Suctioning (Endotracheal, Oral, Nasal, Tracheal)

Suctioning is a procedure used to clear secretions from the airway when a patient is unable to do so effectively on their own. This lesson will cover the different types of suctioning: endotracheal, oral, nasal, and tracheal.

I. General Principles of Suctioning

Before discussing the specific types of suctioning, it’s important to understand some general principles:

• Indications: Suctioning is indicated when there are signs of respiratory distress or airway obstruction due to secretions, such as:
  • Visible secretions in the airway
  • Noisy breathing (e.g., gurgling)
  • Decreased oxygen saturation
  • Increased respiratory rate or effort
  • Inability to cough effectively
• Contraindications: Suctioning is generally safe, but there are some relative contraindications:
  • Epiglottitis or croup (suctioning may worsen airway obstruction)
  • Bleeding disorders (suctioning may induce bleeding)
  • Recent neck or head surgery
  • Unstable cardiovascular status
• Equipment:
  • Suction machine with adjustable pressure
  • Suction catheters (appropriate size and type)
  • Sterile gloves
  • Sterile saline solution (for lubrication and/or flushing)
  • Oxygen source (for pre- and post-oxygenation)
  • Pulse oximeter (to monitor oxygen saturation)
• Procedure:
  • Assess the patient’s condition and need for suctioning.
  • Gather and prepare the necessary equipment.
  • Explain the procedure to the patient (if possible).
  • Position the patient appropriately.
  • Apply sterile gloves.
  • Pre-oxygenate the patient.
  • Insert the suction catheter without applying suction.
  • Apply intermittent suction as you withdraw the catheter, using a rotating motion.
  • Limit each suction pass to 10-15 seconds.
  • Monitor the patient’s condition throughout the procedure.
  • Post-oxygenate the patient.
  • Dispose of used supplies properly.
  • Document the procedure and the patient’s response.
• Complications:
  • Hypoxemia
  • Trauma to the airway mucosa
  • Bleeding
  • Infection
  • Bronchospasm
  • Cardiac arrhythmias
  • Increased intracranial pressure

II. Types of Suctioning

There are several types of suctioning, each targeting different parts of the airway:

• Oral suctioning:
  • Removes secretions from the mouth.
  • Used for patients who can cough but cannot clear secretions from their mouth.
  • Equipment:
    • Rigid suction catheter (e.g., Yankauer) or flexible suction catheter
  • Procedure:
    • Insert the catheter along the side of the mouth.
    • Apply suction as you withdraw the catheter.
• Nasal suctioning (Nasopharyngeal):
  • Removes secretions from the nasal passages and pharynx.
  • Used for patients who cannot clear secretions from their nose and throat.
  • Equipment:
    • Flexible suction catheter
    • Water-soluble lubricant
  • Procedure:
    • Lubricate the catheter.
    • Insert the catheter gently along the floor of the nasal passage.
    • Advance the catheter into the pharynx.
    • Apply suction as you withdraw the catheter.
• Tracheal suctioning:
  • Removes secretions from the trachea.
  • Performed through an artificial airway (endotracheal tube or tracheostomy tube).
  • Equipment:
    • Flexible suction catheter (size should be less than half the diameter of the artificial airway)
    • Sterile saline solution (optional, for instillation)
  • Procedure:
    • Pre-oxygenate the patient.
    • Insert the catheter gently into the artificial airway.
    • Advance the catheter until resistance is met (carina) then withdraw 1-2 cm.
    • Apply suction as you withdraw the catheter, using a rotating motion.
    • Limit each suction pass to 10-15 seconds.
    • Post-oxygenate the patient.
    • Monitor for complications.
• Endotracheal suctioning:
  • This is essentially the same as tracheal suctioning, specifically referring to suctioning through an endotracheal tube.
  • Key considerations include:
    • Using the correct size catheter to prevent airway trauma.
    • Maintaining sterile technique to prevent infection.
    • Monitoring the patient closely for changes in vital signs or respiratory status.