Suctioning technique

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