8 Complications of Endotracheal Suctioning and How to Prevent Them

Endotracheal suctioning can reduce morbidity and mortality. But like all medical procedures, it carries a risk of complications, particularly when treating vulnerable patients or in the hands of inexperienced providers. 


Regular training, particularly for patients who present with a difficult airway, can help reduce the risk of serious complications. And though there are no absolute suctioning contraindications, basic medical history, and patient observation can help identify a patient’s risk for endotracheal suctioning complications.


However, an excellent technique and a diligent approach can prevent many common complications of airway suctioning. 


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Resistance and Psychological Distress 

Suctioning can be extremely distressing to patients who may already be in pain and a state of terror. Some patients, especially geriatrics and children, may resist suctioning.

Rather than coercing or forcing them, remain calm and reassuring. This greatly reduces the risk of combativeness and psychological trauma. Even resistant patients have a right to informed consent and compassionate care, so remain warm and supportive. 


Airway Injuries 

The wrong suctioning technique, particularly with a difficult airway, can cause several different airway injuries. Minor damage to mucosal structures may cause pain and slightly increase the risk of infection, but more severe injuries can also occur. They include: 


  • Atelectasis
  • Pneumothorax 
  • Bleeding in the airway 

You must assess the airway before and after treatment and monitor patients for signs of pain or an airway injury. Geriatric patients are generally more vulnerable to airway injuries because of comorbidities and age-related changes in the shape and musculature of the airway. 



Though endotracheal suctioning can offset the effects of serious infections and prevent aspiration, it is also a risk factor for infection. A contaminated endotracheal tube may transmit pathogens from the environment or another patient, so use only fully sealed and sanitized equipment. Injuries to the airway may also provide an entry site for pathogens, particularly in patients with compromised immunity. 



Suctioning can be painful, especially when a provider uses an inappropriately sized tube or rushes or forces the process. Pain is not a trivial complication because it can lead to psychological trauma, reduce trust in healthcare providers, and make patients reluctant to undergo treatment in the future. Gentle reassurance, a confident technique, and the right equipment can greatly reduce the pain. 


Cardiac Arrhythmias 

Suction stimulates the vagus nerve. This may lead to bradycardia in some patients. In others, especially those who become hypoxic during suctioning, tachycardia can occur. Be mindful that cardiac arrhythmias may also be indications for suctioning.


Blood Pressure Instability

Thanks in part to vagus nerve stimulation, blood pressure may suddenly drop during suctioning, triggering a cascade of effects that may include tachycardia and fainting. Some patients also experience high blood pressure or instabilities in blood pressure. Closely monitor blood pressure before and after suctioning.


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Hypoxia is one of the most common suctioning complications and may exacerbate other symptoms. To reduce the risk, preoxygenate the patient before suctioning. If suctioning fails or requires another pass, oxygenate prior to each subsequent suctioning pass. 


Never suction a patient for longer than 10-15 seconds because this may increase the risk of both hypoxia and heart rhythm irregularities. 


Failed Treatment

A failure of suctioning can occur when complications interfere with treatment. Failed suctioning may also occur with an ineffective device or with a device that is too challenging for a novice practitioner. Regular training, support from a team, and prompt management of complications can reduce the risk. 


The right suctioning machine is also critical. Portable suction machines may further reduce the risk of failed treatment by preventing treatment delays. A prompt response may even reduce the risk of suctioning complications.


For help finding the right portable suction machine for your agency, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.


Editor's Note: This blog was originally published in April, 2021. It has been re-published with additional up to date content.