Respiratory suctioning uses negative pressure to remove mucus, saliva, and other secretions from a patient’s upper or lower airway. This intervention is often necessary when an individual cannot effectively clear their own airway due to a compromised cough reflex, sedation, or a medical condition that leads to excessive secretion production. The primary objective is to maintain a clear and open airway, which improves gas exchange and prevents complications like infection or partial airway obstruction. It must be performed with precision and care to ensure patient safety and maximize effectiveness.
Identifying the Need for Suctioning
The decision to suction a patient should always be based on specific clinical indications rather than a fixed schedule. One of the most obvious signs is the visible presence of secretions, such as mucus or vomit, in the mouth or in an artificial airway. The patient may exhibit noisy breathing, often described as gurgling or rattling sounds, which suggests that secretions are pooling in the large airways and interfering with airflow.
The patient’s respiratory effort may also increase, characterized by a faster breathing rate, the use of accessory muscles in the neck, or flaring of the nostrils. Ineffective coughing is a significant indicator, as the patient cannot generate the force needed to move secretions. When a blockage becomes more severe, the patient’s oxygen saturation level, measured by a pulse oximeter, may drop below their baseline. Other signs of respiratory distress include restlessness or a change in the patient’s level of consciousness.
Necessary Equipment and Pre-Procedure Steps
Before beginning the procedure, all necessary equipment must be gathered and checked. The core equipment includes a functional suction machine, connecting tubing, and a collection canister to trap the aspirated secretions. The suction pressure must be correctly set to avoid damaging the delicate airway lining, with a common range for adults being 100 to 150 millimeters of mercury (mmHg) for wall suction.
The appropriate size of the suction catheter is determined by the patient’s size and the type of airway being suctioned. The catheter diameter should not exceed half the internal diameter of an artificial airway. For nasopharyngeal suctioning, a water-based lubricant is needed to ease the catheter’s passage and prevent trauma. Sterile gloves, as well as sterile water or saline for flushing the catheter and tubing post-procedure, should be readily available.
Once the equipment is prepared, the patient must be positioned correctly, typically in a semi-Fowler’s position with the head of the bed elevated 30 to 45 degrees, which helps maximize lung expansion. If the patient is receiving supplemental oxygen, they should be pre-oxygenated with 100% oxygen for 30 seconds to several minutes before the procedure. This step is performed to build an oxygen reserve and minimize the risk of a drop in blood oxygen levels during the suctioning process.
Performing the Suctioning Procedure
The specific technique varies based on the location of the secretions, whether it is shallow (oral/nasopharyngeal) or deep (tracheal) suctioning. For deep tracheal suctioning, maintaining a sterile field is necessary to prevent introducing bacteria into the lungs. The catheter is inserted without applying suction by keeping the thumb port open or uncovered.
The catheter is gently advanced until the patient coughs or a slight resistance is felt, indicating the tip has reached the carina or the end of an artificial airway. Once the catheter is in position, suction is applied by covering the thumb port, and the catheter is withdrawn slowly with a rotating motion. This rotation helps contact the entire surface of the airway wall, increasing secretion removal while minimizing mucosal trauma.
The application of suction must last no longer than 10 to 15 seconds per pass. Suctioning removes oxygen from the airway along with secretions, and prolonged passes increase the risk of hypoxia and a slowed heart rate. Between each suction pass, the patient must be allowed a recovery period of 30 seconds to one minute to rest and re-oxygenate before attempting another pass. After the secretions are cleared, the catheter and tubing should be flushed with sterile water or saline to clear any remaining mucus.
Recognizing and Managing Adverse Effects
Suctioning can cause adverse effects that require prompt recognition and management. A frequent complication is a drop in the patient’s oxygen saturation, or hypoxia, which occurs because the catheter temporarily blocks the airway or the suction removes oxygen. Bradycardia, a slowing of the heart rate, is caused by the catheter stimulating the vagus nerve in the trachea.
Forceful insertion or excessive suction pressure can lead to mucosal trauma, resulting in visible bleeding in the secretions. If adverse responses occur, such as a significant drop in oxygen saturation, a sustained heart rate decrease, or severe coughing spasms, the procedure must be immediately stopped. The first step is to hyperoxygenate the patient using the manual resuscitation bag or the ventilator to restore oxygen levels.
If the adverse effects persist, the healthcare provider should be notified immediately for further instruction and intervention. Individuals performing this procedure, particularly deep tracheal suctioning, should have received specialized training and must constantly monitor the patient’s heart rate and oxygen saturation before, during, and after the procedure.