Suctioning is a procedure used to clear secretions from the trachea of patients who cannot cough effectively. It has both therapeutic and diagnostic purposes. Therapeutically, suctioning is indicated when a patient has coarse breath sounds, noisy breathing, visible secretions, decreased oxygen levels, or inability to cough. It aims to clear secretions and improve breathing. There are risks like hypoxia, trauma, bleeding, and dysrhythmias. Suctioning can be open or closed. Open suction is regularly used for intubated patients while closed suction allows for continued ventilation. The procedure involves preparing the patient, setting the suction regulator, inserting and rotating the catheter while applying suction, and assessing the patient

1. SUCTIONING
PATEL.YASH.GIRISHBHAI (KAPC)

2. WHAT IS SUCTIONING
 The patient with an artifact airway is not capable of
effectively coughing, the mobilization of secretions from
the trachea must be facilitated by aspiration. This is be
facilitated by aspiration. This is called as suctioning.
 INDICATION
1 THERAPUTIC
2 DIAGNOSTIC

3. THERAPEUTIC
 Coarse breath sounds.
 Noisy breathing.
 Visible secretions in the airway.
 Decreased spo2 in the pulse oximeter and deterioration of
arterial blood gas values.
 Clinically increased work of breathing
 Patient’s inability to generate an effective spontaneous
cough.

4. CONTINUE
 Presence of pulmonary atelectasis or consolidation,
presumed to be associated with secretion retention.
 During special procedure like bronchoscopy.

5. DIAGNOSTIC
 The need to obtain a sputum specimen/ ETA (endo
tracheal aspiration) for bacteriological or microbiological
or cytological investigations.

6. HZARDS AND COMPLICATIONS
 Hypoxia / Hypoxemia
 Tracheal and bronchial mucosal trauma
 Pulmonary hemorrhage/ bleeding
 Cardiac dysrhythmias
 Bronchoconstriction / bronchospasm
 Elevated ICP
 Interruption of mechanical ventilation

7. ASSESMENT OF NEED
 Qualified personnel should assess the need for tracheal
suctioning as a routine part of a patient/ ventilator
system check.

8. EQUIPMENT
 Stethoscope
 Vacuum source with adjustable regulator suction jar
 Sterile gloves for open suctioning method
 Clean gloves for closed suctioning method
 Clear protective goggles, apron and mask
 Sterile normal saline
 Ambu beg for preoxygenate the patient

9.  TYPE OF SUCTIONING
1 OPEN SUCTION
2 CLOSED SUCTON

10.  OPEN SUCTION SYSTEM:
 Regular using system the intubated patients.
 CLOSED SUCTION SYSTEM
 This is used to facilitate continuous mechanical
ventilation and oxygenation during the suctioning.

11.  OPEN SUCTION SYSTEM:

12.  CLOSED SUCTION SYSTEM:

13. MONITORING
 Breath sounds
 Oxygen saturation
 RR and pattern
 Hemodynamic parameters (pulse rate, BP)
 Cough effort
 ICP (if indicated and available)
 Sputum characteristics (colour, volume, consistency and
odor)

14. PATIENT PREPARATION
 Explain the procedure to the patient (if patient is
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.

15. PROCEDURE
 Perform hand hygiene, wash hands. It reduces
transmission of microorganisms.
 Turn on suction apparatus and set vacuum regulator to
appropriate negative pressure. For adult a pressure of
100-120 mm hg, 80-100 mmhg for children and 60-80
mmhg for infants.

16. COUTINUE
 Goggles, mask and apron should be worn to prevent splash
from secretions.
 Preoxygenate with 100% o2
 Open the end of the suction catheter package and
connect it to suction tubing.
 Wear sterile gloves with sterile technique

17.  With a help of an assistant disconnect the ventilator
 Kink the suction tube and insert the catheter in to ET tubr
until resistance is felt.
 Resistance is felt when the catheter impacts the carina or
bronchial mucosa, the suction catheter should be
withdrawn 1 cm out before applying suction.
 Apply continuous suction while rotating the suction
catheter during removal

18.  The duration of each suctioning should be less the 15sec.
 Instill 3 to 5 ml of sterile normal saline in to the artificial
airway, if required.
 Assistant resumes the ventilator.
 Give four to five manual breaths with bag or ventilator.

19.  Return patient to ventilator.
 Flush the catheter with water in the suction tray.
 Suction nares and oropharynx above the artificial airway.
 Discard used equipment
 Flush the suction tube with hot water
 Auscultate cheat
 Wash hands

20. ASSESSMENT OF OUTCOME
 Improvement in breath sounds.
 Increased tidal volume delivery during ventilation
 Improvement in arterial blood gas values or saturation as
reflected by pulse oximetry. (spo2)
 Removal of pulmonary secretions.

21. NASOPHARYNGEAL SUCTION
 It is very unpleasant experience for the conscious patient
and should only be used when absolutely necessary.
 The patient’s neck should be extended.
 The lubricated catheter is held between the finger and
thumb of the gloved hand and introduced into the nose.

22.  OROPHARYNGEAL SUCTION:
 A lubricated plastic airway is needed to prevent the
patient biting the catheter.
 It is inserted with its tip directed toward the roof of the
mouth and then rotated so that the tip lies over the back
of tonged.