Suctioning a patient’s airway is not a “one size fits all” procedure. Whether to clear secretions that the patient cannot mobilize, remove vomitus or foreign materials from the pharynx or trachea, or to maintain the patency of an artificial airway, some suction strategies will work better than others for a particular situation.
Today, let’s examine some suction recommendations for some types of patients you might encounter in the hospital. As always, please refer to your hospital’s specific policies and procedures to guide your practice.
An adult patient with an endotracheal tube
As mentioned in a previous blog, the American Association for Respiratory Care released “Clinical Practice Guidelines for Endotracheal Suctioning of Mechanically Ventilated Patients with Artificial Airways 2010.” According to these guidelines there are some key points to keep in mind:
- Select the . The appropriate sized catheter should be no bigger in diameter than one-half the diameter of the endotracheal tube (American Association for Respiratory Care, 2010).. Shallow suctioning is recommended over deep suctioning. In shallow suctioning the catheter is advanced to a depth that is equivalent to the length of the ET tube plus the adapter. Compared to deep suctioning, shallow suctioning appears to lead to less adverse events and decreases mucosal trauma (AARC, 2010).
- Hyperoxygenate for 30-60 seconds with 100% O2 before and after suctioning (AARC, 2010).
- Use closed suctioning for patients who are receiving high amounts of FiO2 or PEEP so as not to disrupt oxygenation and ventilation. This may lead to less lung derecruitment (AARC, 2010).
- Suction using sterile technique for less than 15 seconds and only when secretions are present (AARC, 2010).
A non-intubated adult patient
When a patient is unable to clear secretions or foreign material from the trachea or nasopharyngeal area by coughing, nasotracheal suction may be needed, especially if the patient is showing signs of distress. The AARC also developed Clinical Practice Guidelines for this procedure. These guidelines recommend:
- Do NOT perform nasotracheal suction in cases of epiglottitis or croup. This is considered an absolute contraindication. Many other contraindications are observed in the AARC document. (AARC, 2004).
- Use a sterile, flexible multi-eyed catheter that is lubricated with water based lubricant or normal saline (AARC, 2004)
- Connect the catheter to an appropriate vacuum source, such as in-wall suction or a portable suction machine. Use the regulator to set the negative pressure to an appropriate level, no higher than 150 mm Hg for adults according to the AARC. Do not suction for longer than 15 seconds (AARC. 2004).
- Explain the procedure to the patient and provide sedation or pain relief as indicated. There is a risk involved when performing this type of suction, such as mechanical trauma, and a combative patient increases this risk (AARC, 2004)
- Consider a nasopharyngeal airway if frequent nasopharyngeal suction is anticipated (AARC, 2004).
An intubated neonate
Managing the airway of a newly born infant can be extra challenging, and the AARC also sets forth some recommendations for suctioning a neonate.
- Use a suction catheter with a diameter that is less than 70% of the diameter of the endotracheal tube (AARC, 2010).
- Neonates should be receive a 10% increase from their baseline FiO2 prior to and after suctioning (AARC, 2010).
- Use of closed suction and avoiding disconnecting from the ventilator is suggested for all neonates (AARC, 2010).
It is clear that as your patients change, so will your suction strategies. An awareness of these differences will ensure that you provide your patients with the safest and most effective methods of airway clearance.
These recommendations, and more are embodied in the American Association for Respiratory Care’s Clinical Practice Guidelines. Follow that hyperlink to read the entire document.
American Association for Respiratory Care. (2010). AARC Clinical Practice Guidelines Endotracheal Suctioning of Mechanically Ventilated Patients With Artificial Airways 2010. Respiratory Care, 55(6), 758-64. Retrieved from http://www.rcjournal.com/cpgs/pdf/06.10.0758.pdf
American Association for Respiratory Care. (2004). AARC Clinical Practice Guidelines Nasotracheal Suctioning- 2004 Revision and Update Respiratory Care, 49(9), 1080-84. Retrieved from http://rc.rcjournal.com/content/49/9/1080.full.pdf