Sooner or later, every nurse must suction a patient. For nurses who work in intensive care units or emergency care or who support patients with spinal cord injuries, suctioning may be a daily part of the job. When suctioning becomes routine, it’s easy to lose sight of the risks. A few simple precautionary measures can reduce the risk and improve patient outcomes.
Conduct a Risk Assessment
Some patients face a higher risk of suctioning-related morbidity. They include:
- Patients with a recent head or neck injury
- Geriatric and pediatric patients, who have more fragile airways
- People with cognitive or mental health conditions that make it more difficult for them to understand the procedure and cooperate
- Patients with loose dental hardware
- Patients with a difficult airway or a history of suctioning complications
- Patients with bradycardia
- Patients with hypoxia
No single condition is an absolute contraindication for suctioning, but nurses must avoid routinely suctioning patients without first assessing risk.
Prepare the Patient
Suctioning can be scary and uncomfortable. Prepare the patient ahead of time by telling them what you need to do and why—even if they seem uncooperative. When working with a child or a person with cognitive disabilities, explain things in terms they can understand, and be warm and reassuring. Ask their caregiver to remain present and avoid using force or restraints unless absolutely necessary for a life-saving procedure.
During the procedure, reassure the patient that they are safe. If there are unusual sounds that could be frightening or complications that require additional treatment, continue to reassure the patient and talk them through what you are doing. Even if the patient is very young, very old, or very confused, talking to them can be reassuring and is a sign of respect. Do not talk about the patient as if they are not there or cannot hear you.
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, withdraw 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. Yet 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.
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.
Choose the Right Equipment
Without the right equipment, even a flawless suctioning technique may prove inadequate. The right catheter size is key. In most cases, the suction catheter should have an external diameter that is less than half the internal diameter of the endotracheal tube. Geriatric and pediatric populations often require smaller suction catheters. Children have smaller airways, and elders may have more difficult airways due to loss of muscle tone.
You must also choose the right catheter for the job. For patients who are continuously vomiting or bleeding during resuscitation, the DuCanto catheter enables rapid airway decontamination via the SALAD technique.
A portable emergency suction machine offers more than just emergency care. It enables nurses to care for patients wherever and whenever they need treatment, including while being transported to surgical wings. A portable machine also ensures you can meet your obligations under the Emergency Medical Treatment and Labor Act (EMTALA) to provide treatment to patients within a 250-yard radius of the hospital. For help choosing the right suction machine for your patients, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.
Editor's Note: This blog was originally published in August 2019. It has been re-published with additional up to date content.