Definition
Performing endotracheal or tracheal suctioning is a critical nursing procedure used to maintain a patent airway in patients with artificial airways (e.g., endotracheal or tracheostomy tubes). It helps remove pulmonary secretions, prevent infection, and improve oxygenation.
Purposes
1. To maintain a patent airway by removing secretions.
2. To prevent lower respiratory tract infection from retained secretions.
Articles
Assemble the following articles or obtain a prepackaged suctioning kit: A clean tray containing the following:
- Sterile suction catheters with cover: No. 12-16 Fr-adult and No. 8-10 Fr-child.
- Sterile water/normal saline in a container.
- Sterile gloves
- Mask
- Face shield and gown if appropriate
- Kidney tray
- Alcohol swabs.
- Stethoscope.
A sterile tray containing the following
1. Sterile towel
2. Bowl
3. Gauze pieces
Additional articles
1. Resuscitation bag with a reservoir connected to 100% oxygen source.
2. Suction source-portable suction machine or wall suction unit.
Procedure
| Nursing Actions | Rationale |
| Before procedure 1.a) Assess depth and rate of respiration, auscultate breath sounds. Monitor heart rate if patient is on continuous cardiac monitoring. b) If arterial blood gases are done routinely, check the baseline value. 2. Explain the procedure and what the patient should be expecting during the procedure to the patient (if conscious) relatives. 3. Assist the patient to a semi-Fowler’s or Fowler’s position if conscious. An unconscious patient should be placed in the lateral position facing you. 4. Assemble equipment, check function of suction apparatus and manual resuscitation bag connected to 100% oxygen source. During procedure 5. Wear mask and wash hands thoroughly. 6. Open sterile tray. Take the towel and place in a bib-like fashion on the patient’s chest. Open alcohol swab and place on the corner of the towel. 7. Open sterile catheter pack and place catheter into sterile tray. Fill the bowl with sterile water. 8. if the patient is on mechanical ventilator, make sure that disconnection of ventilator attachment may be made with one hand. 9. Don sterile gloves. Designate one hand as clean hand for disconnecting. bagging, and working the suction control. Usually, the dominant hand is kept sterile and will be used to thread the suction catheter. 10. Connect suction catheter to the suction source. 11.Using clean hands, disconnect the patient from ventilator, CPAP device, or other oxygen source. (Place the ventilator connector on the sterile towel and flip a corner of the towel over the connection to prevent fluid from spraying to the area). 12.ventilate and oxygenate the patient with the resuscitation bag, compressing firmly and as completely as possible approximately 4-5 times with clean hand in a spontaneously breathing patient, coordinate manual ventilations with the patient’s own respiratory efforts (when possible, get a nurse or a respiratory therapist to do the bagging). 13. Lubricate the catheter by dipping into the container of sterile saline/water (except silicon catheter) 14.Turn on suction source with clean hand. 15.Pinch the catheter if there is no “Y” port and insert it in tracheal/endotracheal tube. Insert the catheter about 12.5cm (5 inches) for adults, less for children or until the patient coughs or you feel resistance. 16. Apply suction by releasing thumb from Y port or by releasing the pinch on the catheter. Gently rotate catheter with thumb and index finger of the sterile gloved hand as the catheter is being withdrawn. 17. Apply suction for only a maximum of 10 seconds. Hyperventilate 3-5 times between suctioning or encourage patient to cough and deep breathe between suctioning. 18. Rinse catheter between suction passes by inserting tip in cup of sterile water and apply suction. 19. Repeat suctioning as needed and according to patient’s tolerance of the procedure. Allow the patient to rest at least for one minute between suctioning and replace oxygen delivery setup if necessary. No more than four suction passes should be made per suctioning episode. 20. When the airway becomes clear, return the patient to the ventilator or apply CPAP or other oxygen delivery devices. 21. Suction oral secretions from the oropharynx. 22. When the procedure is completed, turn off suction and disconnect catheter from suction tubing. Remove gloves inside out and dispose of gloves and catheter in proper receptacle. After procedure 23. Replace the articles, clean Ambu bag and mark with alcohol; cover with a sterile glove or sterile 4 ×4 gauze and wash hands. 24. Position patient comfortably. Auscultate over lung area 25. Record the time of suctioning and nature and amount of secretions. Also note the character of patient’s respirations before and after suctioning. 26. Perform oral hygiene procedure if required. | Determines need for suctioning Thorough explanation lessens patient’s anxiety and promotes cooperation. Sitting position helps the patient to cough and breathe more easily. The position also uses gravity to aid in the insertion catheter. Lateral position prevents the airway from becoming obstructed and promotes drainage of secretions. Make sure that all equipment are functional before sterile technique is instituted, to prevent interruptions, use of 100% oxygen will help to prevent hypoxia Prevents infection. The hand designated as sterile must remain uncontaminated, so organisms are not introduced into the lungs. The other gloved hand protects the nurse from infection. Prevents contamination of the connection Ventilator before suctioning helps prevent hypoxia. Attempting to ventilate against the patient’s own respiratory efforts may result in high airway pressure predisposing the patient to barotrauma. Lubrication promotes easy insertion. Silicon catheters do not require lubrication. Using suction while inserting catheter can cause trauma to mucosa and removes oxygen from the respiratory tract. Resistance usually means that the catheter tip has reached the carina. If resistance is felt, the catheter should be withdrawn 1-2 cm before applying suction. Turning the catheter while withdrawing helps clean surface respiratory tract and prevents injury to tracheal mucosa. Suctioning for longer than 10 seconds may result in hypoxia. Hyperventilation reoxygenates the lungs. Flushing cleans and clears catheter and lubricates it for next insertion. Allowing time interval and replacing oxygen delivery setup helps compensate for hypoxia induced by the previous suctioning irritation from multiple suctioning results in an increased amount of secretions. Remove accumulated oral secretions. Prevents transmission of microorganisms. Auscultation helps to determine whether respiratory passageways are cleared of secretions. Respiratory secretions that accumulate are irritating to mucous membranes and unpleasant for the patient. Provides accurate documentation and provides comprehensive care. |
Special Considerations
- 1.The outer diameter of the suction catheter should be no greater than one half the inner diameter of the artificial airway.
- The suction should be discontinued and oxygen applied, or manual ventilation reinstitute during the suction procedure. The heart rate decreases by 20 beats per minute or increases by 40 beats per minute or blood pressure drops, of cardiac dysrhythmia is noted. Suctioning may cause hypoxemia and vagal stimulation.
- Some clinicians believe that removal of secretions may be facilitated with saline instillation in endotracheal/tracheal tube which is followed by vigorous bagging.
Amount of Negative pressure Necessary for Suctioning
| Portable suction machine | Wall suction unit | |
| Adult | 8-15 mmHg | 100-120mmHg |
| Children | 5-8mmHg | 50-100mmHg |
| Infants | 3-5mmHg | 40-60mmHg |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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