An endotracheal tube is a flexible, hollow plastic tube inserted into the trachea (windpipe), usually through the mouth or nose. It provides a clear passageway for air, connecting to a mechanical ventilator that assists or controls breathing. The tube delivers oxygen and inhaled gases to the lungs while protecting them from foreign materials.
Endotracheal suctioning removes mucus and other secretions that accumulate within the breathing tube and airway. It is routinely performed for individuals with an endotracheal tube who cannot effectively clear their own respiratory secretions, such as by coughing. This procedure maintains respiratory function.
Purpose of Endotracheal Suctioning
An endotracheal tube bypasses natural airway defense mechanisms, including effective coughing and cilia function. This increases airway secretions and decreases the ability to clear them, making suctioning a regular requirement.
Removing accumulated secretions helps maintain an open airway, necessary for effective breathing and gas exchange. Clearing blockages directly improves oxygenation and ventilation. Without regular suctioning, thick secretions can build up, potentially obstructing the airway and increasing resistance.
Endotracheal suctioning also helps reduce the risk of serious lung infections. Secretion buildup can create an environment conducive to bacterial growth, increasing the likelihood of ventilator-associated pneumonia (VAP). Regular removal contributes to better lung hygiene and helps prevent complications.
The Suctioning Procedure
Endotracheal suctioning removes secretions using a thin, flexible catheter connected to a suction machine. Healthcare professionals use two main techniques: open-suction or closed-suction. The open technique requires temporarily disconnecting the patient from the ventilator to insert a single-use sterile catheter directly into the endotracheal tube.
In contrast, the closed-suction technique (in-line suctioning) uses a multi-use catheter encased in a sterile plastic sleeve connected to the ventilator circuit. This allows suctioning without disconnecting the patient, which helps maintain lung volume and positive end-expiratory pressure (PEEP). The closed system is often preferred in certain patient populations, such as neonates, due to less physiological disruption.
General steps include preparing sterile equipment and ensuring proper suction pressure settings, which vary by patient age (e.g., 100-150 mmHg for adults, 80-100 mmHg for infants). Patients are often given increased oxygen (hyperoxygenation) beforehand to minimize a temporary drop in oxygen levels.
A sterile suction catheter, sized less than half the endotracheal tube’s internal diameter, is gently inserted to a pre-determined length to avoid tracheal lining trauma. Suction is applied for a short duration, typically under 15 seconds, while the catheter is steadily withdrawn. The patient then recovers, and their respiratory status is re-evaluated.
Potential Complications and Monitoring
Endotracheal suctioning carries potential risks. A temporary drop in oxygen levels (hypoxia or hypoxemia) can occur due to interrupted ventilation or oxygen removal. Patients are preoxygenated, and oxygen saturation is continuously monitored. Suctioning duration is strictly limited, usually to 10-15 seconds per pass, to minimize time the airway is without full ventilation.
Trauma to the tracheal lining is another concern, potentially leading to bleeding or mucosal injury. Healthcare professionals mitigate this by using appropriately sized catheters that do not occlude more than half the endotracheal tube’s diameter and by applying suction only while withdrawing. Cardiac arrhythmias, such as bradycardia or tachycardia, can also occur due to vagal nerve stimulation or hypoxia. Continuous monitoring of heart rate and rhythm allows the medical team to promptly identify and address changes.
Infection, including ventilator-associated pneumonia (VAP), remains a concern, as the procedure can potentially introduce bacteria into the lower airway. To prevent this, strict sterile technique is followed during open suctioning, and closed suction systems minimize contamination of the respiratory circuit. Blood pressure fluctuations are also possible and closely monitored. Medical team vigilance and adherence to established protocols help ensure patient safety.
Patient Experience and Comfort
Endotracheal suctioning can be uncomfortable for patients, potentially triggering coughing or gagging. The sensation of a catheter entering the airway can be distressing, even for sedated individuals. Healthcare providers prioritize minimizing patient distress.
For awake patients, the medical team explains the procedure beforehand to reduce anxiety and encourage cooperation. They might also encourage coughing during the procedure to help mobilize secretions. For critically ill or heavily sedated patients, comfort is managed through careful technique and appropriate medications for sedation and pain relief. This approach aims to make the experience tolerable while ensuring effective secretion clearance.