II. Equipment
- Suction Force (lowest vacuum pressure possible)
- Infants <80 mmHg
- Adults <150 mmHg (typically 80-120 mmHg)
- Suction Catheter
- Pediatric Magill forceps
- Used to directly remove foreign bodies in Trauma
III. Indications: Tracheal Suctioning in Ventilated Patients
- Only suction when needed (do not perform routinely on schedule)
- Improves respiratory function by removing airway secretions and aspirates
- Improves oxygenation
- Decreases Intrinsic PEEP (Auto-PEEP, incomplete expiration with risk of stacked breaths)
- Obtain diagnostic samples
IV. Technique: General
- Always monitor Heart Rate when suctioning infants and young children
- Risk of Bradycardia from Vagal Stimulation
- Do not suction while inserting catheter
- Occlude side of catheter only while withdrawing
V. Technique: Endotracheal Tube Suctioning
- Monitor cardiopulmonary status during suctioning
- Provide Procedural Anesthesia and analgesia
- Prevents pain, Agitation and Increased Intracranial Pressure with procedure
- Consider instilling Normal Saline into Endotracheal Tube prior to suctioning
- Included in some protocols (however does not decrease risk of Ventilator Associated Pneumonia)
- Gently insert suction only 1-2 cm beyond ET end (shallow suctioning)
- Avoid deep suctioning (past the ET Tube end until resistance met)
- Suction only while withdrawing catheter
- Rotate the catheter while withdrawing
- Do not suction for >15 seconds (5 seconds per attempt in children)
- Give 100% oxygen before and after suctioning (typically for 1 minute before and after)
- Decreases risk of Dysrhythmias
VI. Adverse Effects
-
Hypoxemia
- Airway obstruction
- Bronchospasm (transient)
- Pain and Agitation
- Increases Tachycardia and risks other Dysrhythmias
- Increases Intracranial Pressure
- Airway Trauma
- Mucosal injury and bleeding
- Infection
VII. References
- Warrington (2017) Crit Dec Emerg Med 31(3): 13