PROPER SUCTIONING TECHNIQUES
The suctioning techniques were given more attention in this article. Definition of Suctioning, what is the equipment needed, what are the different types of suctioning, when to suction, and how to suction has been discussed for more understanding about suctioning. Moreover, complications and some precautions to take when suctioning have given focus as well for proper prevention.
There are two separate suctioning techniques, namely the closed and open system. Basic principles of suctioning are the same, and care should be incorporated during suctioning.
There is no consensus on the time interval for suctioning airways. It depends on the clinical picture; such as the age of the patient, the associated risk factors, and the ease of obtaining adjunct airway equipment in case of disruption or loss of the airway.
WHAT IS SUCTIONING?
Suctioning is used to obtain mucus and other fluids (secretions) and cells from the windpipe (trachea) and large airways (bronchi) and is typically used in people who are on mechanical ventilation or have problems with nerves or muscles that make coughing less effective for bringing up secretions
WHAT IS SECRETION?
Secretions (mucus) are normally produced in the nose, mouth, and trachea (windpipe). Secretions are usually clear or white.
Important: If you notice a change in the color, amount, smell, or consistency of secretions, contact your health-care team immediately.
PURPOSES OF SUCTIONING
- To maintain a patent airway by removing accumulated tracheobronchial secretions like blood, vomit, other liquids, and food particles using sterile technique.
- To improve oxygenation and reduce the work of breathing.
- Stimulate the cough reflex.
- Prevent infection and atelectasis from the retained secretions.
The following are different types of secretions and their common causes
|Secretion characteristics||Potential causes|
|Thickened||Not enough humidity
Chest physiotherapy has just been performed
|Yellow or green
|Red-streaked or bloody||Infection
Not enough humidity in the secretions Bleeding from gums from infection or trauma (e.g. after brushing or flossing teeth), nose
|Frothy pink||Fluid build-up in the lungs|
WHAT ARE DIFFERENT TYPES OF SUCTIONING?
There are four ways to suction the airway:
- Nasal suction (suctioning in the nose). With nasal suctioning, a catheter or small tip catheter is passed into the nostril. This is helpful when secretions are visible in the nose or you suspect that secretions are blocking the nasal passage.
- Oral suction (suctioning the mouth). For oral suctioning, a hard-plastic tip with a handle called a Yankauer is usually used to suction secretions in the mouth. Oral suctioning is useful when the patient is unable to remove secretions by coughing (for example, they have a weak cough) or they are drooling because they cannot swallow.
- Nasopharyngeal and oropharyngeal suction (suctioning the throat). A suction catheter (a thin, clear, soft plastic tube preferably with depth markings on it) is inserted to a predetermined depth through the nose (nasopharyngeal) or mouth (oropharyngeal) to the back of the throat. These suctioning techniques are useful when secretions are pooled at the back of the throat and your patient does not have the ability to cough them up or swallow them.
- Deep suctioning. This method is usually done with an artificial airway such as a tracheostomy tube. It removes mucus between the end of the tube and the carina (the part where the trachea splits into the bronchi, the tubes that go into the lungs). Deep suctioning is often done in urgent situations when secretions are unable to be removed by the other methods and the child is in distress.
This image shows the correct suctioning depth for nasal, nasopharyngeal, and oropharyngeal suctioning. You will be shown how to measure this by your health-care provider. Very helpful for doing proper suctioning techniques.
WHEN TO SUCTION
Suctioning is important to prevent mucus from blocking the tube and stopping the patient’s breathing. Suctioning should be considered:
- The blue color is seen around the lips and mouth. In fact, this may be a sign that he/she is not receiving enough oxygen and the airway needs to be cleared.
- The airflow in and out of the airway is reduced.
- The patient appears fussy and fidgety.
- He/she is using the muscles of the chest and neck to help facilitate breathing.
- The nostrils on their nose flare out when they breathe in.
- You can hear bubbling or noisy breathing.
REMOVING MUCUS FROM TRACH TUBE WITHOUT SUCTIONING
- Bend forward and cough. Catch the mucus from the tube, not from the nose and mouth.
- Squirt sterile normal saline solutions (approximately 5cc) into the trach tube to help clear the mucus and cough again.
- Remove the inner tube (cannula).
- Call a local emergency alert if breathing is still not normal after doing all of the above steps.
- Remove the entire trach tube and try to place the spare tube.
- Continue trying to cough, instill saline, and suction until breathing is normal or help arrives.
HOW TO SUCTION
Step 1: Gather the Equipment:
A clean suction catheter (Make sure you have the correct size)
Distilled or sterile water
The suction machine in working order
Suction connection tubing
Jar to soak inner cannula (if applicable)
Tracheostomy brushes (to clean tracheostomy tube)
Extra tracheostomy tube
Step 2: Wash your hands.
Wash your hands with soap and water and dry them with a clean towel.
Step 3: Check portable suction equipment.
Make sure all tubing connections and collection jars have a tight seal.
Step 4: Place portable suction unit on a flat, dry and safe surface.
Plug a suction unit into an electrical outlet. Turn unit on.
Step 5: Set the suction pressure.
