Airway management is a priority for both nurses and first responders. A critical component of this is effective airway clearance techniques to manage oropharyngeal secretions. Whether in the field or a hospital, the how and when of oral suctioning must be mastered to ensure the patient's patent airway.
Though oral suctioning can be lifesaving, improper use and technique may cause serious complications and worsen a patient's condition. Employing correct and rapid techniques and using quality equipment is vital in the airway management of patients in both prehospital and hospital settings.
When to Suction
Effective airway management hinges on recognizing the risk or presence of airway obstructions. Fortunately, the indications for oral suctioning are pretty obvious—copious secretions, blood, vomit, or tissue from trauma can be seen and are usually very apparent in the patient's mouth. The oral airway obstruction can usually be swiftly removed using a portable suction unit.
The SALAD Technique for Contaminated Airways
As with so many other emergency care concepts, proper technique and use of quality equipment are necessary to ensure quality patient outcomes. Contamination of the airways and the resulting aspiration of contaminants is often the cause of a patient’s death following an obstructed airway emergency—not hypoxia, as many would assume.
Using the correct device is the first step in removing airway obstruction, but it is ineffective without the proper technique. Suction-assisted laryngoscopy and airway decontamination (SALAD) is a novel technique pioneered by anesthesiologist Dr. James DuCanto. This technique calls for continuous suction provided by a specially designed large bore catheter with proper anatomic shape in the upper airway, continuously removing contaminants. At the same time, the practitioner orally intubates the patient, securing the patency of the patient’s airway. This not only provides a clearer view of the vocal cords during intubation but it also effectively removes material that would otherwise enter the lower airway.
Like all patient care skills, the SALAD technique can be mastered with practice. See Dr. DuCanto explain this technique further.
Choose the Right Equipment for Better Patient Care
Without the right equipment for oral suctioning, knowing the when and how of the procedure is not enough. Various settings have different needs for suction equipment. What is universal is the need for equipment that is accessible, reliable, and easy to use. Having the right suction equipment not only prevents life-threatening emergencies, it improves overall patient outcomes and allows practitioners to focus on what they do best—caring for the patient.
Remember also that under the Emergency Medical Treatment and Labor Act (EMTALA), hospitals must be able to provide for patients within a 250-yard radius of their campus. The equipment they choose must be rugged and portable to meet this need—especially important for prehospital care providers.
Best Practices
Best practices for suction equipment extend beyond the product itself. Care providers need to be diligent about the maintenance and storage of the suction unit and equipment.
Daily maintenance is important for keeping all equipment in working order. In addition to sanitizing the suction unit after every use, care providers must be diligent about storing all parts of the unit together.
Imagine needing the suction unit during an emergency and not having the disposables or attachments you need to use the machine–not only is this frustrating, but it may be life-threatening to the patient. Be sure to always store suction units with these disposables and attachments, and regularly check your supplies to make sure you have a variety of catheter sizes needed for the population you treat.
Remember that best practices surrounding oral suctioning and airway maintenance don’t just involve recognition of obstruction and technique; portable, rugged, and reliable equipment is essential to be able to provide the patient with the life-saving airway management they require.
Editor's Note: This blog was originally published in February, 2019. It has been re-published with additional up to date content.
