A suction machine is a specialized medical device designed to remove secretions and foreign material from a patient’s airway, ensuring the passage of air remains open. This apparatus uses negative pressure to safely draw mucus, saliva, blood, or vomit out of the mouth, nose, or trachea. Maintaining a clear airway is the primary goal of this procedure, as obstruction can quickly compromise breathing and oxygen delivery to the body. The use of a suction machine requires precise technique and an understanding of the underlying physiology to be performed safely and effectively.
Equipment and Indications for Use
The basic setup of a medical suction machine includes several components that create the necessary vacuum. A collection canister gathers the aspirated fluids, preventing contamination. This canister connects via tubing to the power source and the pressure gauge, which allows the operator to monitor and control the level of negative pressure.
The choice of catheter depends on the location and type of secretions needing removal. A rigid Yankauer catheter, often shaped like a shepherd’s crook, is used for clearing large volumes of thick secretions from the oral cavity and the back of the throat. Because of its firmness, the Yankauer is unsuitable for deep or tracheal suctioning.
Flexible suction catheters, sometimes called whistle-tip catheters, are necessary for accessing the nasal, pharyngeal, or tracheal areas. These catheters are softer and more adaptable, allowing them to be inserted deeper into the airway without causing trauma. They are used when a patient cannot effectively clear their lower airway.
Suctioning is necessary when a patient exhibits signs of airway compromise. Indications include audible gurgling or rattling sounds during breathing, visible secretions in the mouth or nose, or the inability to cough forcefully enough to expel material. Other indicators involve changes in respiratory status, such as sudden respiratory distress or a drop in oxygen saturation levels. A loss of consciousness or a diminished gag reflex in the presence of secretions also signals an urgent need for mechanical airway clearance.
Pre-Procedure Setup and Preparation
Infection Control and Supplies
Preparation begins with stringent infection control measures to protect both the patient and the operator. Thorough hand hygiene is the first step in preventing pathogen transmission. This is followed by donning appropriate personal protective equipment (PPE), typically including gloves, and often a face shield or mask to guard against splashing. All necessary supplies must be gathered at the bedside, including the appropriate catheter, a sterile container of sterile water or saline for flushing, and disposable towels. For deep suctioning, maintaining a sterile field is important to prevent introducing bacteria into the lower airway.
Pressure Calibration
The suction machine requires calibration to ensure the pressure applied is effective yet safe. Suction pressure is measured in millimeters of mercury (mmHg) and must be set according to the patient’s age and size.
Recommended Pressure Settings
- Adults: 100 to 150 mmHg
- Children: 80 to 100 mmHg
- Neonates and Infants: 60 to 80 mmHg
Exceeding these ranges can cause trauma to the trachea, leading to swelling, bleeding, or hypoxemia. The pressure should be checked against the gauge while the tubing is briefly occluded to confirm accuracy.
Patient Positioning
Proper patient positioning must be completed before catheter insertion. For conscious patients, the semi-Fowler’s position (head of the bed elevated 30 to 45 degrees) optimizes the airway and allows gravity to assist with drainage. The patient’s head should be turned slightly to the side during oral suctioning. If the patient is unconscious or has a diminished gag reflex, a lateral or side-lying position is preferred to reduce the risk of aspiration.
Technique for Safe Suctioning
Oral Suctioning (Yankauer)
For oral suctioning, the rigid Yankauer device is used without measuring the depth, as the goal is simply to clear the mouth and oropharynx. The Yankauer is inserted gently along the side of the mouth to avoid stimulating the gag reflex. It is withdrawn with a continuous, sweeping motion to clear secretions.
Deep Suctioning (Flexible Catheter)
Deep suctioning of the pharynx or trachea requires the flexible catheter and a sterile approach. The operator first measures the insertion distance to prevent trauma to the carina, the point where the trachea divides. This distance is estimated by measuring from the patient’s earlobe to the tip of the nose, then down to the sternal notch.
The catheter is connected to the tubing and lubricated with sterile saline or water, if needed, before being inserted without applying any vacuum. Applying suction during insertion can cause oxygen depletion and mucosal damage. The patient should be encouraged to take deep breaths, or supplemental oxygen may be administered prior to the procedure to optimize saturation.
The catheter is advanced quickly and smoothly until resistance is met or the measured distance is reached. Once in position, the operator applies suction by covering the control port and begins to withdraw the catheter. Withdrawal must use a continuous, rotating, and circular motion to maximize secretion removal from the airway lining.
The vacuum must be applied only during the withdrawal phase. A single suction pass should not exceed 10 to 15 seconds, as prolonged suctioning rapidly depletes oxygen stores, leading to hypoxemia and cardiac disturbances. If the patient’s oxygen saturation drops or heart rate slows, the pass must be immediately terminated and supplemental oxygen administered. If more secretions remain, the patient must be allowed a recovery period of 20 to 30 seconds between passes to reoxygenate. The procedure is repeated until the airway sounds clear, but no more than three passes should be attempted in a single session.
Post-Procedure Care and Safety Warnings
Immediately following the procedure, the patient must be closely monitored for changes in condition and vital signs. The operator should assess the patient’s respiratory rate, breathing effort, skin color, and oxygen saturation levels to confirm improvement. A clear airway should result in easier breathing and increased oxygen saturation.
To prevent clogging, the operator must flush the catheter and connecting tubing with sterile water or saline solution. All used catheters and gloves must then be disposed of properly in designated biohazard containers to maintain infection control. The contents of the collection canister must be measured and disposed of according to facility protocol, and the canister itself cleaned and disinfected. Proper disposal is important for hygiene and for accurately documenting the patient’s fluid output.
Suctioning is an invasive procedure that can trigger adverse physiological responses. Potential complications include physical trauma to the airway lining from vigorous suctioning, resulting in bloody secretions and swelling. Excessive stimulation of the vagus nerve can also lead to a sudden drop in heart rate, known as bradycardia.
Any persistent signs of distress, such as continued severe shortness of breath, a sudden drop in heart rate, or the appearance of large amounts of bright red blood, require immediate medical attention. Recognizing these safety warnings ensures the patient receives timely and appropriate care.