Suction

1. EndoTra
cheal
Suctioning

2. Introduction.....
The patient with an artificial
airway is not capable of effectively
coughing, the mobilization of
secretions from the trachea must
be facilitated by aspiration. This is
called suctioning.

3. WHAT IS SUCTIONING?
Endotracheal suctioning
is the removal of
secretions from
tracheobroncheal tree
through an
endotracheal tube with
the help of mechanical
suction device.

4. PURPOSES
➢ To maintain a patent airway by removing
retained tracheobroncheal secretions.
➢ To prevent lower respiratory tract
infection from retained secretions.
➢ To provide effective ventilation.
➢ To stimulate coughing.

5. INDICATION
Therapeutic Diagnostic

6. Therapeutic:
➢Noisy breathing
➢Visible secretions in the airway
➢Decreased SpO2 in the pulse oximeter &
Deterioration of arterial blood gas values
➢Patient’s inability to generate an effective
spontaneous cough
➢Presence of pulmonary atelectasis or consolidation,
presumed to be associated with secretion retention
➢During special procedures like Bronchoscopy &
Endoscopy

7. Diagnostic:
➢The need to obtain a sputum specimen / ETA
(Endo Tracheal Aspiration) for investigations.

8. COMPLICATIONS
➢Hypoxia
➢Tracheal or bronchial mucosal trauma
➢Cardiac or respiratory arrest
➢Pulmonary hemorrhage / bleeding
➢Cardiac dysrhythmias
➢Pulmonary atelectasis
➢Bronchospasm
➢Hypotension / hypertension
➢Elevated ICP

9. TYPES OF ET SUCTIONING
OPEN SUCTION CLOSED SUCTION

10. ❖ASSESSMENT
❖PREPARATION OF PATIENT &ARTICLES
❖IMPLEMENTATION
❖EVALUATION

11. ASSESSMENT
Patient should be monitored prior to, during &
after the procedure for following :
➢Breath sounds
➢Oxygen saturation
➢Respiratory Rate & pattern
➢Hemodynamic parameters (pulse rate, Blood pressure)
➢Cough effort
➢ICP (If indicated and available)
➢Sputum characteristics (color, volume, consistency &
odor)
➢Ventilator parameters (PIP, Vt & FiO2)

12. ASSESSMENT….
Assess the depth and
rate of respiration,
auscultate breath sounds.
Assess for wheeze or
rattling sound in chest:
a harsh sound caused by
partial obstruction of the
airways

13. Patient Preparation
➢ Explain the procedure to the patient if
conscious.
➢ The patient should receive hyper
oxygenation by the delivery of 100%
oxygen for >30 seconds prior to the
suctioning
➢ Position the patient in supine position.
➢ Auscultate the breath sounds.

14. COMMUNICATE……
Explain the
procedure to the
patient and
importance of
coughing if
conscious.

15. EQUIPMENT ASSEMBLYING
➢Stethoscope
➢Vacuum source with adjustable
regulator suction jar
➢Sterile gloves
➢Sterile suction catheter
➢Protective goggles, apron &
mask
➢Sterile normal saline
➢AMBU bag for pre & post
oxygenation

16. SUCTION CATHETER
Catheter can be
selected according
to the ET tube size.
Sterile suction
catheter of 12-14 Fr
is used for adults
and for children 8-
10 Fr is used.

17. SUCTION PRESSURE
Turn on suction apparatus
to appropriate negative
pressure for:
adults-100-120 mmHg
children-50-100 mmHg
infants-40-60 mmHg.

18. IMPLEMENTATION
HAND WASH
Perform hand
hygiene, wash hands.
It reduces
transmission of
microorganisms.

19. ➢Goggles, mask & apron should
be worn to prevent splash from
secretions
➢Open the end of the suction
catheter package & connect it to
suction tubing (If you are alone)
➢Wear sterile gloves with
sterile technique
➢With a help of an assistant open
suction catheter package & connect
it to suction tubing
Continue…..

20. Continue…..
➢With a help of an
assistant disconnect
the ventilator
➢Kink the suction tube & insert
the catheter in to the ETtube
until resistance is felt
➢Resistance is felt when the
catheter impacts the carina or
bronchial mucosa, the suction
catheter should be withdrawn 2cm
out before applying suction

21. Continue.....
➢Apply continuous
suction while rotating the
suction catheter during
removal
➢The duration of each
suctioning should be 10-15sec.
➢Instill 3 to 5ml of sterile
normal saline in to the
artificial airway, if required
➢Give four to five manual
breaths with bag or ventilator

22. Continue…..
➢Return patient to ventilator
➢Flush the catheter with
NS in the suction tray
➢Suction nares &
oropharynx above the
artificial airway
➢Discard used equipments
➢Flush the suction tube
with hot water
➢Wash hands

23. POST PROCEDURE CARE…
When the procedure is
complete
hyperventilate the
patient again.
When the airway
becomes clear, return
the patient to
ventilator or oxygen
source.

24. DOCUMENTATION…
Record the time of
suctioning, nature &
amount of secretions.
Document indications
for suctioning & any
changes in vitals &
patient’s tolerance.

25. CAUTION..
➢Suctioning is potentially an
harmful procedure if carried
out improperly.
➢Suctioning should be
done when clinically
necessary (not routinely).
➢The need for suctioning
should be assessed at least
every 2hrs or more
frequently as need arises.

26. Thank you