Suctioning a patient can maintain a patent airway, remove life-threatening airway obstructions, and prevent aspiration in vomiting or bleeding patients. But airway suctioning is not without risks, including changes in blood pressure. First responders must understand the link between suctioning and blood pressure to prevent both hypotensive and hypertensive states.
How Suctioning Affects Blood Pressure
Suctioning can trigger both low and high blood pressure. A study analyzed 79 mechanically ventilated patients and found that suction complications were common, affecting 47 patients–59.5%. Of those 47 patients, 14 experienced hypertension, and seven experienced hypotension.
The proper suctioning technique can lower, but not eliminate, the risk of complications. Hypoxia is a common trigger, so preoxygenating the patient is critical. The release of endogenous catecholamines due to the stress of suctioning, as well as sudden changes in intrathoracic pressure, may also be contributing factors. Implement the American Association for Respiratory Care Guidelines to greatly reduce the rate of suction-related adverse reactions, including changes in blood pressure.
Vagus Nerve Stimulation and Blood Pressure
Vagus nerve stimulation may also affect blood pressure. When suctioning stimulates the vagus nerve, patients may experience bradycardia, hypoxia, and hypotension. In patients already in a hypotensive state, the risk increases. This vasovagal reaction can trigger fainting, cardiac arrhythmias, and other complications.
Other Risks of Suctioning
Blood pressure changes can interact with other side effects of suctioning, so first responders must be mindful of all potential side effects. In addition to blood pressure swings, other common side effects include:
- Hypoxia: This can happen when suctioning does not fully disrupt a hypoxic state or when a provider suctions the patient for too long or does not preoxygenate the patient.
- Airway trauma: This often occurs in patients with difficult airways, especially if the provider cannot fully visualize the airway. Airway trauma can trigger other complications, such as an airway obstructed by blood.
- Bradycardia: This is usually due to vagus nerve stimulation, but may also happen as a result of hypoxia.
- Infection: Many indications for suctioning elevate a patient’s risk of infection. For example, aspiration exposes a patient to airway contaminants that can cause dangerous infections even after the immediate respiratory crisis is resolved. Suctioning itself may increase the risk of infection by injuring the airway, allowing dangerous pathogens to enter.
These risks are not a reason to delay or avoid suctioning, especially if a patient suffers a life-threatening airway obstruction. Instead, first responders must continuously monitor blood pressure and other vital signs and adjust treatment based on patient response.
The right equipment is key to promptly and effectively responding to patients in respiratory crises. First responders should ensure their kits are fully stocked with suction catheters in a range of sizes and that suction equipment is functioning and ready to be used. For help choosing the right portable suction machine for your agency, download our free e-book, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.
Editor's Note: This blog was originally published in July 2019. It has been re-published with additional up-to-date content.