ENDOTRACHEAL SUCTIONING

REFLECTION
In intensive care units, endotracheal suctioning (ETS) is an essential
procedure. It entails removing pulmonary secretions from a patient who is
wearing an artificial airway. Suction from an endotracheal tube (ETT) is
required to remove secretions and preserve airway patency, allowing for
optimal oxygenation and ventilation in a ventilated patient. ETT suction is a
typical treatment performed on infants who have been intubated. Although
there have been a small number of studies that suggest conducting ETS every
1, 3, 4, 6, 8, or even 12 hours, the main consensus is to suction only as needed
(as needed). 1-3 The reason for this is that utilizing “routine” suctioning carries
a significant danger. ETS should be performed at least every 8 hours, according
to Pedersen et al3, to slow the growth of the secretory biofilm within the lumen
of the endotracheal tube (ETT). Clifton-Koeppel1 provided an excellent overall
advice that ETS be performed as infrequently as possible—yet as often as
necessary.

This innovative equipment helps the patient to remove his or her

secretions when he or she cannot do so. By this, she or he can have a patent
airway and can receive the supplemental oxygen that he or she needed. When
an artificial airway is in place, the tube needs to be kept clear so that air can
pass into the lungs easily. Sometimes patients without an artificial airway may
also need suctioning. Suctioning allows for rapid clearing of secretions and
prevents the airway from becoming blocked.

It makes me happy that I will be able to learn this procedure for it will be
useful when I am already working in the hospital. It can be more appreciated if
we do face to face return demonstration of suctioning, in order for us to know
what we did wrong and to be guided well by our professors.

Equipment:
 Portable suction machine
 Clean suction catheter
 Sterile normal saline
 Resuscitator bag (also known as the Ambu Bag)/Oxygen resources
 Sterile Gloves
 One helper
Procedure:
  Assess the patient’s breath sound using a stethoscope (auscultate). Note
for adventitious breath sound such as rales and rhonchi.
 Check the patient’s monitor, note for oxygen saturation, heart rate and
respiratory rate. Check if patient is anxious or showing some agitation.
 Gather the equipment needed.
 Check portable suction equipment. Make sure all tubing connections and
collection jar have a tight seal.
 Wash your hands with soap and water. Dry them with a clean towel.
 Put on gloves using sterile technique.
 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.
 Test the vacuum source, make sure it is working appropriately.
 Before suctioning, give the patient supplemental oxygen, hyper oxygenate
the patient, do not hyperventilate. The person must receive extra breaths
during suctioning. This is done by using the Ambu Bag.
 Insert the tube using sterile technique. Go straight down the ET tube
until the resistance of the patient is seen or until he or she starts to
cough. Pull up a centimeter and perform intermittent suctioning. Cover
the suction port with your thumb. Slowly pull the suction catheter up
and out. Do not leave the suction catheter in the ET tube for more than
10 seconds.
 Bag the person.
 Reassess the patient. Check the O2Sat, HR and RR. Note for abnormal
findings such as arrythmias.
 Repeat procedure (suctioning) until the mucus is cleared. If you notice
that the mucous is thick, you can use normal saline to make it thinner.
Squirt a small amount into the tube and then bag the person with the
Ambu Bag. This will help loosen up the mucous and make it easier to
suction.
 Reassess the patient. Check the O2Sat, HR and RR.
 Assess if there is any oral mucosa to determine if there is a need to
suction saliva secretions inside.
 Clean the tube and remove or disconnect the vacuum source. Remove
the gloves with the disconnected vacuum source inside of it and discard.
 Wash hands and assess the patient again for O2Sat, HR, RR and
auscultate for lung sounds.
 Document the findings and the procedure done.

Nursing Responsibilities:
Before

 Prepare the equipment needed and check if the suction apparatus

is functioning.
 Explain the procedure to patient or his relatives
 Assess the base line data and respiratory status of patient i.e.
breath sound, ABG value etc.
 Place the patient to semi fowler’s position
 Perform handwashing
 Apply gloves

During

 Place towel or waterproof pad across the patient chest

 Connect the suction catheter to suction tubing connected with
suction device
 Turn on the suction
 Insert catheter to mouth or nasal cavity move catheter in cavity
until suction are cleared
 Rinse the catheter with water until the secretion is cleared from
suction tubing.

After

 Evaluate the respiratory status

 Remove the towel and gloves
 Reposition the client in comfortable position
 Wash and clean the articles used in suction
 Replace the articles
 Perform handwashing
 Document the procedure, finding and condition of patient pre and
post suction.