3. INTRODUCTION
• Suction can be used to remove
secretions from intubated patients
and from infants and children who
are unable to cough and
expectorate.
4. GENERAL PRINCIPLES
• The technique should be as quick, clean and gentle as possible.
• Suction is very traumatic to delicate mucosal tissue and it is very easy to introduce
infection, especially in intubated patients.
• Suction should only be carried out as and when necessary, rather than on a routine
basis.
10. SUCTION TROLLEY:
• All the equipment needed for airway suction should be set out on a trolley for ease
of access:
1. Sterile plastic gloves - disposable.
2. Suction catheters - appropriate sizes for the patient.
3. Lubricating jelly water-based only, not oil-based, for use in nasopharyngeal
suction.
4. Sterile gauze swabs - to transfer jelly to tip of catheter.
5. sterile water - to flush the secretions through the catheter and tubing. Sodium
bicarbonate acts as a solvent of the secretions.
6. Forceps (if used).
7. Plastic bag for the collection of disposables
11. INDICATION
1. Whenever secretions can be heard in an intubated patient.
2. For retained secretions in the spontaneously breathing patient who is unable to
cough and expectorate efficiently.
3. Before and during the release of the cuff on a tracheostomy tube.
4. If the inflation pressure of the ventilator suddenly' rises. This may indicate the
presence of a large plug of mucus in one of the larger bronchi or even within the
endotracheal or tracheostomy tube.
5. If the minute volume (MV) drops, this may indicate retained secretions
12. RISKS AND COMPLICATIONS OF
SUCTION
1. Trauma:
• Mucosal haemorrhage and erosion frequently occur in the patient who has been
suctioned, leading eventually to the formation of granulation tissue.
• The amount of trauma depends upon the frequency of suction, the amount of
negative pressure applied, the size and type of catheter used and the vigour of
insertion.
13. 2. Hypoxia.
• This can occur following suction.
• To avoid this the suctioning time should be kept to a minimum, particularly in tl](ose
patients who are dependent on a ventilator, and the inspired oxygen and/or
ventilation may be increased prior to suction providing there are no contra-
indications.
14. • Cardiovascular effects.
• Cardiac arrhythmias and hypotension can occur during suction due to hypoxia
and/or vagal stimulation from direct pharyngeal and tracheal irritation.
• Particular care should be taken with neonates as bradycardia and apnoea can follow
nasopharyngeal suction in these patients
15. •Atelectasis.
• Too large a suction catheter in too small an airway will prevent room air from
entering around the catheter during suctioning and atelectasis, in varying degrees,
may occur.
• Too high a negative suction pressure may also cause atelectasis and airway collapse.
16. •Pneumothorax.
• This can occur primarily in premature infants with severe underlying lung disease
due to perforation of segmental bronchi by a suction catheter
17. TYPES
Depending on site of Suctioning
A. Nasotracheal suctioning (NT)
B. Oropharyngeal suctioning
C. Tracheostomy suctioning (TT)
D. Endotracheal suctioning
Depending upon circuit
A. Open circuit
B. Closed Circuit
18. PROCEDURE:- SUCTION FOR
INTUBATED PATIENTS
1. Wash hands.
prepare saline or mucolytic solution - prepare gloves/forceps.
2. Prepare equipment: - turn on vacuum, check pressure - attach suction catheter -
3. Prepare patient - if conscious the patient should be swaddled in a blanket being
aware of infusions, drains, tubes, etc; or he should be held firmly by an assistant.
The procedure should be explained to the child and constant reassurance given
while suctioning is taking place.
4. Physiotherapy may be carried out at this point if indicated.
19. 5. Place glove on the hand that is to hold suction catheter.
6. Withdraw catheter from its sterile pack with the gloved hand.
7. Disconnect ventilated patient from ventilator.
8. Insert catherter into tube without applying suction.
9. Push catheter gently and quickly down tube until a slight resistance is met.
10. Withdraw catheter 0.5cm.
11. Apply suction.
12. Withdraw catheter quickly, rotating gently between thumb and first finger and
interrupting the suction pressure every few seconds.
