Airway suctioning is a procedure designed to remove secretions from the respiratory tract by applying negative pressure. This mechanical method is used when a person cannot effectively clear their own airway due to illness, injury, or a decreased level of consciousness. The primary goal is to maintain a clear airway, which improves breathing, supports effective oxygenation, and reduces the risk of secretions pooling and causing complications. While this guide provides general information for awareness and basic home care scenarios, it is not a substitute for professional medical training or instruction from a licensed healthcare practitioner.
Identifying the Need for Airway Clearance
Suctioning is indicated when a patient shows clear signs of retained secretions that they cannot manage with a cough. An immediate need for clearance can be identified by audible signs, such as a gurgling, rattling, or coarse sound during breathing, which suggests secretions are present in the upper airway. Visible secretions in the mouth or nose are also a direct indicator that removal is necessary.
The patient’s respiratory status should be monitored for signs of distress, including labored breathing, an increased respiratory rate, or a decrease in oxygen saturation levels. Other signs that can signal the need for suctioning include drooling, a weak or ineffective cough, or an altered mental status. Suctioning should only be performed when indicated by these assessments, as routine, unnecessary suctioning can cause harm.
Suctioning should be approached with caution, or may be contraindicated, in certain circumstances. Conditions such as severe facial or head trauma, active bleeding disorders, or recent surgery to the head, neck, or throat may require a modified procedure or alternative interventions. A thorough assessment of the patient’s condition must always occur before proceeding, including noting any pre-existing heart or lung conditions.
Preparing the Necessary Equipment
Before beginning the procedure, all necessary equipment must be gathered and checked to ensure safety and efficiency. The core of the setup is the suction machine, which provides the negative pressure. This can be a portable unit or a wall-mounted system. The machine must be connected to a collection canister, which traps the removed secretions, and the connecting tubing.
The type of catheter used depends on the location of the secretions. A rigid, firm-tipped Yankauer catheter is typically used for oral or oropharyngeal suctioning to clear secretions from the mouth and throat. For nasal or deeper nasopharyngeal access, a long, flexible suction catheter is used.
Setting the correct suction pressure prevents mucosal damage and ensures effective removal. For adults, the recommended pressure is 100 to 150 mmHg on a wall unit, or 10 to 15 mmHg on portable units. For children, the pressure should be lower, between 80 and 120 mmHg. The pressure gauge must be checked by temporarily occluding the tubing end to confirm the setting before insertion.
Gloves, a mask, and eye protection (PPE) should be worn to prevent exposure to body fluids and potential infection. Sterile water or saline is needed to rinse the catheter and clear the tubing between passes. Ensure all connections are airtight and the suction is functioning correctly before approaching the patient.
Step-by-Step Oral and Nasal Suctioning
The first step is to ensure the patient is in a safe and comfortable position to facilitate secretion removal. The semi-Fowler’s position, sitting upright, is generally recommended to reduce aspiration risk. If the patient is unconscious, position them on their side to prevent the tongue from blocking the airway.
Perform hand hygiene and apply non-sterile gloves, as oral and nasal suctioning are considered a clean, not sterile, technique. Attach the catheter to the tubing and test the suction by drawing a small amount of water or saline through it. This step lubricates the catheter tip, making insertion smoother and reducing the risk of mucosal irritation.
For oral suctioning, gently insert the Yankauer catheter into the mouth, sweeping along the gum line toward the pharynx. Suction is applied only by covering the thumb hole on the catheter while withdrawing it, not during insertion. The catheter should be kept moving to prevent it from suctioning to the delicate tissue of the oral mucosa.
For nasal suctioning, the flexible catheter’s insertion depth must be measured to prevent deep insertion that could cause trauma. Estimate the depth by measuring the distance from the tip of the nose to the patient’s earlobe or the angle of the jaw. Gently insert the catheter into the nostril without applying suction, aiming toward the back of the throat.
Once inserted, apply suction by covering the control vent, and slowly withdraw the catheter. Limit the duration of each suction pass to 10 to 15 seconds. For pediatric patients, the duration should be shorter, 5 to 10 seconds.
After the pass, clear the tubing by suctioning sterile water. Allow the patient to rest for 30 seconds to one minute to recover. Reassess the patient’s breathing status and repeat the procedure if secretions remain, alternating nostrils for nasal passes if possible. The color, amount, and consistency of the removed secretions should be documented after the procedure is complete.
Safety Measures and Recognizing Adverse Effects
A primary safety concern is the risk of hypoxia, which is a drop in the body’s oxygen levels. This risk is heightened because the suction process removes air from the lungs along with secretions. To mitigate this, suctioning must never exceed the recommended time limit of 10 to 15 seconds per pass.
Suctioning can stimulate the vagus nerve, causing a sudden slowing of the heart rate (bradycardia). Limiting the depth of catheter insertion and the duration of suction helps minimize this risk.
Mucosal trauma can be prevented by using the correct, gentle pressure setting, lubricating the catheter, and applying suction only while withdrawing the device. Visible blood streaks in the removed secretions can be a sign of mucosal injury.
If the patient exhibits sudden distress, the procedure must be stopped immediately. Signs of distress include:
- A change in skin color (becoming blue or pale)
- Severe coughing
- Agitation
- A significant drop in oxygen saturation readings
If these adverse reactions persist, or if the patient’s breathing does not improve, professional medical help should be sought without delay.