--- title: The Importance of Negative Pressure for Endotracheal Suctioning description: Endotracheal suctioning requires adequate negative pressure from a reliable portable suction unit. Here's a review of the steps involved. image: https://blog.sscor.com/hubfs/Blog/rsz_gettyimages-469044650.png --- [![dark-header.jpg](https://blog.sscor.com/hs-fs/hub/212347/file-1107077240.jpg?width=940&name=file-1107077240.jpg "dark-header.jpg")](https://www.sscor.com/) ## **Thank you for visiting the SSCOR Blog.** Whether you're in a Hospital or EMS setting, this is the place for you. We'll share information on current industry news, tips, as well as the latest and greatest in SSCOR products. Our hope is that this blog is not only informative but a collaborative and open forum for you to share your thoughts on developing opportunities and challenges within your profession. Subscribe. Share your thoughts. Enjoy. -SSCOR Team   # [The Importance of Negative Pressure for Endotracheal Suctioning](https://blog.sscor.com/the-importance-of-negative-pressure-for-endotracheal-suctioning) Posted by [Sam D. Say](https://blog.sscor.com/author/sam-d-say) May 16, 2026 8:00:01 AM 4 min read - [![LinkedIn Social Icon](https://cdn2.hubspot.net/hub/142915/file-2628248555-png/images/icons/linkedin-small.png) ](https://blog.sscor.com/the-importance-of-negative-pressure-for-endotracheal-suctioning#) 0 - [![Facebook Social Icon](https://cdn2.hubspot.net/hub/142915/file-2623658044-png/images/icons/fb-small.png) ](https://blog.sscor.com/the-importance-of-negative-pressure-for-endotracheal-suctioning#) 0 ![The Importance of Negative Pressure for Endotracheal Suctioning](https://blog.sscor.com/hs-fs/hubfs/Blog/rsz_gettyimages-469044650.png?width=700&name=rsz_gettyimages-469044650.png "The Importance of Negative Pressure for Endotracheal Suctioning")  The patient has suffered a [gunshot wound to the chest](https://blog.sscor.com/respiratory-emergencies-recognizing-thoracic-trauma), and his blood pressure is dangerously low. You’ve covered the entry wound to prevent a sucking wound, but the patient is exhaling copious bloody froth. You successfully intubate the patient and are bagging, with good chest rise, but the bloody froth continues to interfere with air exchange. It’s time to suction the tube.     Suctioning the endotracheal tube is not something most rescuers do regularly. In most cases, placing an endotracheal tube ensures a patent airway with a reduced chance of aspiration. But in some situations, such as chest trauma or in patients with COPD, you can get mucus or blood invading the tube, necessitating suction. But suctioning the tube is more complicated than simply suctioning the oral or nasal cavity. For one thing, it requires adequate negative pressure from a [reliable portable suction unit](https://www.sscor.com/S-SCORT_III_suction_unit.html). It also requires different equipment and special techniques, and poses specific dangers that oral/nasal suctioning does not. So let’s review the steps involved in [suctioning the endotracheal tube](https://www.aacn.org/docs/Photos/Procedure-10-kmptp0mn.pdf). [![New: Free Emergency Aspirator Purchasing Guide for Hospitals](https://no-cache.hubspot.com/cta/default/212347/8b3f08ff-a209-4f08-b702-68de84bac45b.png)](https://cta-redirect.hubspot.com/cta/redirect/212347/8b3f08ff-a209-4f08-b702-68de84bac45b) ## **Avoid Hypoxia** Before you begin the procedure, it is important to preoxygenate your patient. One of the greatest dangers of suctioning is [hypoxia](https://blog.sscor.com/5-complications-of-suctioning-and-how-to-prevent-them). By preoxygenating your patient with 100 percent 02 and avoiding prolonged suctioning, you reduce the risk of hypoxia and can maintain adequate oxygen saturation–from 95% to 100%. ## **Properly Prep Your Equipment** Just as in intubating, you should [have all your equipment](https://blog.sscor.com/what-is-your-mobile-suction-device-inventory) laid out next to the patient. Proper readiness will ensure the procedure goes smoothly and swiftly. The last thing you want is to be fumbling in the airway bag, looking for lubricant. Lay everything out for an easy grab. ### **Next, Follow These Steps** - Maintain universal precautions. - Choose the appropriately sized flexible catheter: