SUCTIONING

INDICATION
• To maintain a patent airway and remove
saliva, pulmonary secretions, blood,
vomitus or foreign material from the
pharynx
• It helps a patient who can’t successfully
clear his airway by coughing and
expectorating.
 PURPOSE
• To remove secretions that obstruct
the airway
• To facilitate ventilation
• To obtain secretions for diagnostic
purposes
• To prevent infection that may result
from accumulated secretions.
 TYPES OF SUCTION
CATHETERS
• ACCORDING TO TIPS
• A. Open- ended catheter
- Effective when the mucus is very thick and
tenacious, but it does have a tendency to
pull at tissue unless it is used carefully.
B. Whistle-tip catheter
- Large oblique opening in the end, which
has a lesser tendency to grab or pull
tissue.
TYPES OF SUCTION
CATHETERS

Whistle-tip

Open -
ended
 TYPES OF SUCTION
CATHETERS
C. Oral suction tube/ Yankauer device
- Used to suction the oral cavity.
SUCTION CONTROLS
What size catheter
should I use?
 Age Catheter Size
Premature 5/6 fr.

Term Newborn 5/6 – 8 fr.

Newborn – 6 mo. 8 – 10 fr.

1 yr. – 8 yrs. 10 fr.

8 yrs. or older 10 – 14 fr.

 SUCTION SOURCE
• Wall outlet suction device
PORTABLE SUCTION MACHINE
What suction pressure
should I use?
 WALL UNIT
• ADULT- 100-150 mmHg
• Children – 100-120 mmHg
• Infants – 80 – 100 mmHg
• Neonates – 60-80 mmHg
• FOR PORTABLE
A.ADULT- 10-15 cm Hg
B.Children – 10-12 cmHg
C.Infants – 8 – 10 cmHg
D.Neonates – 6-8 cmHg
ROUTES OF SUCTIONING

1. OROPHARYNGEAL
2. NASOPHARYNGEAL (NP)
3. NASOTRACHEAL
4. SUCTIONING THROUGH THE
ARTIFICIAL AIRWAY
How do I measure for
NP suctioning?
 Route
• Oropharyngeal- assess the
length of catheter to the back
of the throat
• Nasopharyngeal- distance
from the tip of the nose to
the tip of one ear lobe, or
about 5 inches (
approximately 12.5cm) for
the adult.
• Tracheostomy- insert the
catheter into the
tracheostomy until the
patient coughs or
resistance is felt ( usually
5 inches(12.5cm).
Withdraw the catheter
about ½ inch (1-2cm)
ENDOTRACHEAL
• Suction should only be to the tip of
the ETT, and should never exceed
more than 0.5cm beyond the tip of
the ETT.

• Length is determined by using the

cm markings on the ETT; and by
adding the length of additional
space of the ETT adapter (usually
1-1.5 cm).
Complications with Suctioning
• Hypoxemia—dysrhythmia
• Atelectasis or lung collapse
• Mucosal trauma/damage---bleeding
• Broncho spasm
• Dysrhythmias
• Nosocomial pulmonary tract infection
• Sepsis
• Cardiac arrest
 Procedure Considerations
• Suctioning removes secretions, & also Oxygen
• Suction pressure too high (>120mmHg) can cause
mucosa damage & bleeding
• Suction pressure too low may not clear secretions & be
ineffective
• Suction mouth with a (yankauer) not the same suction
catheter as trachea to avoid cross contamination
• Do not apply suction while inserting the catheter
• May be necessary to pre-oxygenate the patient prior to
and after suctioning
• Use personal protective equipment (i.e. goggles, mask,
face shield
 ASSESSMENT
• Assess for lung sounds
• Assess Oxygen saturation
• Assess respiratory status including
respiratory rate and depth
• Assess patient for respiratory distress
• Assess effectiveness of coughing and
expectoration
• Assess for history of deviated septum,
nasal polyps, nasal obstruction, nasal
injury, epistaxis or nasal swelling
 NURSING DIAGNOSIS
• Ineffective Airway
Clearance
• Impaired Gas Exchange
• Ineffective Breathing
Pattern
• Risk for Aspiration
 EXPECTED OUTCOME
• Patient will exhibit improved breath
sounds and a clear, patent airway.
• Pt. Will exhibit an Oxygen saturation
level within acceptable parameters
• Patient will demonstrate a respiratory
rate and depth within acceptable
parameters.
• Patient will remain free of any signs of
respiratory distress.
 Decision to Suction
• Frequency of suction will vary and must be
individually assessed & not done on a schedule
Factors to Consider:
• Is the pt able to cough &/or clear secretions?
• Increased work to breath?
• Changes to respiratory rate
• Amount and consistency of secretions
• Decreased O2 saturation
• Secretions are audible
• Pt request
• Other Respiratory S & S (i.e. SOB, cyanosis, restless,
anxiety)
 Suctioning

Insert catheter until you meet resistance &/or pt coughs

forcibly then pull back slightly & start suctioning
 Suctioning
• Test suction pressure before instilling catheter 60-120 mm
Hg
• Suction catheter: ½ diameter of tube
• Prepare clean cup with NS to lubricate and clear secretions
from suction catheter
• Dominant hand remains sterile with clean glove, and will be
inserting the catheter, while the non-dominant gloved hand
grasps the suction port
• Apply suction only on removal of catheter no during insertion
• Suction efficiently and quickly depending on secretion
amount, consistency
• Do not exceed 3 attempts and allow 20 to 30 seconds
between each, oxygenate pt between PRN
 Inducing Cough
• If you suction and don’t obtain secretions you can
instill normal saline (sterile ampule) to loosen
secretions
• ( induce cough reflex) for suctioning
• Note: this should not be done as a routine
• (may flush particles into resp system, increase
infection, aspiration pneumonia)
• Secretions may build up within the inner
cannula, and narrow the passage----pull out
cannula and observe if copious secretions
discard (if disposable)and place new one (if not
disposable) clean and reapply
 Dysphagia Infection Control
• May not be able to eat • Risk of
orally pneumonia/respiratory
• May have difficulty infections increased
swallowing, require • Humidity applications
puree or thickened • Clean equipment
fluids • Change suction
• Risk for aspiration catheters/tubes
• Clean trach
• Hand washing
• Cough etiquette
 Additional Nursing
Considerations
• Hygiene • Communication
• Good mouth • Alteration in
care communication
• Brush teeth • Lip reading
• Prevent • Communication
pneumonia board
What you need to document:
• Type of suctioning • Color
• Nasal, oral, NP • Clear, white, yellow,
• Frequency/hour green, red streaks
• Time • Thickness
• Amount • Thin, thick, frothy
• None, scant, • How the patient
small, medium, tolerated the
large, copious procedure
• Cooperative, crying,
resisting
 References
• http://www.atitesting.com/ati_next_gen
/skillsmodules/content/airway-
management/equipment/types-of-
suctioning.html
• http://www.rch.org.au/rchcpg/hospital_
clinical_guideline_index/endotracheal_
tube_suction_of_ventilated_neonates/
• Taylor’s Clinical Nursing Skills
• Basic Nursing Skills
•The earlier you
start working on
something, the earlier
you will see the
result!