Endotracheal suctioning is a medical procedure involving the mechanical removal of secretions from a patient’s airway through an artificial tube, such as an endotracheal tube (ETT). This process uses a suction catheter connected to a suction machine to apply negative pressure, effectively clearing excess or abnormal secretions from the trachea and main-stem bronchi. The procedure is a routine aspect of care for individuals unable to clear their airways independently, helping to maintain an open air passage.
Why Endotracheal Suction is Essential
Endotracheal suctioning maintains a clear airway for patients with artificial airways, which bypass the body’s natural defense mechanisms like the cough reflex and mucociliary escalator. The presence of an ETT can impair the body’s ability to mobilize and expel secretions, potentially increasing mucus production. Accumulation of these secretions can lead to airway obstruction, poor oxygen exchange, and an imbalance in ventilation and perfusion, increasing the risk of respiratory complications.
This procedure helps remove accumulated mucus, preventing conditions such as hypoxemia, hypercapnia, atelectasis (lung collapse), and infection, including ventilator-associated pneumonia (VAP). By clearing the airways, suctioning optimizes oxygenation and ventilation. Patients who require this procedure include those on mechanical ventilation, individuals with compromised cough reflexes due to sedation or neurological deficits, and those with neuromuscular diseases that impair effective airway clearance. Visible or audible secretions, coarse breath sounds, increased work of breathing, and decreased oxygen saturation indicate the need for suctioning.
Overview of the Suctioning Process
Endotracheal suctioning involves a series of steps. The basic equipment includes a suction catheter, a suction machine, and personal protective equipment (PPE). A sterile technique is followed to minimize the risk of infections.
Before the procedure, pre-oxygenation with 100% oxygen is performed to help prevent a decrease in arterial oxygen levels during suctioning. The suction catheter is then inserted into the endotracheal tube without applying suction until resistance is met, or to a pre-determined length. Suction pressure is then applied, between 80-120 mmHg for adults, while the catheter is withdrawn. The duration of suction application is kept short, around 15 seconds, to minimize adverse effects.
There are two approaches to endotracheal suctioning: open and closed suctioning. In the open suction technique, the patient is temporarily disconnected from the ventilator or oxygen source, and a catheter is inserted into the tube. The closed suction system, in contrast, uses a suction catheter connected to the ventilator circuit, allowing suctioning to occur without disconnecting the patient from the ventilator. Closed suctioning is preferred for mechanically ventilated patients as it can reduce the risk of hypoxemia, maintain lung volume, and lower the risk of ventilator-associated pneumonia by minimizing circuit disconnection.
Managing Potential Risks and Complications
Endotracheal suctioning, while beneficial, carries risks. One concern is hypoxemia, a decrease in blood oxygen levels, which can occur during the procedure due to the temporary interruption of ventilation or removal of oxygen from the airway. This risk is minimized through pre-oxygenation with 100% oxygen before suctioning and limiting the duration of each suction pass.
Airway trauma, such as bleeding or mucosal injury to the trachea, is another complication. This can result from excessive suction pressure, improper catheter size, or deep suctioning that extends beyond the ETT tip. To mitigate this, the suction catheter size should not exceed one-half the diameter of the ETT, and deep suctioning, where the catheter is advanced until resistance is met, is not recommended as it can cause mucosal damage, tracheal perforation, or hemorrhage.
Cardiac arrhythmias, including bradycardia (slow heart rate) or tachycardia (fast heart rate), can also occur due to vagal nerve stimulation during the procedure. Monitoring of the patient’s vital signs, including heart rate and rhythm, before, during, and after suctioning, helps in early detection and management of such events. Infection, particularly ventilator-associated pneumonia, is a risk given the artificial airway bypasses natural defenses. Adherence to sterile technique and proper hand hygiene are implemented to reduce this risk. Patient assessment, proper technique, and continuous monitoring of oxygen saturation and vital signs ensure patient safety and minimize complications during endotracheal suctioning.