Although many first responders express reservations about airway suctioning, it is a potentially life-saving procedure that when performed correctly has a low risk of complications. With both cold and flu season and allergies causing year-round respiratory issues, it is always a great time for first responders to brush up on their airway management skills. Continuing education classes and regular drills can prepare you to manage even difficult airways. It’s equally important to be mindful of the main complications of suctioning. Awareness of these potential complications can guide your technique while encouraging your team to remain vigilant and diligent.
Hypoxia
Hypoxia during suctioning can happen in a few ways. First, if suctioning is ineffective, then it may not disrupt hypoxia. It’s important to ensure you’re utilizing an effective technique, and that you never suction longer than a few seconds—most guidelines recommend less than 15 seconds.
In some patients, suctioning may also stimulate the vagus nerve, triggering hypoxia and bradycardia.
Suctioning itself can also cause hypoxia because the suction tube itself can be a form of airway obstruction. If the patient is not pre-oxygenated, the risk of hypoxia is high, so preoxygenate the patient and promptly remove the tube. If you must suction the patient multiple times, oxygenate them before each suctioning procedure.
Airway Trauma
Physical trauma to the airway is a common suctioning injury, especially in patients with difficult or swollen airways. Weaker muscles and other physiological changes among geriatric populations make them more vulnerable to airway trauma, so it’s important to proceed slowly and ensure you can visualize the airway.
Any trauma can be painful and upsetting. Severe trauma may complicate existing injuries or even become life-threatening.
Psychological Trauma
Humans naturally resist having anything inserted through their noses or down their throats. This resistance helps prevent choking and other injuries, but it can also make suctioning more difficult. Patients may experience fear and frustration before, during, or after suctioning.
In children, people with dementia, people with cognitive disabilities, and any other group that cannot fully understand the need for suctioning, the trauma can be overwhelming. It’s important to carefully explain the procedure and avoid using force or restraint unless doing so is the only way to save a patient’s life.
Pain
Suctioning can be painful, especially in a person with a pre-existing airway injury. A careful and diligent technique reduces the risk of pain. Talk to the patient ahead of time to explain the procedure and let them know that suctioning only takes a few seconds.
Bradycardia
Suctioning stimulates the vagus nerve. In some patients, this can trigger episodes of bradycardia, as well as related symptoms such as fainting or lightheadedness. Ask about a history of cardiovascular health issues because bradycardia can be more dangerous in patients with heart health issues.
Infection
Suctioning can introduce microbes into the airway. This is more likely when first responders reuse equipment, do not properly sterilize reusable equipment, or do not wear protective gear.
When suctioning injures the airway, the risk of infection increases. Wounds in the airway open the body to dangerous microbes, especially when a patient already has an infection or has aspirated. Be sure your portable suction unit is clean.
Ineffective Suctioning
Ineffective suctioning can be stressful and painful for patients, and provide no quantifiable benefit. First responders must ensure that their suctioning technique is sound and that they use the right equipment. Portable emergency suction units can help with this goal because they allow first responders to go wherever the patient is and not undertake the risk of transporting a patient who is already in respiratory distress.
The right suction unit is versatile and delivers effective and reliable suctioning with a long battery life. For help selecting the right emergency portable suction device for your agency, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.
Editor's Note: This blog was originally published in July, 2022. It has been re-published with additional up to date content.
