SUCTIONING
Suctioning
● Refers to the method of clearing secretions from the
airways of the patient who can not mobilize and
expectorate them without assistance.
● Used to clear retained or excessive lower
respiratory tract secretions in patients who are
unable to do so effectively for themselves. This
could be due to the presence of an artificial
airway, such as an endotracheal or tracheostomy
tube, or in patients who have poor cough due to an
array of reasons such as excessive or neurological
involvement.
INDICATIONS:
● patients incapable of coughing at voluntary or
reflex level.
● Ineffective coughing due to weakness and
exhaustion in very sick patients.
● Patients who are breathing spontaneously but
are unwilling or unable to cough effe tively
due to confusion, pain.
● Deeply conscious or, patients with respiratory
muscle paralysis
● all intubated patients.
CONTRAINDICATIONS
Patients with acute head injury or after
intracranial surgery
severe coagulopathy
recent oral or facial surgery
hypoxemia
cardiac instability
unstable cervical spine
SUCTION EQUIPMENTS
Wall-Mounted Suction Units:
These are installed directly onto the walls of patient care areas
and are connected to the central vacuum system or a portable
suction unit. They typically include vacuum regulators,
collection canisters, tubing, and suction catheters or Yankauer
suction tips.
Portable Suction Units:
These are standalone devices that can be easily moved from one
location to another, allowing for suctioning in various settings,
including patient rooms, ambulances, and outpatient clinics.
Portable suction units are battery-powered or electric-powered
and may include disposable or reusable collection canisters.
Suction Catheters:
Suction catheters are flexible, plastic tubes used to
remove secretions or fluids from the patient's airway or
respiratory tract. They come in various sizes and
styles, including open-tip catheters for oropharyngeal
suctioning and closed-tip catheters for endotracheal
suctioning.
Commonly used sizes for the adult patients are 10,12,
14, 16 and 18 FG are colour coded for size (5, 8 in
pediatric and neonates.
The size of the catheter should not exceed half the
diameter of the endotracheal or tracheosstimy tube
Yankauer Suction Tips:
also known as tonsil or tonsil-tip suction devices, are rigid, plastic
suction instruments with a bulbous tip and multiple side openings.
They are commonly used for oral suctioning and are designed to
remove larger volumes of fluid or debris from the mouth and throat.
Suction Canisters: Suction Tubing and Connectors:
Collection canisters are containers Suction tubing connects the suction
used to collect and contain suctioned source (e.g., suction unit or wall
fluids and secretions. They come in outlet) to the suction catheter or
Yankauer suction tip. It is
various sizes and designs, including
typically transparent and flexible,
disposable and reusable options. allowing for easy visualization of
Disposable canisters are often made of fluid flow. Tubing connectors are
plastic and are discarded after single used to secure and join different
use, while reusable canisters are components of the suction system,
typically made of durable materials such as tubing to suction catheters
such as glass or autoclavable plastic. or collection canisters.
Vacuum Regulators: Suction Accessories:
Vacuum regulators control the level of Various accessories may be used in
suction pressure delivered to the conjunction with suction equipment,
patient during suctioning. They are including suction catheter kits,
adjustable to allow for precise suction catheter holders, suction
regulation of suction pressure based
traps or filters, and
on patient needs and clinical
indications. Vacuum regulators may be bacterial/viral filters to prevent
integrated into suction units or contamination of the suction system
provided as standalone devices. and protect healthcare providers
from exposure to infectious agents.
Suction Trolley
All the equipment's needed for airway should
be set out on a trolley for ease of access.
Sterile plastic gloves
(disposable)
Suction catheters of
appropriate size
Lubricating jelly
Sterile gauze swabs
Sterile water
Plastic bags
SUCTION PROCEDURE
1.Assessment and Preparation:
1.Assess the patient's respiratory status, including
breath sounds, oxygen saturation, and signs of
respiratory distress.
2.Gather necessary equipment, including suction
catheter, sterile saline solution (if indicated),
gloves, mask, goggles, suction tubing, and sterile
gloves.
2.Hand Hygiene and Personal Protective Equipment (PPE):
1.Perform hand hygiene and don appropriate PPE,
including gloves, mask, goggles, and sterile gloves,
to minimize the risk of contamination and infection
transmission.
3. Positioning:
Position the patient in a semi-Fowler's or high Fowler's
position to optimize lung expansion and facilitate drainage of
secretions.
Stabilize the patient's head and neck to prevent movement
during the procedure.
4. Preoxygenation:
Administer supplemental oxygen to the patient via the
ventilator or manual bag-valve-mask ventilation for 1-2
minutes before suctioning to optimize oxygenation and reduce
the risk of hypoxemia.
5. Open and Prepare Suction Equipment:
Open the suction catheter packaging and connect it to the
suction tubing.
Adjust the vacuum regulator on the suction unit to the
appropriate suction pressure level based on the patient's
condition and clinical indications.
6. Preparation of Suction Catheter:
Measure the depth of insertion by extending the suction catheter
from the end of the endotracheal tube to the tip of the patient's
carina.
Apply suction briefly to ensure the functionality of the suction
catheter.
7. Hyperoxygenation:
Hyperoxygenate the patient by delivering several manual breaths of
100% oxygen via the ventilator or bag-valve-mask ventilation for 30
seconds to 1 minute before suctioning.
8. Insertion of Suction Catheter:
Lubricate the suction catheter with sterile saline solution to
facilitate insertion.
Insert the suction catheter gently into the endotracheal tube until
resistance is met or until the predetermined depth is reached.
Apply intermittent suction while withdrawing the catheter to remove
secretions from the airway.
9. Suctioning Technique:
• Limit suctioning to no more than 10-15 seconds at
a time to minimize the risk of hypoxemia.
• Rotate the suction catheter gently while
withdrawing it to ensure thorough suctioning of
all areas of the endotracheal tube.
10. Monitor and Assess Response:
• Monitor the patient's vital signs, oxygen
saturation, and respiratory status throughout the
procedure.
• Assess the quantity and quality of suctioned
secretions and document findings.
11. Repeat as Necessary:
If additional suctioning is required, allow the patient
to rest briefly before repeating the suctioning
procedure as needed.
Repeat the procedure while monitoring the patient's
response and adjusting suction pressure or technique as
necessary.
12. Post-Suctioning Care:
Provide oral care to the patient, including suctioning
of the oral cavity and mouth care, to alleviate dryness
or discomfort caused by suctioning.
Monitor the patient for any signs of complications, such
as hypoxemia, bradycardia, or trauma to the airway, and
intervene promptly if necessary.
13. Documentation:
•Document the endotracheal suctioning
procedure, including indications,
technique, patient response, quantity
and quality of suctioned secretions, and
any complications or adverse events
encountered.