20. 13. Reconnect patient to ventilator.
14. The same catheter can then be used to clear secretions from the mouth and nose.
15. Discard both the glove and the catheter.
16. Repeat until secretions are cleared.
21. SUCTION FOR NON-INTUBATED PATIENTS
• Children and infants should always be suctioned in side lying to prevent aspiration
of vomit.
1. Wash hands.
2.Prepare equipment: - turn on vacuum, check pressure - attach suction catheter -
prepare saline or mucolytic solution - prepare gloves/forceps.
3. Prepare patient - if conscious the patient should be swaddled in a blanket being
aware of infusions, drains, tubes, etc; or he should be held firmly by an assistant. The
procedure should be explained to the child and constant reassurance given while
suctioning is taking place.
4. Physiotherapy may be carried out at this point if indicated.
5. Place glove on the hand that is to hold suction catheter.
6. Withdraw catheter from its sterile pack with the gloved hand
22. 7. Gently insert catheter into the nose using an upward motion until the nasal
septum is passed, then using a downward motion. If a slight resistance is met,
withdraw catheter slighdy and try again.
8. Insert catheter to the back of the throat until a cough has been stimulated. It is
possible to pass a catheter into the trachea by inserting the catheter during
inspiration, but an effective cough can be elicited merely by stimulating the
pharynx.
9. Apply suction.
10. Withdraw catheter, rotating slightly between thumb and first finger and
interrupting the suction every few seconds.
11. Repeat procedure via other nostril.
12. Discard both the glove and the catheter.
13. Repeat until secretions are cleared.
23. ORAL SUCTION
8. Pass suction catheter to the back of the throat until a cough has been stimulated.
Ensure that the catheter is not curling up in the mouth.
9. Apply suction.
10. Withdraw catheter.
11. Repeat until secretions are clear.
12. Discard both the glove and the cathete
24. CONTRAINDICATIONS TO SUCTIONING
THE INTUBATED PATIENT
1. Frank haemoptysis
2. Severe bronchospasm
3. Undrained pneumothorax
4. Compromised cardiovascular system.
25. CLOSED-CIRCUIT SUCTION
• Closed-circuit suction systems are
available and consist of a catheter in
a protective closed sheath which
remains attached to the endotracheal
or tracheostomy tube for 24 hours.
• The indications for use are: immuno-
suppressed patients, actively
infectious patients (e.g. open TB) and
patients with severe refractory
hypoxaemia on high levels of PEEP.
26.
27. PRECAUTIONS
1. 100 — i20mmHg is ideal for most patients although pressure up to —200mmHg
may be needed for thick secretions.
2. Nasopharyngeal suction:
I. When introducing a suction catheter via the nose it is helpful if the patient’s neck
is extended so that the head is tilted backwards resting on a pillow. If the patient
can co-operate the tongue should be protruded, as this helps when attempting to
pass the catheter between the vocal cords and into the trachea
II. It must be remembered that nasopharyngeal suction is a very unpleasant
experience for the conscious patient and should only be used when absolutely
necessary.
III. Nasopharyngeal suction should not be used for patients with head injuries where
there is a leak of CSF into the nasal passages.
28. 3. Oropharyngeal suction.
I. A lubricated plastic airway is usually tie eded to prevent the patient biting the catheter
and it is difficult to direct the catheter accurately into the pharynx and beyond.
4. Suction via tube
I. Whatever the mode of entry, the physiotherapist must ensure that no suction
pressure is applied while the catheter is being introduced.
II. If, during nasopharyngeal suction, the patient becomes cyanosed I and the
catheter was difficult to insert, it is acceptable to disconnect the suction, leaving
the catheter in situ, while administering oxygen J until the patient recovers and
suction can be resumed.
III. No longer than 15 seconds should elapse between the disconnec - I tion and
reconnection of the patient to the ventilator, more than adequate time for
effective removal of secretions by the experienced I operator. j Where possible,
the patient should be suctioned in side lying or 1 with the head rotated to one
side to avoid aspiration of gastric contents should vomiting occur.
