The suction machine is a common hospital device used to clear the airway so a patient can breathe effectively. Its purpose is to maintain an open airway by mechanically removing secretions (mucus, saliva, or blood) that a patient cannot clear independently. This intervention is common for individuals with compromised respiratory function due to illness, sedation, or an artificial airway.
Medical Necessity for Suctioning
The decision to use a suction machine is guided by clinical signs indicating a patient’s inability to maintain a clear airway. Obvious indications include the visible presence of secretions or the audible sound of gurgling or rhonchi (a coarse rattling noise) upon breathing. When a patient’s natural cough reflex is impaired due to neurological conditions, sedation, or muscle weakness, mechanical assistance is required to prevent aspiration and airway blockage.
A drop in the patient’s oxygen saturation level is a serious indicator, signaling that secretions are causing hypoxia. Signs of increased work of breathing, such as rapid or labored breaths or the use of accessory muscles, also necessitate immediate assessment. Guidelines advocate for “as-needed” suctioning based on these clinical assessments, rather than performing the procedure routinely, to minimize irritation.
Preparing the Equipment and Environment
Proper preparation is necessary for safe and effective suctioning. The technical setup begins by ensuring the suction machine is functional, with the collection canister secure and the filter clean. A primary step involves setting the appropriate vacuum pressure, which is regulated to remove secretions without damaging the airway lining.
Recommended suction pressure ranges vary by age: 100 to 150 mmHg for adults, 100 to 120 mmHg for children, and 80 to 100 mmHg for infants. Selecting the correct catheter size is important, as a catheter that is too large can obstruct the airway and cause lung collapse. For artificial airways, the catheter’s outer diameter should be no more than half the inner diameter of the tube.
Once the equipment is ready, the provider must perform hand hygiene and don appropriate personal protective equipment (PPE), including gloves, mask, and face shield. The patient should be positioned, typically in a semi-Fowler’s position (head of the bed elevated), to facilitate comfort and access.
Execution of Airway Suctioning Techniques
Airway suctioning varies based on the target area: upper airway (oropharyngeal/nasopharyngeal) or lower airway (tracheal/endotracheal). Oropharyngeal suctioning, used for secretions in the mouth and upper throat, often uses a rigid Yankauer device. This is a non-sterile procedure where the tip is inserted along the side of the mouth to quickly remove secretions.
Nasopharyngeal and tracheal suctioning require a flexible, soft catheter and sterile technique to prevent introducing bacteria into the lungs. Before insertion, the patient is pre-oxygenated, often with 100% oxygen for 30 to 60 seconds, to prevent a drop in blood oxygen levels. The catheter is gently advanced without applying suction until resistance is met or the patient coughs.
Suction is applied only as the catheter is slowly withdrawn, using a gentle rotation to capture secretions from all sides. The entire pass must be limited to 10 to 15 seconds to minimize hypoxia and mucosal injury. Between passes, the catheter is cleared by suctioning sterile saline, and the patient rests for 30 seconds to one minute for reoxygenation.
For patients on a ventilator, a closed-suction system is preferred. This system allows the procedure to be performed without disconnecting the patient from the ventilator circuit, maintaining positive pressure and oxygenation.
Post-Procedure Assessment and Documentation
Immediately following suctioning, the provider must assess the patient’s response. Monitoring vital signs, especially heart rate, respiratory rate, and oxygen saturation, is an immediate concern. Any adverse reactions, such as a drop in oxygen levels or a change in heart rhythm, must be addressed and documented.
The effectiveness of suctioning is determined by assessing the patient’s respiratory status. This includes listening for clearer breath sounds and observing a reduction in the work of breathing. The absence of gurgling or rhonchi, combined with improved oxygen saturation, confirms the airway has been successfully cleared.
Meticulous documentation is required, detailing the time, the route used, and the patient’s tolerance. Documentation must also include the amount and character of the secretions removed (color, consistency, and odor). Used supplies are disposed of safely, and the collection canister is emptied and cleaned for the next use.