Introduction​:-​Endotracheal suctioning can be accomplished through an endotracheal

tube that the physician inserts through the patient’s mouth and into the trachea.It can
remain in place for several days and,when its cuff is inflated to provide a tight connection,it
can be attached to a respirator for controlled ventilation.

The inflated cuff also aids in preventing aspiration of blood, vomitus or foreign material
into the bronchus.Although endotracheal suctioning is a common procedure,it is one that
interferes with arterial oxygenation.The decrease in oxygen in the alveoli is directly
proportional to the amount of suction and the length of time the procedure takes.The
amount of oxygen in the blood drops suddenly and produces serious hypoxia.It is essential
to oxygenate the patient pre and post suctioning.

Definition:-​It is the process of applying a negative pressure to the distal endotracheal

tube or trachea by introducing a catheter to clear excess or abnormal secretions.

Purposes:-
● To maintain a patent airway by removing secretions.
● To prevent lower respiratory tract infection from retained secretions.

Principles of endotracheal suctioning:-

● Maintain aseptic technique
● ETT suction should be based on a clinical assessment of the patient
 ● patient should receive hyper oxygenation by the delivery of100%oxygen for more
than 30 seconds prior to the suctioning event.

● Negative pressure should only be applied when the suction catheter is being withdrawn
from the ETT
● Apply suction for only maximum 10 seconds.
● Allow patient to take rest at least 01 minute between suctioning and replace oxygen
delivery set up if necessary.
● Minimize risk of complication.
● Ensure effectiveness of the procedure

Indications for endotracheal suction:-

● Desaturations
● Bradycardia
● Trachycardia
● Absent or decresed chest movement
● Visible secretions in ETT
● Irritability
● Course or decreased breath sound
● Increased work of breathing
● Blood pressure fluctuations
● Recent history of large amounts of thick/tenacious secretions
●

Effectiveness of ETT suction shoud be assessed after the procedure by observing:

● Improvement of breath sounds

● Removal of secretions
● Improved oxygen saturation,heart rate,blood pressure,respiratory rate
● Decreased work of breathing,improved chest movement

​Patient preparation:​-​In preparation for the suctioning event,the patient should

receive hyper oxygenation by the delivery of100%oxygen for more than 30 seconds prior
to the suctioning event.
Assessment​:​-ETT suction should be based on a clinical assessment of the patient.
Auscultate with stethoscope before and after ETT suction to evaluate necessity and
effectiveness of the procedure.

Monitor the patient closely before , during and after the procedure to assess the baseline
,acute physiological changes and recovery.

​Parameters to observe:

1. Oxygen saturation
2. Heart rate
3. Respiratory rate
4. Blood pressure
5. Respiratory function monitoring (during conventional modes of
ventilation)including flow,pressure,tidal volume and minute volume.

Articles:-​Assemble the following articles or obtain a prepackaged suctioning kit:

A clean tray containing:

Articles Purpose
1.Sterile suction catheter with cover For suctioning
2.Sterile water /normal saline in a container For lubricating and washing the
catheter
3.Sterile gloves and mask
To prevent infection and universal
4.Kidney tray precaution
5.Alcohol swabs Todiscard used material
6.Stethoscope To clean stethoscope,ambubag and
mask
To assess the patient

A sterile tray containing:

Articles Purpose
1.Sterile towel To make sterile field
2.Sterile bowl
 To collect sterile water

Additional articles:

Articles Purpose
1.Resuscitation bag with a reservoir To hyperoxygenate the patient
connected to 100% oxygen source
2.Suction source-protable suction machine For suctioning
or wall suction unit