- Airway suction is used to remove secretions from the lungs in intubated patients unable to cough effectively. - Proper suction equipment includes pumps, tubing, connections, catheters, and suction trolleys. Pumps can be wall vacuum, electrical, portable, or foot operated. - Correct suction technique is important to minimize trauma, hypoxia, arrhythmias, atelectasis, and bleeding by using the proper catheter size, intermittent suction, and sterile technique.

1. MEDICAL VACUUME
AND SUCTION
Dr Nisar Ahmed Arain
Assistant Professor
Anesthesia / Critical Care / ER

2. -Airway suction is frequently usedto remove
secretions from the lungs
-suctionofthelungsisdonewhenever secretions canbe heard
in an intubated patient who is unable to cough and
expectorate efficiently
-Before and during the release of the cuffon or
tracheostomy tube
-Presence of alarge plug of mucus in one of the larger
bronchi If the minute volume (MV)drops
INTRODUCTION

3. Suctionequipment
1. Suctionpumps
2. Tubing
3. Connections
4. Catheter
5. Suctiontrolley

4. Suctionpumps
- Common vacuum pumps
-A vacuum point is present close to the patient’s
bed
-Thepower is provided by alarge motor situated at
some convenient site within the hospitalgrounds
-Commonly found in ICUsand in wards in modern
hospitals
-An on/off switch is present
-Control dial to set negative pressure tobe increased
or decreasedis present
-A manometer displays the pressure in use
-Theyhave approximately —5o mmHg,— 1oo
mmHg and 300 mm Hg

5. Suctionpumps

6. 2.
Suctionpumps
- Electrical suction apparatus
-Powered from themains
-Thistype hasits own small motor
with an on/off switch and a control
dial
-Thisis the equipment most
commonly used on wards where
a vacuum point is not available

8. Suctionpumps
- Portable suction apparatus
-Available powered by rechargeable batteries
-Hasasmall motor and on/off switch
-The machine should be tested at frequent
intervals to check the batteries
Foot pump
- The power is provided by the operator
-Thispump 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 usein the community or for an
emergency resuscitation team.

9. Suctiontubing
-Thisleadsfrom the suctionbottle to the
connection for the suctioncatheter
-Usuallythe tubing is madefrom clear
plastic for easyviewing of secretions
-Thisis disposabletube
-Sometimesrubber tubing isused

10. Connections
- Theseare usually plastic and either clear or semi
transparent connections. Most connections have
threeholes.Y-connector has three arms;one at either
ends and athird at the side usedasthe control port
-Thisopening offers lessresistance to the suctionforce
Toapply the suction force to the catheter the operator
placesa finger or thumb over theopening

11. Catheters
-Mostly are soft, clear plastic, anddisposable
-Itis importantthat the correct sizeof catheter is usedfor eachpatient
-Itshouldnot exceed half the diameter of the endotracheal or
tracheostomytube
-Toolarge acatheter maycausealveolar collapse when suction is
applied
-Soft rubber catheters are still usedin most of the hospitals. Theyare
softer and more flexible than the plastic catheters. Theymaybe too
short for someendotrachealtubes

12. Catheters cont:
- Coude catheters
-- Sometimes known asbronchoscopy or Pinkerton’s
catheters
--Theseare extra long catheters with acurved tip
usedfor selective suctioning of the leftmain
bronchus
--A straight catheter passedbeyond the carina
--Usingacoude catheter with the head side
flexed tothe right gives agreater chanceof
the catheter entering the left main bronchus

13. Catheters cont:
-- ArgyleAero-Flo catheters
-- which have aspecially designed
tip to minimize mucosal trauma
-- Thesecatheters have abead
surrounding the distal hole at the
end of the catheter and there are
foursmall holes

16. Suctiontrolley
-- IMPORTANT ITEMS
-- Sterile plastic gloves
--Disposablesuction catheters
--Appropriate sizesfor thepatient lubricating jelly
water-based only not oil based, for usein
nasopharyngealsuction
-- Sterile gauzeswabs- to transfer jelly to the tip of
the catheter
--Abowl of sodium bicarbonate or sterile water to
flush the secretions from the catheter and the
tubing
-- Plastic bagfor the collection of disposablematerial
-- Bowl of antiseptic solution for the collection of items
to be sterilized

17. Suctiontechniques
-Sterile technique
-Mode of entry
-Nose
-Mouth
-Tube
-First practice should always be
with the unconscious patients

18. Suctiontechnique cont:
-Nasopharyngeal
-Neckextended
-Introduce on Inspiration phaseonly
-Not for head injury patient due to leakage of CSF
-Oropharyngeal
-Lessuse
-Plastic airway to avoid catheter bit by patient
-Suction via tube
-catheter is introduced into an endotracheal,
tracheostomy ormini- tracheotomy tube
-Breath hold technique byphysiotherapist
-Tracheostomy mini tube

19. Procedure
-Whatever the mode of entry, no suction pressure isapplied
while the catheter is beingintroduced. Toavoid tracheal
trauma
-Three-hole connection, catheter itself maybe pinched or
disconnected from the tubing during introduction
-Advanceduntil either acoughreflex is elicited or some resistance
in the trachea ismet
-Apply suction gently catheter withdrawn while with rolling the
catheter
-Observe the patient for signsof hypoxia
-Disconnected for 15 secondsmaximum, then interval technique
-Side lying or with the head rotated to one side to avoid
aspiration of gastric contents should vomitingoccur

20. Infection avoided by steriletechnique
Trauma- minimized by the correct choice of catheter and
negative pressure combined with goodtechnique
Hypoxia - minimized by the accurate useof the applied
negative pressure,and accuratetiming - not too
powerful or too long
Cardiacarrhythmias –followed by hypoxia, correct hypoxia
it will becorrected
Atelectasis –proper suction force and time
Bleeding –proper technique
HAZARDS OF AIRWAY SUCTION

21. THANK YOU