This document outlines the key aspects of airway clearance through suctioning. It defines suctioning as the mechanical aspiration of pulmonary secretions from a patient with an artificial airway. It describes the different sites where suctioning can be performed including the oropharynx, nasopharynx, tracheostomy, and endotracheal areas. The purposes of suctioning are to maintain a patent airway and prevent infections from retained secretions. Indications for suctioning include noisy breathing, decreased oxygen levels, inability to cough effectively, and obtaining sputum samples. The document provides guidance on choosing the right size catheter, setting the correct suction pressure, assessing the patient, and documenting the procedure.

2. Airway Clearance

3. Supervised by Asso. Prof. Ameera Al-Sumat, MD
Senior Consultant Internist & Pulmonary diseases
Deanship of Graduate Studies and Scientific Research
21 September University of Medical & Applied Sciences
Abdulrahman Al-Huthifi
Student of Master of Science in Respiratory Care
Deanship of Graduate Studies and Scientific Research
21 September University of Medical & Applied Sciences

6. 1. Terminology
2. Definition of suctioning .
3. Sites for suction .
4. Difference between oropharengyeal /
nasopharyngeal suctioning and
endotracheal / tracheostomy suctioning .
5. Purposes for suctioning .
6. Indications for suctioning.
Outlines

7. 7. Choosing the right size catheter.
8. Setting the correct pressure .
9. Documentation.
10.Complications of suctioning .
Outlines Cont.

8. • Airway Suction: The removal of airway secretions/foreign material by
artificial means, using an applied negative pressure
• Yankauer Suction Catheter: A rigid suction tip used to aspirate
secretions from the oropharynx
• Oropharyngeal Suction: (OP) requires the use of an airway adjunct
(Guedel Airway)
• Nasopharyngeal Suction: (NP) may be undertaken directly via the nostril
without an airway adjunct. If repeated suction is anticipated a
nasopharyngeal airway should be utilised. This is inserted only by those
that are trained to do so.
• Suction is an invasive procedure and should NOT be carried out on a
routine basis. But, suctioning is an integral part of the management of
intubated/ventilated patients.
Terminology

9. Is 'the mechanical aspiration of pulmonary
secretions from a patient with an artificial
airway in place'.
The procedure involves patient preparation,
the suctioning event(s) and follow-up care
Definition

10. Sites for Suctioning

11. Sites for Suctioning
Nasopharyngeal

12. Sites for Suctioning
Tracheostomy

13. Sites for Suctioning
Endotracheal.

14. Endotracheal/Tracheostomy
suctioning
Oropharyngeal
/Nasopharyngeal
suctioning
Remove secretion from the trachea and
bronchi or the lower respiratory tract .
Remove secretion from
the upper respiratory
tract .
Difference between Oropharyngeal
/Nasopharyngeal suctioning and
Endotracheal/ tracheostomy suctioning

15. Oral / Nasal
suction
1- maintain oral/ nasal
hygiene.
2- comfort for the patient.
3- remove blood and
vomit in an emergency
situation.
Purposes Of Suctioning :-

16. Tracheal/ Endo-
tracheal suction
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.
Purposes Of Suctioning :-

17. Indication
Therapeutic Diagnostic

18. Therapeutic Indications
 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

19. Diagnostic Indications
Indication
 The need to obtain a sputum specimen / E
T
A (Endo
Tracheal Aspiration) for investigations.

20. Choosing the right size
catheter
OPAs are made in various sizes. The correct size OPA
should track from the corner of the patient's mouth to the
angle of the jaw. Insertion of an OPA of incorrect size may
push the tongue back toward the pharynx creating an
obstruction.
Size
Age
#12 to #18
Adult
#8 to # 10
Children
# 5 to #8
Infant

21. Choosing the right size
catheter
Estimating NPA length by measuring the distance from the
tip of the nose to the tragus of the ear has not been validated
in adults. A study in Chinese children found a close
association between nares-vocal cord distance and nose tip-
earlobe distance, with the ideal NPA length being slightly
less than this anthropometric measurement
Size
Age
#12 to #18
Adult
#8 to # 10
Children
# 5 to #8
Infant

22. Setting the Correct Pressure
Portable Unite
Wall Unit
Age
10 to 15 mm Hg
100to 120 mm
Hg
Adult
5 to 10 mm Hg
95 to 110 mm
Hg
Child
2 to 5 mm Hg
50 to 95 mm Hg
Infant

23. Types of ET Suctioning
Closed SUCTION
- Do not disconnect from ventilator. Similar
procedure to open technique but no
application of sterile glove
- Enables a clinician to clear the lungs of
secretions whilst maintaining ventilation and
minimising contamination with the least
possible disruption to the patient
- Helpful in preventing cross contamination
and infection
Open SUCTION
- Clearing the airways of a mechani
cally ventilated patient with a suct
ion catheter inserted
into the endotracheal tube after th
e patient has been disconnected fr
om the ventilator circuit

24. 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.

25. 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)

26. 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

27. Documentation
• Record the
procedure :
➢The amount .
➢Consistency .
➢Color .
➢Odor of the mucus .
➢Client breathing
status before and
after.

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

29. A Name is Better Than riches.
‫الحسن‬ ‫الصيت‬
...
‫المجموع‬ ‫المال‬ ‫من‬ ‫خير‬

30. Have a
great day