SUCTIONING

SN AMELLYA AMIR
ICU 2
SUCTION WHAT IS SUCTIONING
Suctioning
Definition

Aspirating secretion through a catheter

connected to a suction machine or a
wall suction outlet.
SUCTION PURPOSES
Oral / Tracheal/
Nasal Endotrach
suction eal suction
1- To maintain
Remove
oral/ nasal P pulmonary
hygiene. U
R secretions in
2- comfort for
P patients who are
the patient. O unable to cough
3- remove blood S
E
and clear their
and vomit in an
S own secretions
emergency
effectively.
SUCTION DIFFERENCE
Deferent between
Oropharyngeal
/Nasopharyngeal suctioning
and Endotracheal/
tracheostomy suctioning
Endotracheal / Oropharyngeal
Tracheostomy /Nasopharyngeal
suctioning suctioning

Remove secretion from the Remove secretion from

trachea and bronchi or the the upper respiratory
lower respiratory tract . tract .
SUCTIO
N
INDICATIONS
 Oropharyngeal and Nasopharyngeal suctioning
required for:

1- Patient who has head and neck surgery.

2- Signs of respiratory distress .

3- Evidence of unable to cough up and

expectorate secretions.

4- Obtain sample of secretion for diagnostic

purposes

5- Prevent infection.
SUCTIO
N
INDICATIONS

Tracheal suctioning required for :

1- Patients unable to clear their secretions

themselves.

2- patients with mechanical ventilation.

SUCTIO
N
INDICATIONS
1-Therapeutic 2-Diagnostic
SUCTION
THERAPEUTIC
•Noisy breathing

•Visible secretions in the airway

•Decreased SpO2 in the pulse oximeter

• Deterioration of arterial blood gas values

•Clinically increased work of breathing

•Suspected aspiration of gastric or upper airway secretions

•Patients inability to generate an effective spontaneous

cough

•Increased PIP decreased Vt during ventilation

SUCTION
THERAPEUTIC
•X-ray changes consistent with retained secretions

•The need to maintain the patency and integrity of the artificial airway

•The need to stimulate a cough in patients unable to cough effectively

secondary to changes in mental status or the influence of medication

•During special procedures like Bronchoscopy or Endoscopy

SUCTIO
N
DIAGNOSTIC
•The need to obtain a sputum specimen / ETA
(Endo Tracheal Aspiration) for Bacteriological or
microbiological or cytological investigations.
Nasopharyng Oropharynge
eal al

Sites for Suctioning

Endotrachea Tracheostom
.l y
SUCTIO
N
CHOOSING THE RIGHT SIZE
Size Age group
to #18 #12 Adult
to # 10 #8 Children
to #8 5 # Infant

•Half the diameter (or less) of the tracheal tube.

SUCTIO
N
CHOOSING THE RIGHT SIZE
to #18 #12 Adult Sizes

#12 Fr #14 Fr #16 Fr

SUCTIO
N
CHOOSING THE RIGHT SIZE
to #10 #08 Children
Sizes
#08 Fr #10 Fr
 How to choose suction catheter with
appropriate ETT or tracheostomy tube

 Suction catheter not more than ½ ID ETT

 Suction catheter commonly labeled in french (Fr).Catheter size by
circumference (C) in mm
 Formula = ETT size(3)
2
SUCTIO
N
RECOMMENDED PRESSURE
Portable Unite Wall Unit
to 15 mm Hg 10 100to 120 mm Adult
Hg .

to 10 mm Hg 5 to 110 mm 95 Child
. Hg

to 5 mm Hg 2 to 95 mm Hg 50 Infant
.
 TYPES OF SUCTIONING

OPEN SUCTION CLOSED SUCTION

LEAF TYPES OF SUCTIONING
•OPEN SUCTION SYSTEM
•Disconnected from ventilator and a single-use suction catheter is inserted
into the endotracheal tube.

•CLOSED SUCTION SYSTEM

•This is used to facilitate continuous
mechanical ventilation and oxygenation during the
suctioning.
• No need to disconnect the patient from the ventilator.

•Closed suctioning is also indicated when PEEP level above 10 cmH2O.

SUCTION PATIENT PREPARATION
•Explain the procedure to the patient (If patient is conscious).

•The patient should receive hyper oxygenation by the delivery of 100% oxygen for
30 seconds prior to the suctioning (Either with circuit or by increasing the FiO2 by
mechanical ventilator).

•Position the patient in supine position.

•Auscultate the breath sounds.

SUCTION OPEN SUCTIONING

•Perform hand hygiene, wash hands. It reduces transmission of microorganisms.

•Turn on suction apparatus and set vacuum regulator to appropriate negative pressure.

• For adult a pressure of 100-120 mmHg

• 80-100 mmhg for children

•60-80 mmhg for infants.