one that will extend beyond the tip of the endotracheal tube. - Use sterile technique when handling the catheter: remember, this is going INSIDE your patient! - Lubricate the suction catheter for ease of insertion. - Preoxygenate the patient for one to two minutes before suctioning. - Insert the catheter without suction, then slowly withdraw while applying suction and rotating the catheter. - Suction for no longer than 10 seconds to prevent hypoxia. - Monitor the patient closely for signs of hypoxia (cardiac arrhythmias, drop in 02 sat). - Reassess the airway, endotracheal tube, and lungs, and continue ventilating. - Repeat the suction procedure as necessary, but ensure reoxygenation between suction events. ## **Choosing the Right Suction Machine** Your [choice of a portable suction machine](https://blog.sscor.com/how-to-choose-the-right-portable-suction-unit) will obviously be made prior to your need to suction the endotracheal tube. But you should consider such events when deciding on the type of unit for your agency. Here are a few considerations: - **Power:** Choose a suction unit that offers adequate negative pressure, especially in the event of heavy mucus or clotted blood. - **Adjustable Pressure:** Certain situations require you to dial back the pressure, and having a [portable suction unit](https://www.sscor.com/S-SCORT_VX2_Option_portable_ems_suction.html) that enables this is a plus. These instances include - [Catheter Selection](https://blog.sscor.com/which-suction-catheter-tip-do-you-need)**:** Choose small, flexible catheters for endotracheal suctioning and a selection of hard-tipped catheters for oral and nasal suction. When responding to chronic patients, you may be called upon to suction a permanent airway, such as a stoma. Once again, you must employ a sterile technique to avoid introducing contaminants. Use the same procedure you would when suctioning the endotracheal tube, only when you insert the catheter, advance until the patient coughs. [![New: Ultimate Guide To Purchasing A Portable Emergency Suction Device](https://no-cache.hubspot.com/cta/default/212347/55c49bab-8acd-48d9-a274-d480a9b3e678.png)](https://cta-redirect.hubspot.com/cta/redirect/212347/55c49bab-8acd-48d9-a274-d480a9b3e678) ## **Potential Suctioning Complications** Endotracheal suctioning, like oral or nasal, poses complications for your patient. Here are some considerations:   - **Hypoxia** is always a risk during any type of suctioning - **Trauma** to the airway tissues - **Cardiac arrhythmias**—monitor the patient at all times - **Increased intracranial pressure**—avoid prolonged suctioning - **Inability to clear mucus plug**—repeat procedure until the airway is clear, but be sure to reoxygenate between suction attempts Suctioning the endotracheal tube can pose a challenge, but it can be safely performed in the field. Ensure adequate oxygenation of your patient, use sterile and proper technique, and have the right equipment on hand. Having a portable suction machine that provides adequate negative pressure is critical, and one that can provide adjustable pressure can ensure that special populations (elderly patients and the very young) are taken care of.   *Editor's Note: This blog was originally published in January, 2023. It has been re-published with additional up to date content.* [![New Call-to-action](https://no-cache.hubspot.com/cta/default/212347/9612b368-68bd-40fd-8df2-b49e908313ab.png)](https://cta-redirect.hubspot.com/cta/redirect/212347/9612b368-68bd-40fd-8df2-b49e908313ab) Topics: [Airway management](https://blog.sscor.com/topic/airway-management), [Medical Suction](https://blog.sscor.com/topic/medical-suction) ![Author Photo](https://blog.sscor.com/hs-fs/hubfs/SDS2-648378-edited.jpg?width=70&name=SDS2-648378-edited.jpg) ## AboutSam D. Say Sam D. Say is owner and CEO of SSCOR, Inc., a medical device manufacturer specializing in emergency battery operated portable suction devices for the hospital and pre-hospital settings. Mr. Say has been involved in developing product for healthcare providers for over 35 years. His passions include contributing to the management of the patient airway and providing solutions that save lives in difficult conditions. 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