You are called to a residence in the middle of the night. A frantic father meets you at the door and ushers you upstairs to his son’s room, where you find a four-year-old boy, perched anxiously on the side of his bed. He is braced in a tripod position, his small arms rigidly fixed by his side as he leans forward, drooling into a puddle on the floor. The father noticed a fever last night when he put the boy to bed, but is astounded by the child’s rapid deterioration.
You jump into action, reassuring the boy as you set up your equipment. You instantly recognize the four D’s of epiglottitis:
- Dysphagia (difficulty swallowing)
- Dysphonia (difficulty speaking due to a physical disorder of the mouth)
Children with epiglottitis are at high risk for airway obstruction, so you automatically set up your portable suction unit.
But there’s a danger to suctioning this particular patient. So be sure to know when it’s appropriate to suction and when it is not.
Here’s a quick review.
Indications for Oral Suctioning
Effective suctioning is one of your most imperative procedures and can mean the difference between a patent and non-patent airway. And the situations in which your patient requires suctioning are fairly obvious. They include any form of airway obstruction, such as:
- Excessive secretions (mucus, phlegm, saliva)
- Blood, tissue, or teeth from traumatic injuries
- Vomiting (stay alert to prevent aspiration!)
Contraindications for Oral Suctioning
Just as the indications for oral suctioning are straightforward, so are the contraindications. When it comes to suctioning, the contraindications are easy to remember, for there are NONE!
There is absolutely no reason to withhold suctioning from a patient with an obstructed airway. If your patient lacks a patent airway, anything else you do for them will be for naught. This doesn’t mean that you can suction with abandon. Every life-saving procedure requires precision and caution, so here is a quick rundown of the possible complications of suctioning:
- Hypoxemia – the most critical to remember!
- Trauma – do not do more damage to an already sick patient!
- Infection – try to keep it clean when working around mucous membranes!
- Cardiac Arrhythmias – watch for signs of increased cardiac workload!
Although there are potential complications with oral suctioning, there are a few easy steps to take to avoid them. These steps include:
- Pre-oxygenating your patient for at least 30 seconds prior to suctioning to prevent hypoxemia
- Using caution and proper technique when suctioning to prevent damage to delicate oral tissues
- Preventing contamination by keeping your suction unit clean and disinfecting after EVERY use
- Carefully monitoring your patient while suctioning, preferably with cardiac monitor, capnography, blood pressure and pulse oximetry.
So let’s return to our young patient…. As a paramedic, you know one of the primary dangers with patients suffering from epiglottitis is swelling of the airway that can lead to complete obstruction, which is why you maintain a calm environment and keep oral invasive procedures to a minimum.
Children with epiglottitis can be very difficult to intubate, and you don’t want to do anything that would aggravate an already tenuous airway. So aggressive oral suctioning is something you should avoid. As long as the drooling doesn’t impede the airway, simply let the patient drool and keep them in a position of comfort. But keep that suction unit handy, for you never know when you might need it!
2011, Pollak, A., Ed.
Critical Care Transport, American College of Emergency Physicians, Jones and Bartlett.
Editor's Note: This blog was originally published on Sept 2016. It has since been updated with current content.