Suction is frequently used to remove secretions from the lungs in intubated or tracheostomy patients unable to cough effectively. Proper suction equipment includes pumps, tubing, connections, and catheters. Pumps can be wall vacuum, electrical, portable battery-powered, or foot pumps. Tubing leads from pumps to connections, usually Y-connectors. Catheters come in soft plastic or rubber and range in size but should not exceed half the tube diameter. Proper suction technique minimizes trauma and hypoxia through controlled pressure and timing.

1. Suction
MURUGANANDAM
ASSISTANT PROFESSOR
LPU - PUNJAP

2. Introduction
• Airway suction frequently used to removal of secretion in lung
• Is to be given whenever
• secretions can be heard in an intubated patient
• who is unable to cough and expectorate efficiently
• Before and during the release of the cuff on a tracheostomy tube
• presence of a large plug of mucus in one of the larger bronch
• If the minute volume (MV) drops

3. Suction equipment
1. Suction pumps
2. Tubing
3. Connections
4. Catheter
5. Suction trolley

4. Suction pumps
1. Common vacuum pumps
• A vacuum point close to the patient’s bed
• The power is provided by a large motor situated at some
convenient site within the hospital grounds
• Commonly found in ITUs and on wards in modern hospitals
• An on/off switch
• Control dial for set negative pressure to be increased or
decreased
• A manometer displays the pressure used
• They have approximately — 5ommHg,— ioommHg and —
300mmHg.

5. Suction pumps

6. Suction pumps
2. Electrical suction apparatus
• Powered from the mains
• This type has its own small motor, with an on/off switch and a
control dial
• This is the equipment most commonly used on wards where a
vacuum point is not available

8. Suction pumps
3. Portable suction apparatus
• available powered by rechargeable batteries
• Has a small motor and on/off switch
• The machine should be tested at frequent intervals to check the batteries
5. Foot pump
• The power is provided by the operator
• This pump was the only type available in the period when intensive care
was developing
• Modern versions are available and, like the battery operated pumps, these
are suitable for use in the community or for an emergency resuscitation
team

9. Suction tubing
• This leads from the suction bottle to the connection for the
suction catheter
• Usually the tubing is made from clear plastic for easy viewing
of secretions
• Disposable
• Sometimes rubber tubing is used

10. Connections
• Usually plastic and either clear or semitransparent
• Most connections have three holes
• Y-connector three arms; one at either end and a third at the side used
as the control port
• This opening offers less resistance to the suction force
• To apply the suction force to the catheter the operator places a finger
or thumb over the opening

11. Catheters
• Mostly soft, clear plastic and disposable
• Vital that the correct size of catheter is used for each patient
• Should not exceed half the diameter of the endotracheal or
tracheostomy tube
• Too large a catheter may cause alveolar collapse when suction is
applied
• Soft rubber catheters are still used in some hospitals
• They are softer and more flexible than the plastic catheters
• They may be too short for some endotracheal tubes

12. Catheters
• Coude catheters
• sometimes known as bronchoscopy or Pinkerton’s catheters,
• These are extra long catheters with a curved tip used for
selective suctioning of the left main bronchus
• A straight catheter passed beyond the carina
• Using a coude catheter with the head side flexed to the right
gives a greater chance of the catheter entering the left main
bronchus

13. Catheter
• Argyle Aero-Flo catheters
• which have a specially designed tip to minimize mucosal trauma
• These catheters have a bead surrounding the distal hole at the
end of the catheter, and there are four small holes

16. Suction trolley
• Sterile plastic gloves - disposable
• Suction catheters - appropriate sizes for the patient
• Lubricating jelly water-based only, not oil-based, for use in
nasopharyngeal suction.
• Sterile gauze swabs - to transfer jelly to tip of catheter
• Bowl of sodium bicarbonate or sterile water - to flush the
secretions through the catheter and tubing
• Plastic bag for the collection of disposables
• Bowl of antiseptic solution for the collection of items to be
sterilised

17. Suction techniques
• Sterile technique
• Mode of entry
• Nose
• Mouth
• Tube
• First practice with unconscious patient

18. Suction technique
• Nasopharyngeal
• Neck extended
• Introduce on Inspiration phase only
• Not for head injury patient due to leakage of CSF
• Oropharyngeal
• Less use
• Plastic airway to avoid catheter bit by patient
• Suction via tube
• catheter is introduced into an endotracheal, tracheostomy or mini-
tracheotomy tube
• Breath hold technique by physiotherapist
• Tracheostomy mini tube

19. Procedure
• Whatever the mode of entry, no suction pressure is applied while the
catheter is being introduced
• To avoid tracheal trauma
• Three-hole connection , catheter itself may be pinched or disconnected
from the tubing during introduction
• Advanced until either a cough reflex is elicited or some resistance in the
trachea is met
• Apply suction gentle withdrawn of catheter with rolling
• observe the patient for signs of hypoxia
• 15 seconds maximum disconnection, interval technique
• side lying or with the head rotated to one side to avoid aspiration of
gastric contents should vomiting occur

20. HAZARDS OF AIRWAY SUCTION
• Infection avoided by sterile technique
• Trauma - minimized by the correct choice of catheter and
negative pressure combined with good technique
• Hypoxia - minimised by the accurate use of the applied
negative pressure, and accurate timing - not too powerful or
too long
• Cardiac arrhythmias – followed by hypoxia, correct hypoxia it
will be corrected
• Atelectasis – proper suction force and time
• Bleeding – proper technique