II. 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. Infant and small child (<14 kg): 8 French (<70% ET Tube diameter)
      2. Child and small adult: 10 French (<50% ET Tube diameter)
      3. Adult: 12 French
  3. Pediatric Magill forceps
    1. Used to directly remove foreign bodies in Trauma

III. Indications: Tracheal Suctioning in Ventilated Patients

  1. Only suction when needed (do not perform routinely on schedule)
  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

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. Consider instilling Normal Saline into Endotracheal Tube prior to suctioning
    1. Included in some protocols (however does not decrease risk of Ventilator Associated Pneumonia)
  4. Gently insert suction only 1-2 cm beyond ET end (shallow suctioning)
    1. Avoid deep suctioning (past the ET Tube end until resistance met)
  5. Suction only while withdrawing catheter
    1. Rotate the catheter while withdrawing
  6. Do not suction for >15 seconds (5 seconds per attempt in children)
  7. Give 100% oxygen before and after suctioning (typically for 1 minute before and after)
    1. Decreases risk of Dysrhythmias

VI. Adverse Effects

  1. Hypoxemia
    1. Airway obstruction
    2. Bronchospasm (transient)
  2. Pain and Agitation
    1. Increases Tachycardia and risks other Dysrhythmias
    2. Increases Intracranial Pressure
  3. Airway Trauma
    1. Mucosal injury and bleeding
    2. Infection

VII. References

  1. Warrington (2017) Crit Dec Emerg Med 31(3): 13

Images: Related links to external sites (from Bing)

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Ontology: Tracheal aspiration (C1535528)

Concepts Therapeutic or Preventive Procedure (T061) , Diagnostic Procedure (T060)
SnomedCT 129112001, 69126007
Italian Aspirazione tracheale, Aspirazione della trachea
Dutch luchtpijp aspiratie, aspiratie luchtpijp
French Aspiration trachéale, Ponction transtrachéale
German tracheale Aspiration, Aspiration der Luftroehre
Japanese 気管吸引, キカンキュウイン
Czech Aspirace z trachey, Aspirace z trachei
English Aspiration tracheal, tracheal suction, aspiration trachea, suctioning tracheal, tracheal aspiration, suction tracheal, Tracheal suction, Aspiration from trachea (procedure), Aspiration from trachea, Aspiration of trachea, NOS, Tracheal aspiration, NOS, Tracheal aspiration
Hungarian Trachealis aspiratio, Trachea aspiratio
Spanish aspiración de la tráquea (procedimiento), aspiración de la tráquea, Aspiración traqueal
Portuguese Aspiração traqueal