3. Don goggles and mask or face shield.
Potential for contamination
4. Turn on suction apparatus and set vacuum
regulator to appropriate negative pressure. Recommend 80-120
mmHg; adjust lower for children and the elderly. Significant
hypoxia and damage to tracheal mucosa can result from
excessive negative pressure.
5. Prepares suction apparatus. Secure one
end of connecting tube to suction machine, and place other
end in a convenient location within reach.
6. Use in-line suction catheter or open
sterile package (catheter size not exceeding one-half the
inner diameter of the airway) on a clean surface, using the
inside of the wrapping as a sterile field.
7. Prepares catheter and prevents
transmission of microorganisms. Catheter exceeding one-half
the diameter increases possibility of suction-induced hypoxia
8. Prepare catheter flush solution.With in-line
catheter use sterile saline bullets to flush catheter. With
regular suctioning set up sterile solution container and
being careful not to touch the inside of the container, fill
with enough sterile saline or water to flush catheter.
9. With in-line suction catheter use clean
gloves. With regular suctioning, done sterile gloves.
Maintain sterility. Universal precautions. In regular
suctioning the dominant hand must remain sterile throughout
10. Pick up suction catheter, being careful
to avoid touching nonsterile surfaces. With nondominant hand,
pick up connecting tubing. Secure suction catheter to
connecting tubing. Maintains catheter sterility. Connects
suction catheter and connecting tubing
11. Ensures equipment function. Check
equipment for proper functioning by suctioning a small amount
of sterile saline from the container. (skip this step in in-line
12. Remove or open oxygen or humidity
device to the patient with nondominant hand. (skip this step
with in-line suctioning). Opens artificial airway for
catheter entrance. Have second person assist when indicated
to avoid unintentional extubation.
13. Replace O2 delivery device or reconnect
patient to the ventilator. Hyperoxygenate and hyperventilate
via 3 breaths by giving patient additional manual breaths on
the ventilator before suctioning. Hyperoxygenation with 100%
O2 is used to offset hypoxemia during interrupted oxygenation
and ventilation. Preoxygenation offsets volume and O2 loss
with suctioning. Patients with PEEP should be suctioned
through an adapter on the closed suction system.
14. Without applying suction, gently but
quickly insert catheter with dominant hand during inspiration
until resistance is met; then pull back 1-2 cm. Catheter is
now in tracheobronchial tree. Application of suction pressure
upon insertion increases hypoxia and results in damage to the
15. Apply intermittent suction by placing
and releasing dominant thumb over the control vent of the
catheter. Rotate the catheter between the dominant thumb and
forefinger as you slowly withdraw the catheter. With in-line
suction, apply continuous suction by depressing suction valve
and pull catheter straight back. Time should not exceed 10-15
seconds. Intermittent suction and catheter rotation prevent
tracheal mucosa when using regular suctioning methods. Unable
to rotate with closed- suction method.
16. Replace oxygen delivery device.
Hyperoxygenate between passes of catheter and following
suctioning procedure. Replenishes O2. Recovery to base PaO2
takes 1 to 5 minutes. Reduces incidence of hypoxemia and
17. Rinse catheter and connecting tubing
with normal saline until clear. Removes catheter secretions.
18. Monitor patients cardiopulmonary
status during and between suction passes. Observe for signs
of hypoxemia, e.g. dysrhythmias, cyanosis, anxiety,
bronchospasms, and changes in mental status.
19. Once the lower airway has been
adequately cleared of secretions, perform nasal and oral
pharyngeal or upper airway suctioning. Removes upper airway
secretions. The catheter is contaminated after nasal and oral
pharyngeal suctioning and should not be reinserted into the
endotracheal or tracheostomy tube.
20. Upon completion of upper airway
suctioning, wrap catheter around dominant hand. Pull glove
off inside out. Catheter will remain in glove. Pull off other
glove in same fashion and discard. Turn off suction device.
Reduces transmission of microorganisms.
21. Reposition patient. Supports
ventilatory effort; promotes comfort; communicates caring
22. Reassess patients respiratory
status. Indicates patients response to suctioning
23. Dispose of suction liners and
connecting tubing, sterile saline solution every 24 hours and
set up new system. Decreases incidence of organism
colonization and subsequent pulmonary contamination.
1. Minimize suctioned-induced atelectasis and hypoxemia:
a. Avoid using catheters larger than one-half the
diameter of the airway.
b. Administer one or more postsuctioning
hyperinflations, using manual or sigh breaths on the
ventilator or ambu bag if not ventilated.
2. Maintain rigorous sterile technique when suctioning the
intubated patient. Impaired pulmonary defense systems and
invasive instrumentation of the pulmonary tract predisposes
these patients to colonization and infection. Never use same
catheter to suction the trachea after it has been used in the
nose or the mouth.
3. Limit the frequency of suctioning and avoid, as much as
possible, catheter impaction in the bronchial tree when the
patient is anticoagulated or when hemorrhage from suction-induced
trauma is evident.
4. Minimize the frequency and duration of suctioning when
patient is on positive end-expiratory pressure (PEEP) greater
than 5 cm or continuous positive airway pressure (CPAP).
Small suctioning-induced changes may have profound effects on
these marginally oxygenated patients.
5. Maintain awareness of the limitations of ET/tracheal
suctioning. Maneuvers and catheter design have been proposed
to increase the likelihood of passage into the left bronchus;
however, these have been shown to be of limited success.
Because the left main stem bronchus emerges from the trachea
at the 45-degree angle from the vertical, suction catheters
are almost inevitable passed into the right bronchus (when
they pass the carina) despite head-turning, etc.
6. The use of saline installations for loosening
secretions has been controversial and recent research shows
that in fact it is detrimental and poses a greater risk of
pneumonia for the patient.