Airway Suction

Aka: Airway Suction, Tracheal Suction, Tracheobronchial Suction, Endotracheal Tube Suction

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II. Indications: Tracheal Suctioning in Ventilated Patients

  1. Only suction when needed (do not perform routinely on schedule)
    1. Significant secretions
    2. Worsening oxygenation
  2. Improves respiratory function by removing airway secretions and aspirates
    1. Improves oxygenation
    2. Decreases Intrinsic PEEP (Auto-PEEP, incomplete expiration with risk of stacked breaths)
  3. Obtain diagnostic samples

III. Equipment

  1. Suction Force (lowest vacuum pressure possible)
    1. Infants <80 mmHg
    2. Adults <150 mmHg (typically 80-120 mmHg)
  2. Suction Catheter
    1. Rigid Wide-bore Yankauer catheter (Tonsil tips)
    2. Sizing
      1. Size of suction catheter (in French): 2 * (size of ET or Tracheostomy tube - 2)
      2. Infant and small child (<14 kg): 8 French (<70% ET Tube diameter)
      3. Child and small adult: 10 French (<50% ET Tube diameter)
      4. Adult: 12 French
  3. Pediatric Magill forceps
    1. Used to directly remove foreign bodies in Trauma

IV. Technique: General

  1. Always monitor Heart Rate when suctioning infants and young children
    1. Risk of Bradycardia from Vagal Stimulation
  2. Do not suction while inserting catheter
    1. Occlude side of catheter only while withdrawing

V. Technique: Endotracheal Tube Suctioning

  1. Monitor cardiopulmonary status during suctioning
  2. Provide Procedural Anesthesia and analgesia
    1. Prevents pain, Agitation and Increased Intracranial Pressure with procedure
  3. Preoxygenate
    1. Give FIO2100% oxygen before and after suctioning (typically for 1 minute before and after)
    2. Decreases risk of Dysrhythmias
  4. Consider instilling Normal Saline into Endotracheal Tube prior to suctioning
    1. Included in some protocols (however does not decrease risk of Ventilator Associated Pneumonia)
  5. Gently insert suction only 1-2 cm beyond ET end (shallow suctioning)
    1. Avoid deep suctioning (past the ET Tube end until resistance met)
  6. Suction only while withdrawing catheter
    1. Rotate the catheter while starting to withdraw catheter
  7. Do not suction for >15 seconds (5 seconds per attempt in children)

VI. Adverse Effects

  1. Hypoxemia
    1. Airway obstruction
    2. Bronchospasm (transient)
  2. Vagal Response (esp. neonates)
    1. Bradycardia
    2. Hypotension
  3. Pain and Agitation
    1. Increases Tachycardia and risks other Dysrhythmias
    2. Increases Intracranial Pressure
  4. Airway Trauma
    1. Mucosal injury and bleeding
    2. Infection
  5. Miscellaneous Serious Complications
    1. May provoke Cardiac Dysrhythmias
    2. Spontaneous Intracranial Hemorrhage (neonates)

VII. References

  1. Warrington (2017) Crit Dec Emerg Med 31(3): 13
  2. Warrington (2025) Crit Dec Emerg Med 39(5): 23-4

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