The portable suction pressure should not be set higher than 15 mm/Hg.
Check pressure by turning the machine on and covering the open end of the suction line with one hand.
Look at the pressure dial. It should rise but not go any higher than the 15 markers on the dial.
If the pressure does not go up, re-check all tubing connections, or adjust to the correct pressure.
Step 6: Pick up a clean suction catheter, put on gloves, and connect the tubing to the suction catheter.
Pick up the long connecting tubing that comes from the suction machine and attach it to the suction catheter.
Step 9: Turn on the suction machine.
Step 10: “Bag” the person.
Allow the patient to receive extra breaths during suctioning. Use the Ambu bag for giving breaths. Attach the bag to the person’s airway and squeeze the bag to give extra breaths. Follow the directions you were given by your doctor or therapist.
A person will need to bag before, during, and after each suctioning.
FOLLOW THE DIRECTION
Step 11: Place the catheter into the trach tube.
Place the catheter into the opening of the trach. Be careful not to let it touch anything before entering the opening. Please remember that the inner cannula must always be in place when a person is suctioned.
The inner cannula is the tube that fits into the trach at the neck plate. It can be reusable or disposable depending on your specific situation. Certainly, never suction without it in place. If resistance is felt slowly move the catheter down into the trach. Do not force the catheter down.
Step 12: Cover the suction port.
Cover the suction port with your thumb. Slowly pull the suction catheter up and out. Do not leave the suction catheter in the trach tube for more than 10 seconds.
Suction Off (port open)
Suction On (port closed)
Step 13: Bag the person.
Repeat steps 10, 11 until the mucous is gone.
If you notice that the mucus is thick, you can use normal saline to make it thinner and squirt a small amount into the trach tube and then bag the person with the Ambu Bag. This will help loosen up the mucous and make it easier to suction. Now you may insert the suction catheter and repeat Step 11.
Step 14: Disconnect the catheter from the suction tubing.
Set it aside for washing.
Step 15: Rinse the suction tubing.
Once suctioning is complete, the canister tubing must be rinsed. Doit it with tap water or normal saline. With the suction machine still on, put the tubing in a container of water or squirt some normal saline into the tubing. Rinse the tubing until mucus disappears.
Step 16: Shut off the suction unit, remove all gloves, wash your hands. Lastly, wash the suction catheter.
WHAT ARE THE MOST COMMON COMPLICATIONS OF SUCTIONING?
- Airway Trauma
- Psychological Trauma
- Cardiac arrhythmias
- Respiratory arrest
SUCTIONING TECHNIQUES THAT MOSTLY EFFECTIVE
Careful and Cautious
Certain situations demand extreme care and caution when suctioning.
Effective and Aggressive
Some situations require an aggressive approach to ensure effective suctioning, primarily in instances of heavy bleeding, active vomiting, or copious secretions. Any of these can lead to complete airway obstruction if not treated aggressively using an efficient evacuation tool.
Traditional Maintainance Suction
Most situations call for standard suctioning, achieved through the use of a catheter with a small enough tip for easy maneuvering, yet a large interior diameter for effective evacuation. You need a reliable, durable unit that is portable and powerful.
PRECAUTIONS TO TAKE WHEN SUCTIONING
Prepare the Patient
Suctioning can be scary and uncomfortable. Prepare the patient by telling them what you need to do and why—even if they seem uncooperative. During the procedure, make sure that the patient is safe. Talking to them can be reassuring and is a sign of respect. In most cases, you can gain consent by gaining the patient’s trust.
Do Not Suction Too Long
Prolonged suctioning increases the risk of hypoxia and other complications. Never suction a patient for longer than 15 seconds. Rather than prolong suctioning, pull out the catheter, re-oxygenate the patient, and suction again.
Avoid Forcing the Catheter
A difficult airway can be stressful and upsetting, particularly if the patient requires emergency suctioning techniques. Indeed forcing the catheter can cause serious airway trauma. Never force the catheter, and do not attempt to insert it into an airway you cannot see.
Choose the Right Equipment
Without the right equipment, even flawless suctioning techniques may prove inadequate. In short, the right catheter size is key.
Never reuse disposable equipment, and keep all equipment sealed until use. Preventing airway trauma can reduce the risk of infection, so only suction a patient whose airway is visible.
Aspiration is also a risk factor for infection. Minimizing the volume of contaminants, a patient inhales decreases the risk of infection. If a patient is actively vomiting or bleeding from the airway, use Suction-Assisted Laryngoscopy and Airway Decontamination (SALAD) to quickly decontaminate the airway.
BE CAUTIOUS ON COMPLICATIONS
Monitor for Complications
During and after suctioning, monitor the patient for common complications such as bradycardia and hypoxia. Take their vital signs before and after the procedure and be mindful of any complaints the patient reports. Light-headedness, difficulty breathing, a racing heart, raspy breathing sounds, and similar symptoms may signal suction-related complications.
Suctioning will become a habit, and providing proper techniques is one of the most important life-saving skills you will learn.
JOHN HOPKINS MEDICINE https://www.hopkinsmedicine.org/tracheostomy/living/suctioning.html