Endotracheal tube (ET) suctioning removes accumulated secretions from the lungs and trachea of patients with an artificial airway, such as a ventilator tube. This intervention maintains a clear airway, which is necessary for effective gas exchange and proper ventilation. The ET tube bypasses the body’s natural defense mechanisms, like coughing and ciliary function, leading to secretion buildup.
Clearing the airway is essential for optimizing oxygenation and ensuring the patient can breathe without obstruction. However, endotracheal suctioning is an invasive procedure that carries significant risks, including potential trauma, hypoxemia, and infection. It should only be performed by skilled medical staff in a controlled healthcare setting.
Recognizing the Need for Endotracheal Suctioning
Suctioning should only be performed when a patient assessment reveals specific clinical signs of retained secretions. Indications include the audible or visible presence of secretions within the airway or the ET tube, often heard as coarse crackles or noisy breathing sounds upon auscultation.
Secretions obstructing the airway cause changes in the patient’s physiological status. Signs of respiratory distress include an increased work of breathing, persistent coughing, or a sudden decrease in oxygen saturation (SpO2). For mechanically ventilated patients, the ventilator may display changes, such as an increase in peak inspiratory pressure or a decrease in delivered tidal volume. A “sawtooth pattern” on the flow-volume loop waveform also suggests airflow interference. The decision to suction relies on a comprehensive evaluation of these findings, as routine suctioning increases the risk of complications.
Essential Equipment and System Setup
Preparation requires gathering specific equipment and setting up the suction system. The suction source, whether wall-mounted or portable, connects to a vacuum regulator to control negative pressure. For adults, the recommended pressure ranges from -100 to -150 mmHg, but the lowest effective pressure should be used to minimize trauma.
The correct suction catheter size depends on the ET tube diameter to prevent airway occlusion. The catheter’s outer diameter should be no more than half the inner diameter of the ET tube. Using an oversized catheter can rapidly remove air, leading to atelectasis (lung collapse).
Two main techniques are used: the open system and the closed system. The open system requires disconnecting the patient from the ventilator to insert a sterile catheter. The closed system uses an in-line catheter enclosed in a sterile sleeve, allowing the patient to remain connected to the ventilator. The closed system is preferred for patients dependent on high oxygen levels or positive end-expiratory pressure, as it helps maintain ventilation.
Step-by-Step Suctioning Procedure
The procedure begins with pre-oxygenation to safeguard the patient against temporary oxygen deprivation. The patient receives 100% oxygen or increased inspired oxygen (FiO2) for 30 to 60 seconds before catheter insertion. This hyperoxygenation builds an oxygen reserve and mitigates the risk of hypoxemia when the airway is temporarily occluded.
Sterile technique must be maintained using sterile gloves and handling the catheter only with the designated sterile hand. For an open system, the catheter is introduced after disconnecting the ventilator. In a closed system, the catheter is advanced through the valve port while the patient remains connected to the breathing circuit.
The catheter is advanced gently without applying suction to prevent mucosal injury. Insertion depth is limited to the pre-measured length of the ET tube, or no more than 1 centimeter beyond its tip (“shallow suctioning”). Advancing the catheter until resistance is met (“deep suctioning”) is avoided because it risks irritating the carina, where the trachea divides.
Suction is applied only while the catheter is being withdrawn. Applying suction during insertion or while stationary can cause trauma to the tracheal lining. The catheter is withdrawn using a continuous, rotating motion to effectively clear secretions from all sides of the tube lumen.
The total time for applying suction and withdrawing the catheter must be strictly limited to 10 to 15 seconds per pass. This time limit prevents severe desaturation and cardiac rhythm changes. After the pass, the patient is reconnected to the ventilator or manually ventilated to re-oxygenate and restore lung volume before a second pass is considered.
Assessment and Managing Adverse Reactions
Following the procedure, a thorough re-assessment of the patient’s respiratory status is immediately necessary. Lung sounds should be re-auscultated to confirm secretion removal and improved air entry. Vital signs, including heart rate, blood pressure, and oxygen saturation, must be closely monitored to ensure they return to baseline levels.
Adverse reactions are common due to physical stimulation and pressure changes. these include hypoxemia (a drop in blood oxygen levels) and cardiac arrhythmias, particularly bradycardia caused by vagus nerve stimulation. Blood pressure fluctuations, such as hypotension and hypertension, may also occur.
If an adverse reaction, like a significant drop in heart rate or oxygen saturation, occurs, the procedure must be stopped immediately. Corrective actions involve administering 100% oxygen and manually ventilating the patient until vital signs stabilize. Persistent complications or signs of mucosal damage, such as blood-tinged secretions, require immediate communication with the medical team.