Suctioning can be life saving, and may prevent serious complications in the dental office or surgical suite. But suctioning can also be painful and traumatic, especially if the first attempt fails. Suction complications are common and become more likely when you use the wrong suction strategy. These tips can help you choose the right suction strategy for every patient every time.
Identify the Reason for Suctioning
It seems obvious that there needs to be a reason for suctioning, but in some contexts, suctioning has become routine. For example, the World Health Organization now advises against the routine suctioning of newborns unless they show clear suctioning indications.
Some common reasons for suctioning a patient include preventing aspiration, clearing the airway of an anesthetized or ventilated patient, or intervening because of respiratory distress.
Once you identify the reason for suctioning, consider following the guidelines for managing that condition. Often, it is appropriate to perform other interventions as well. Asthma patients may need glucocorticoids, and those in anaphylaxis may need epinephrine.
Assess Patient Risk Factors
Before suctioning any patient, you must assess them for any potential risk factors, such as a difficult airway. Young children or elders with dementia may be uncooperative, requiring a slower, more compassionate approach. People with a history of upper-airway injuries may be more prone to airway injury and infection.
To assess for a difficult airway, look at three key areas:
- Anatomy: Certain anatomical factors, such as an anterior trachea, loose dental structures, an overbite, short and thick necks, or obesity, can increase the risk of a difficult airway.
- Trauma: Traumatic injuries to the mouth, face, and airway may make it more difficult to intubate. In some cases, the severity of these injuries does not become apparent until you attempt intubation.
- Medical issues: Pre-existing conditions, such as cleft palate or dysphagia, may interfere with intubation. Cognitive and mental health issues can also make intubation more difficult because the patient may be fearful, confused, or uncooperative. Do not force intubation, but rather work with the patient to gain trust and encourage cooperation.
Know When Suction May be Contraindicated
There are no absolute contraindications to suctioning a patient, particularly in a life-threatening emergency. But certain types of suctioning may be contraindicated for certain patients, and disregarding these patient suction guidelines may endanger your patient:
- Check for croup or epiglottitis. They are absolute contraindications to nasotracheal suctioning.
- Limit suctioning to 15 seconds or less to reduce the risk of hypoxia, and always pre-ventilate the patient before suctioning.
- Always gain the consent of the patient or caregiver prior to suctioning. Never suction a patient who does not consent.
- Use only closed suctioning in ventilated patients receiving large quantities of fraction of inspired oxygen (FiO2) or positive end expiratory pressure (PEEP).
- Ensure that suctioning does not increase the risk of infection by using only clean, sterile equipment that has been stored away from contaminants. Do not store dirty equipment with clean equipment. Wear appropriate protective gear and wash hands before touching a patient or the suction machine.
Develop Your Suction Strategy
Armed with the knowledge you need to treat the patient, pause for a moment to contemplate your suction strategy. Again, this might seem obvious, but when you suction patients every day, it is easy for things to become routine. Developing a clear strategy before treating each patient encourages you to think critically about what will work best for that particular patient.
In the era of COVID-19 and beyond, portable suction is key. It allows you to treat patients wherever they are, without treatment delays or transports that could expose others to infectious diseases. For help finding the right emergency portable suction for your agency, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.
