Sooner or later, almost every medical provider sees a patient who needs nasal suctioning. This mainstay of emergency medicine saves lives, shortens hospital stays, and reduces medical complications. If you work in EMS, you may suction patients daily. For other providers, suctioning is a rarity. No matter where you work, a basic familiarity with the procedures for nasal suctioning is critical to quality patient care.
Types of Suctioning
Nasal suctioning falls into three broad categories.
The most invasive form of suctioning, nasotracheal suctioning can help critical patients maintain a patent airway. It requires the longest catheter length, measuring from the top of the nose to the earlobe and then down toward the thyroid cartilage. The catheter should be 20-24 centimeters for adults, 14-20 centimeters for older children, and 8-14 centimeters for young children and infants.
Nasopharyngeal suctioning suctions the nose and the throat. It can help secure an airway for intubation, and may also be used in surgical settings. It requires a slightly shorter catheter than nasotracheal suctioning does. Measure from the tip of the nose to the base of the earlobe and choose a catheter of about 16 centimeters for adults, 8-12 centimeters for older children, and 4-8 centimeters for infants and young children.
The least invasive form of suctioning, nasal suctioning is primarily used for neonates who cannot clear their airway. Doctors once routinely suctioned newborns at birth, but most guides now recommend suctioning only if the baby is not born through clear amniotic fluid, or cannot clear their own airway. Parents may perform airway suctioning at home with bulb suction devices when their babies are sick or congested. Though nasal suctioning does not require any special skills, effective suctioning is key. The wrong equipment or technique increases the risk of traumatic injuries.
When to Suction
The indications for suctioning include:
- Aspiration or a high risk of aspiration
- A baby who is born in meconium or who cannot clear their airway
- Respiratory distress in a neonate
- Audible respiratory sounds coupled with an inability to clear the airway
- Vomiting during surgery or while unconscious
- A fully or partially obstructed airway
- Airway trauma that causes an actively bleeding airway
As with all medical procedures, suctioning carries some risks. You can reduce the risk by:
- Oxygenating the patient before invasive suctioning procedures. Hypoxia is a common suctioning side effect.
- Minimizing suction time. Never suction a patient for longer than 10-15 seconds.
- Working slowly, and ensuring you can see the airway. Airway trauma secondary to suctioning increases the risk of infection and other complications.
- Suctioning only when medically necessary, not as a routine aspect of daily practice.
- Offering reassurance to the patient during suctioning. Suctioning can be traumatic and frightening, particularly to children and people with mental health or cognitive impairments.
- Practicing diligent hygiene to avoid spreading pathogens to patients. The people who require suctioning are often the most vulnerable to serious infections, including COVID-19.
The Right Equipment Matters
No matter whom you treat or which equipment you use, consistent, reliable suction can save lives, reduce caregiver burnout, and decrease patient morbidity. Wall-mounted suction is a core piece of medical equipment, but it’s inflexible. You need other alternatives that allow you to suction patients in parking lots and waiting rooms—in homes and birthing suites. Invest in quality suction and your patients will be more likely to thrive. For help selecting the right suction machine for your organization, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.