Airway Anatomy and Suction The Top 5 Things You Need to Know

Every first responder goes over the basics of airway anatomy in EMT or paramedic school. You know the nose, mouth, pharynx, and larynx are interconnected and that injuries to any of these structures can lead to bleeding, hypoxia, and other medical emergencies. Knowing the basics isn’t enough. A keen understanding of airway anatomy—how it differs from person to person, how it may change with time or infirmity—can help you protect the airway and maintain patency. 


Here are the top five things you need to know about airway anatomy and suction. 


  1. Age and Health Can Alter the Airway

The aging process fundamentally changes the airway, so a delicate suctioning touch is critically important in geriatric populations. Some concerns in this age group include:


  • Decreased responsiveness to certain drugs. This increases the risk of pneumonia and can make aspiration especially dangerous.
  • Decreased muscle tone may slightly change the shape of the airway and make it more difficult to maintain a patent airway.
  • Thinning mucous membranes that make the airway more vulnerable to injuries.
  • Age-related cognitive changes. Elders with dementia or brain injuries or who have suffered a stroke may have difficulties with mobility or following directions. This may increase the risk of airway injuries and make compliance more difficult. 


Neonates likewise face special airway concerns. Newborns are obligate nose breathers and may not open their mouths if there is an obstruction. This means that an obstruction in the nose of a neonate is as threatening as an obstruction in the throat would be in an older person. Their tiny airways can make suctioning difficult and necessitate small catheters. The risk of injury is also greater in this population, so a slow and careful approach is critically important.


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  1. No Two Airways Are Exactly Alike

In school, you probably reviewed the general shape of the airway dozens of times. While all people have the same basic parts and general shape, no two airways are exactly alike. Individual anatomical variability, the effects of age and disease, positioning, and even fear during an emergency can change the shape of the airway.

The takeaway here is that you cannot suction blindly. You must be able to see the airway before inserting anything into it. If you can’t, you risk traumatic injuries, dislodging dentures, and other structures, or failing to notice a major obstruction. Position the patient so you can see the airway, and don’t proceed with suctioning until you’re confident you can do so safely. 


  1. Nasal Suction Can Be Difficult

If you must suction through the nose, the risk of injury is greater. Suction should be intermittent, and the catheter should be inserted slowly. Use a twirling motion when suctioning, and be mindful of obstructions. Watch for bleeding or vomiting and stop suctioning immediately if there are signs of injuries to the airway.


  1. Be Mindful of Artificial Devices

As a patient’s health deteriorates, their likelihood of needing artificial devices—ranging from dentures to artificial airways—increases. Be mindful of these artificial structures since dentures, bridges, and crowns can be knocked loose. If your agency routinely serves hospitalized patients with artificial airways, consider offering training on protocols for managing an artificial airway. The risk of injury is greater, and these patients may already be in poor health. 


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  1. The Right Suction Machine Matters

The suction machines of today are more powerful than ever before. This allows them to more rapidly clear even highly compromised airways. Yet high clearance and intense suction aren’t always the most important goals of suctioning the airway. In patients with delicate airways, iatrogenic suction-related injuries are common. Suction can cause bleeding of delicate nasopharyngeal tissue or dislodge dentures and cause airway obstructions. To reduce the risk of injury, lower the pressure on the suction machine.

 The safest and most effective suction machines are easy to operate, with suction and pressure that can be easily adjusted to meet your patient’s needs. They’re compatible with the equipment you already have, boast a long battery life, and can easily be transported to the patient. 


So which suction machine is right for you? That depends on your patient population. For help choosing the right machine—or combination of machines—download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.


Editor's Note: This blog was originally published in October, 2018. It has been re-published with additional up to date content.

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