SUCTION CONTINUE
•Goggles, mask apron should be worn to prevent splash from secretions

•Preoxygenate with 100% O2

•Open the end of the suction catheter connect it to suction tubing

(If you are alone)

•Wear sterile gloves with sterile technique

•With a help of an assistant open suction catheter connect it to suction tubing

•With a help of an assistant disconnect the ventilator

• Insert the catheter in to the ET tube until resistance is felt

•Resistance is felt when the catheter impacts the carina or bronchial mucosa, the
suction catheter should be withdrawn 1 cm out before applying suction
SUCTION CONTINUE
•Apply continuous suction while rotating the suction catheter during removal

•The duration of each suctioning should be less the 10sec.

•Assistant resumes the ventilator

•Give four to five manual breaths with bagging or ventilator

•Continue making suction, bagging patient between passes, until clear of
secretions, but no more than four passes

•Return patient to ventilator

•Flush the catheter with sterile water

•Discard used equipments

•Wash hands

•Document
CLOSED SUCTIONING PROCEDURE

 Wash hands

 Wear clean gloves

 Connect tubing to closed suction port

 Pre-oxygenate the patient with 100% O2

 Gently insert catheter tip into artificial airway without applying

suction, stop if you met resistance or when patient starts
coughing and pull back 1cm out
Continue…..
 Place the dominant thumb over the control vent of
the suction port, applying continuous or intermittent
suction for no more than 10 sec as you withdraw the
catheter into the sterile sleeve of the closed suction
device

 Repeat steps above if needed

 Clean suction catheter with sterile saline until clear;

being careful not to instill solution into the ET tube

 Suction oropharynx above the artificial airway

 Wash hands

 Document
Advantages Close Suctioning

 Maintained PEEP (Positive end expiratory pressure)

 Continuation oxygen supply
 Prevent suction-related to hypoxemia
 Less contaminated and minimize infection
SUCTIO
N
COMPLICATIONS
•Hypoxia / hypoxemia

•Tracheal and / or bronchial mucosal trauma

•Cardiac or respiratory arrest

•Pulmonary haemorrhage / bleeding

•Pulmonary atelectasis

•Bronchoconstriction / bronchospasm

•Hypotension / hypertension

•Interruption of mechanical ventilation

 Techniques to Minimize or Decrease
SUCTION
the Complications

1- Suction only as needed.

2- Sterile technique.
3- Hyperinflation.
4- Hyper oxygenation.
5- Safe catheter size.
6- No saline instillation.
TRACHEOSTOMY SUCTIONING
Tracheostomy tube suctioning
procedure
1.Wash hands to prevent transmission of
micro-organisms/cross contamination.
Wear PPE (goggles or glasses and mask)

2. Explain procedure to patient to reduce

anxiety & encourage cooperation.

3. Position the patient (Fowler’s unless

unresponsive: side lying position
4. Turn on suction (adults: 100-120mm Hg).
Secure connecting tube to suction source.
(Excessive negative pressure traumatizes
mucosa & can induce hypoxia.)

5. Open and prepare suction catheter kit.

6. Preoxygenate patient with 100% oxygen to

prevent hypoxemia. Hyperinflate with ambu bag to
decrease atelectasis r/t suctioning.

7. Wear sterile gloves.

8. Pick up catheter with dominant hand and the
connecting tube with non-dominant hand. Attach
catheter to tubing using sterile technique.

9. Insert catheter into tracheostomy tube (during

inspiration when epiglottis is open) without
applying suction, using sterile technique.

10. Advance catheter until you feel resistance.

Retract catheter 1cm before applying suction
11. Apply suction while withdrawing
the catheter. Limit suctioning time
to 10 seconds to prevent hypoxemia.

12. Hyperoxygenate and hyperinflate if needed.

13. Rinse catheter with saline to clear secretions.

14. Insert the catheter gently along one side of mouth. Advance to
oropharynx. Suction oropharynx after trachea.
15. Rinse catheter and tubing by suctioning saline
through.

16. Remove glove by pulling it over the catheter in

other hand.

17. Ensure suctioning equipment is changed every 24 hours.

18. Document procedure and outcomes

Assessment

 Assess for excess secretions

 Soiled tracheostomy dressing and ties
 Assess respiratory status
 Identify type of tracheostomy tube, keep extra tube at bedside
 Assess client’s ability for self-care
 Identify factors that influence tracheostomy care
COMPLICATION

 Tracheal trauma
 Mucosal Damage
 Ulceration & Hemorrhage
 Hypoxaemia
 Vagal stimulation(bradycardia)
 Arrhytmia-Ventricular ectopic
 Inceased intra cranial pressure
 Infection-respiratory infection
 Documentation
The amount .
• Record the Consistency .
Color .
Odor of the mucus .
Client breathing status
procedure : before and after
suctioning.

• If the technique is carried out frequently it

may be appropriate to record only once , how
ever the frequency of suctioning must be
record
SUCTION