In prehospital and emergency settings, oral suctioning may be overlooked as a basic task that is performed without harm to the patient. The reality is, oral suctioning is not without its risks and complications. In addition to complications related to the procedure itself, oral suctioning complications may arise because of ineffective or incorrect technique. Let’s explore the various oral suctioning procedure complications and discuss ways you can prevent them in your patients.
As you are well aware, negative pressure ventilation is the normal physiologic process of breathing. As the diaphragm contracts and moves downward, the intercostal muscles contract and move upward and out, expanding the lungs. This causes the pressure inside the lungs to decrease, pulling ambient air into the lungs. Oral suctioning from a portable suction unit causes increased negative pressure in the airway and lungs. Too much negative pressure can lead to both atelectasis and hypoxia.
Because oral suctioning may cause hypoxia and hypoxemia, this procedure also places the patient at risk for developing dysrhythmias, especially bradycardia. In some patients, aggressive oral or tracheal suctioning triggers a vasovagal reflex, which may cause both bradycardia and hypotension. Additionally, failure to preoxygenate prior to suctioning increases the risk of hypoxia and hypoxemia and decreased perfusion to the heart. This, in turn, may cause cardiac dysrhythmia. Monitoring your patient’s oxygen saturation and cardiac rhythm will help you recognize the early signs of hypoxia and hypoxemia (restlessness, agitation, tachycardia) as well as a potential vasovagal reflex reaction (bradycardia and hypotension).
Airway tissue trauma and iatrogenic injury may occur with oral suctioning. This may range from mild irritation of the tissue to damage and tearing of the airway. This complication may be difficult to recognize in patients who presented with traumatic injuries that required oral suctioning in the first place.
Aspiration pneumonia is a threat to all patients with compromised airways and retained airway contaminates. When these contaminates—think blood, mucus, vomit—enter the patient’s trachea, they are inhaled into the lungs. To make things worse, positive pressure from assisted ventilation forces these contaminants deeper into the lungs. The complication of infection from oral suctioning may occur because of contaminated equipment inoculating the patient’s airway with harmful bacteria. However, this complication more commonly occurs as a result of ineffective oral suctioning and failure to quickly and efficiently remove these disease-causing airway contaminates.
Atelectasis
Avoid using suction catheters larger than half the diameter of the airway. Increased diameter of suction catheters increases the negative pressure.
Check the negative pressure of the portable suction unit prior to using it. Suction pressure should not be set any higher than the level required for efficient suction use to clear your patient’s airway. Using a portable suction unit with outward-facing controls makes adjusting the negative pressure easy.
Hypoxia
Keep suction attempts and passes under 15 seconds. This may be a challenge in a patient with copious secretions or blood in the airway.
Preoxygenate and reoxygenate. Preoxygenate your patient with 100 percent oxygen for 30-60 seconds prior to suctioning to help prevent hypoxia. Between suction passes, reoxygenate your patient to maintain oxygen saturation greater than 94 percent.
Dysrhythmia and Airway Trauma
Again, preoxygenate and reoxygenate. Preventing hypoxia decreases the risk of arrhythmia, which often occurs as a result of hypoxia and hypoxemia.
Avoid aggressive suctioning. Deep suctioning and overly aggressive techniques may lead to your patient developing a dysrhythmia (usually bradycardia) or airway trauma.
Infection
Keep it clean. The prehospital environment is rarely clean. Do your best to maintain a clean environment while suctioning. Keep the oral suction device off of soiled surfaces, and always disinfect your equipment between uses.
Decontaminate the airway. An improved technique for effective suctioning is Suction Assisted Laryngoscopy and Airway Decontamination (SALAD), pioneered by Dr. James DuCanto. Constant suction provided by the SSCOR DuCanto Catheter continuously removes blood, mucus, vomit, and other airway contaminates while you secure your patient’s airway with intubation.
Oral suctioning may be overlooked by some as a basic procedure that all prehospital and emergency personnel have mastered. However, knowing that this fundamental procedure has its risks and complications will allow you to help identify and decrease these risks for your patients. An effective and correct technique using the best devices are the keys to preventing complications with oral suctioning.
Editor's Note: This blog was originally published in March 2019. It has been re-published with additional up to date content.