
 Step
•4 Assess client’s understanding of
procedure (when applicable)
• Rationale:
• Reveals need for client instruction
and also encourages
cooperation.

Step 5
• Obtain physicians order if indicated by
agency
● policy.
Rationale
●
Some institutions require a
physicians order for tracheal
suctioning
 Step
•6 Help client assume position comfortable for
nurse and client (usually semi-Fowler’s or
sitting upright with head hyperextended,
unless contraindicated).
• Rationale
• Reduces stimulation of gag reflex,
promotes client comfort and
secretion drainage, and prevents
aspiration.
• Lessens strain on nurses’ back.
• Hyperextension fascilitates insertion
of catheter into trachea.
Step
• Place pulse oximeter on client’s finger. Take
7 reading and leave pulse oximeter in place.
• Rationale
• Provides baseline SpO2 to determine
client’s response to suctioning.

Step 8
• Place tower across client’s chest.

●
Rationale
●
Reduces transmission of
microorganisms by protecting gown
from secretions.
 Step
•9 Perform hand hygiene.
• Rationale
• Reduces transmission of
microorganisms.
Step
Preparation for all types Rationale
10
of suctioning
• Open suction kit or • Prepares catheter and
catheter with use of aseptic prevents transmission of
technique. Do not allow the microorganisms.
suction catheter to touch
any unsterile surfaces.
• Unwrap or open sterile
basin and place on
bedside table. Fill basin
with approx 100ml of
sterile normal saline
solution or water.
Step 10forcontinued…
Preparation all types Rationale
of suctioning
• Connect one end of • Equipment must be in
connecting tubing to proper working order to
suction machine. Place prevent delay in the
other end in convenient procedure.
location near client.
Check that equipment is
functioning properly by
suctioning a small
amount of water from
basin.
Step 10forcontinued…
Preparation all types Rationale
of suctioning
• Turn on suction device. Set • Elevated pressure
regulator to appropriate settings increase risk of
negative pressure: wall trauma to mucosa and
suction, 80 can induce greater
– 120mmHg; portable hypoxia.
suction, 7 – 15 mmHg for
adults.
Step 11 – Oropharyngeal
• Apply clean disposable
Suctioning
• glove to dominant hand.
Suction of oral cavity
does not require sterile
glove use.
Consider applying
mask or face shield. • Suction may cause
splashing of body fluids.
 Attach suction catheter
• to connecting tube.
Remove oxygen mask if
present.
• If catheter does not have a
Insert catheter into suction ctrl, apply
client’s mouth. With intermittent suction, take
suction applied, move care not to allow suction
catheter around mouth, tip to invaginate oral
including pharynx and mucosal surfaces with
gum line, until continuous suction.
Step 11 – Oropharyngeal
Suctioning
• Encourage client to cont’d…
cough, and repeat
• Coughing moves
secretions from lower to
suctioning if needed. upper airways into the
Replace oxygen mask if mouth.
used
• Suction water from basin • Clearing secretions before they
through catheter until clear dry reduces probability of
from secretions transmission of microorganisms
and enhances delivery of preset
suction pressures.
• Place catheter in a clean dry • Facilitates prompt
area for reuse with suction removal of secretions
turned off or within client’s when needed in the
reach, with suction on, if future.
client is capable of
suctioning self.
 Nasopharyngeal
Suctioning
• If indicated, increase • Preoxygenation and deep
supplemental oxygen breathing assist in reducing
therapy to 100% or as suction-induced hypoxemia.
ordered by physician. Preoxygenation should be
Encourage client’s deep used with caution in oxygen
breathing. sensitive clients such as those
with chronic heart and lung
conditions and those with
pneumonia.
 Nasopharyngeal
• Open lubricant. Squeeze • Prepares lubricant while
Suctioning…
small amount onto open maintaining sterility. Water
sterile catheter package soluble lubricant is used to
without touching package. avoid lipoid aspiration
pneumonia. Excessive
lubricant can occlude
catheter.
• Reduces transmission of
• Apply sterile glove to each microorganisms and allows
hand nurse to maintain sterility of
suction catheter.
 Nasopharyngeal
• Pickup suction catheter with • Maintains catheter sterility.
Suctioning…
dominant hand without Connects catheter to suction.
touching nonsterile surfaces.
Pick up connecting tubing
with nondominant hand.
Secure catheter to tubing.
• Lightly coat distal 6 to 8 cm
(2-3in) of catheter with • Lubricates catheter for
water-soluble lubricant. easier insertion.
 Nasopharyngeal
• Measure the distance from
Suctioning…
the tip of the nose to the tip
of the earlobe 13 cm (5in) • Proper placement ensures
• Follow natural course of removal of pharyngeal
naris; slightly slant catheter secretions.
downward and advance to
back of pharynx.
• When pulling back the
catheter, slightly roll the • Rolling the tube back and
tube between the thumb forth ensures suctioning in
and index finger. all areas.
 Nasopharyngeal
• Encourage client to cough. • Coughing facilitates
Suctioning…
• Allow for rest periods and removal of secretions
repeat this procedure until • Rest periods allow for rest
airway is cleared. Limit and reoxygenation
suction time to 3-5 mins. • Repeated passes with the
• Reapply oxygen as suction catheter assist in
needed. clearing the airway of
excessive secretions and
promotes oxygenation.
 Nasopharyngeal
• Rinse catheter and • Clearing secretions before
Suctioning…
connecting tubing with they dry reduces probability
normal saline or water until of transmission of
cleared. microorganisms and enhances
delivery of preset suction
pressures.
• Reassess client’s
respiratory status.