suctioning

By::
Saja A al-marshad
 Definition

Airway suctioning removes excess

secretions from the respiratory tract
by insertion of a
catheter and the application of a
negative Pressure
it can be oral, nasal & tracheal root..
 introduction
Suctioning is an invasive technique and
therefore should only be performed as
needed. It should not be just a routine.
The patient should be assessed each
time, prior to suctioning. Indications
when suctioning is required, when
secretions are audible, when sats levels
drop or when the patient indicates it is
needed
 :::Indications for Suctioning
Pt. produce excessive saliva, e.g. if they have
motor neurone disease.
pt,. unable to expectorate secretions adequately
due to reduced function of pulmonary
musculature or poor intra plural pressure
 pt. produce abnormal quantity or quality of
mucous production, e.g.
Cystic Fibrosis
 pt. have a tracheostomy.
 Why we want to remove
??secretion
The removal of bronchial secretions is
necessary for effective gaseous exchange
in the lungs. The removal of these
secretions is usually carried out
subconsciously by the action of the
mucocillary escalator, where they are
brought to the top of the trachea and
swallowed. If there are excess secretion
the cough is the main mechanism to clear
excess secretions. In the presence of a
trachea tube this system is compromised
 Suction Catheter Selection
• there is in-line Sx catheter
which means that u will
connected it to the ETT and
leave it to decrease
infections and not loosing
the volume
• and the other one is the
regular Sx catheter and it is
disposable and it comes in
different sizes & starting
from 6 till 14french
 Closed suctioning techniques
((inline))
• A closed system
multiuse suction
catheter can be used
for a pt receiving
ventilatory suppport .
• These systems are
incorporated directly
into the ventilator circuit
and used repeatedly.
 Also
• All catheters should be used as instructed by the
manufacturer,All catheters should be checked
for their FG size and the expiry date.
• The frequency of suctioning is dependent on
the patient’s individual need. It is
advisable that the suction catheter is no more
than half the diameter of the
tracheostomy tube to minimise a fall in the
arterial oxygen . To calculate
this simply multiply the tracheostomy tube size
by three and then divide by two
the Sx catheters sizes r different from neonate,
pedia and adult
usually if u r going nasally u can judge by looking at
the naris size and choose smaller catheter
but if u are Sxing an intubated pt.
Another way
look at the size of the ETT and x by 2 and take the
next smaller size
for example if the ETT size is 7 then 7x2=14 u will
take the next smallest which means 12 Fr
 Vacuum pressure

for infant 60-80

children 80-100
adult 100-120
 Risk Management
Tracheal trauma can be reduced by ensuring:
 suction pressure is not above 100
 suction is only applied on withdrawal of catheter
 multi-eyed catheters are used.
Hypoxia can occur during tracheal suctioning because oxygen
as well as secretions are removed.
Limiting the time of suctioning to a maximum of 10-15
seconds can relieve this .
Infection can occur during suctioning technique. An aseptic
technique reduces this risk.
 ::EQUIPMENT REQUIRED
 Portable or mains suction machine
 Connection tubing from the unit to
the suction catheter
 An appropriate suction catheter if
performing tracheal suctioning
 Yankeur suction tube if
performing oral suctioning
 Bottle of tap water
 Disposable sterile gloves
 Disposable plastic apron
 Antibacterial hand rub
Ambo bagging to hyperventilate
suctioned pt..
 :Oral Suction Procedure

1. The procedure should be

fully explained to the
patient and Reassuranc
given throughout.
2. Obtain informed consent.
3. Wash hands and dry thoroughly
and put on the disposable apron
and steril gloves
4. Check the suction machine is set to the
appropriate level, which should be
the lowest setting appropriate for the thickness
of the secretion (maximum
of 100mmHg) .
5. Ensure the patient is in a comfortable
position.
6. Attach the yonker to the suction tubing.
7. Switch on the suction machine.
8. Introduce the catheter to the patient’s mouth
without applying suction.
9. Apply suction on withdrawal working from the
back of the mouth forwards.
10.Rinse thoroughly with water to clear the tube
and repeat if necessary.
11.If secretions are collected around or under
mouth plates / gum protectors,
these should be removed cleaned and replaced
12.Remove gloves and ensure the patient is
comfortable.
13.Wash the yonker in hot soapy water and dry
thoroughly.
14.Wash hands and dry thoroughly
Suctioning through tracheotomy
 Suctioning through ET
1. Assess the need for suctioning
2. The procedure should be fully explained to the
patient and reassurance
given throughout.
3. Obtain informed consent
4. Wash hands and dry thoroughly.
5. Attach appropriate suction
catheter to suction tubing via
thumb control valve.
6. Put on disposable gloves
and slide catheter from sleeve,
avoiding contact with anything
other than the gloved hand.
7. Gently insert the catheter into the ET tube .
without applying suction until
resistance is met, then withdraw 1-3
centimetres before application of
suction .
8. Apply suction whilst withdrawing the
catheter, interrupting the vacuum
briefly every 1-2 seconds. Do not rotate the
catheter or use a stirring
action.
9. Limit the duration of the suctioning to 10
seconds.
10.Monitor the patient’s response to the procedure
and discontinue if the
patient displays any sign of trauma or breathing
difficulties and respond
appropriately to this situation.
11.Gather catheter into gloved hand and remove
glove enclosing catheter.
Dispose in a clinical waste bag.
12.Repeat procedure until secretions are cleared
allowing a minimum of 30
seconds between suction attempts.
13.Wash and dry hands thoroughly
Nasotracheal suctioning
 Contraindication

Absolute Relative

Nasal
epiglottitis croup
bleeding
 Other relative
contraindications
• Acute head injury , facial , or neck injury .
• Laryngospasm.
• Irritable airway.
• Bronchospasm.

Nb::
Consider using a nasopharyngeal airway to help
reduce mucosal trauma in the nose of pt who require
long term nasotracheal suctioning. Do not forget to
lubricate ur catheter before going through the nasal
root
 Hazard
Hypoxia / hypoxemia .
Nasal , pharyngeal , tracheal
trauma / pain.
Cardiac or resp. arrest .
Atelectasis.
Bronchospasm.
Mucosal hemorrhage.
Elevated intracranial pressure .
Gagging / vomiting .
THANK YOU