10.03 Airway Suctioning

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Overview

Airway suctioning used to remove secretions from airway

Nursing Points

General

  1. Indications
    1. Oropharyngeal
      1. Excess Saliva
      2. Oral secretions
      3. Can use oral airway
    2. Nasopharyngeal
      1. Nasal drainage
      2. Unable to use oral route
      3. May need nasal trumpet
    3. Endotracheal → Sputum in ET Tube, need to elicit cough
    4. Tracheal → Secretions in trach, pt unable to cough
  2. Risks
    1. Hypoxia
    2. Vagus Nerve Stimulation
      1. Causes Bradycardia
    3. Damage to Mucous Membranes

Assessment

  1. Clinical Signs
    1. Rhonchi
    2. Coughing
    3. Visible sputum in mouth or nose
    4. Gurgling in back of throat
    5. ↓ SpO2

Therapeutic Management

  1. Equipment
    1. Suction Regulator or Portable Machine
    2. Suction Tubing
    3. Yankauer
    4. Suction Catheter (10-14 fr)
    5. Artificial Airway if needed
    6. In-Line suction set-up
    7. Oxygen delivery device
  2. General Rules
    1. Use proper size of equipment
    2. Use medium suction (100-200 cmH2O)
    3. Don’t suction against tissues
    4. Suction intermittently on the way out
    5. Less than 10 seconds
    6. No more than 3 passes
    7. Preoxygenate as needed
    8. Call RT if you need help

Nursing Concepts

  1. Oxygenation
    1. Assess SpO2 before and after
    2. Assess lung sounds before and after
    3. Hyperoxygenate before suctioning
      1. Give 100% FiO2 if on vent
  2. Clinical Judgment
    1. Choose proper equipment
    2. Get help if needed (RT or provider)
  3. Safety
    1. Safety check beginning of shift
      1. Suction regulator working
      2. Tubing available
      3. Yankauer or catheter available
      4. Correct equipment handy
    2. Prevent Respiratory Distress

Patient Education

  1. Keep patient calm if in distress
  2. Explain your steps as you take them
  3. Explain procedure, it may make them cough
  4. Explain purpose for suctioning

Reference Links

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Video Transcript

So there are a lot of things to learn about suctioning, including the steps for the skills themselves. But what we really want to get you here is the nitty gritty basics and the most important things you need to know about suctioning your patients.

The primary reason for suctioning a patient is to remove secretions so that the patient will have a clear airway. It’s possible that the purpose is to obtain a sputum culture, but either way we are removing secretions. We can do oropharyngeal suctioning for someone with excessive saliva or oral secretions. We could even do this through an oral airway if necessary. Then nasopharyngeal suction will allow us to get a bit farther down the back of the throat. This is for excess nasal drainage, excess mucus, or if we can’t use the oral route for some reason. If the patient is biting down or they have their jaw wired shut, the nasal route comes in handy. If they’re needing frequent suctioning we’ll put in a nasal trumpet to prevent trauma to the nose. Then if the patient has an ET Tube or a Trach, we will suction those to keep them clear and to help the patient if they can’t cough effectively on their own. We’d use a small suction catheter or possibly an in-line catheter, that we’ll show you in a second, to go down just beyond the end of the tube in their trachea and pull out the secretions. Most times this will make them cough – which will actually help us get more secretions out.

Of course there are some risks with any procedure, but these are the ones you NEED to have in mind when you’re suctioning your patient. The first is hypoxia – we’re essentially blocking their airway for brief periods so we need to consider this is risk. That’s why we usually limit our suction time to 10 seconds and sometimes will give them extra oxygen right before we start. The second risk is that It’s possible that when we go down and elicit a cough, we could also stimulate the patient’s vagus nerve. That can cause severe bradycardia. This is why, again, we limit our suction time so that we don’t overstimulate that nerve. And finally, we’re applying suction within a very sensitive area in the mouth, throat, and trachea. Those are all mucus membranes so if we catch the tissue in the suction catheter, we can cause some damage. We can also cause damage just by frequent suctioning so we usually limit our suction to 3 passes at a time, then let the patient rest.

Some of the equipment you will see used for suctioning includes the regulator like this one attached to the wall in their room. There are also portable suction machines for transport or on ambulances. They will also need suction tubing which you can see here. And then this is the Yankauer (“yank-ower”). You may also hear “yank-er” or “yon-ker”, but officially it’s Yankauer. We use this for oral and oropharyngeal suction – we can also use it to elicit a gag reflex, but you wouldn’t do that with suction going. Then we have small suction catheters like the one you see here. We use these for nasal suction, ET Tube suction, and tracheal suctioning. One important thing to note is that these catheters are sterile and suctioning an advanced airway like an ET Tube or Trach are sterile procedures. Finally there are In-Line set-ups like the Ballard. Ballard is just a brand, but you may hear people refer to it like that. It’s a closed suction system like what you see being used here that allows repeated suction of an ET Tube or Trach without having to disconnect the circuit – you see this mostly in the ICU.

So when you learn the specific skills, you’ll learn how to perform each type of suction, but we want to give you general rules that have to be followed for all types of suctioning. The first is to make sure you have the right size equipment. If you have a 12 french nasal trumpet, you can’t stick a 14 french catheter through it, right? It would be too big. So always make sure you have the right equipment. We use medium suction of up to 200 cmH2O. Any more than that and we really risk causing damage to the tissues. That’s also why, if we hit resistance, we’ll pull back 1 cm before suctioning – that way we aren’t right up against the tissue when we suction. We insert the suction catheter without applying suction, then we suction intermittently on the way out of the airway – this decreases the likelihood of snagging tissue and causing damage. We keep our suction passes to less than 10 seconds each and no more than 3 passes – that way the patient can rest and catch their breath so they don’t get hypoxic. We will also preoxygenate the patient to prevent hypoxia.

It’s super important to remember these concepts when dealing with a patient who requires suctioning. We need to make sure we are monitoring their SpO2 and oxygen status, as well as preoxygenating before suctioning. We will also listen to their lungs before and after to determine whether our suctioning was successful. We also need to consider safety and clinical judgment. Choosing the right equipment and following the rules will help to prevent any complications like hypoxia or tissue damage.

To recap – remember the whole goal is to protect the airway – that might mean using an artificial airway like a nasal trumpet to help you get access to and clear out the secretions. Make sure you’re choosing the right equipment AND that your suction regulator or machine is working properly. This should be part of a safety check at the beginning of your shift. In an emergency, you don’t want to get stuck trying to suction your patient and not being able to. Then remember we want to achieve our goal without causing any further complications like hypoxia, vagus nerve stimulation, or damage to the mucous membranes.

So those are the basics rules of suctioning a patient’s airway. We hope you learned something and can be confident when it’s time to suction your patient. Happy nursing!

Read more

  • Question 1 of 6

A 27-year-old client has a tracheostomy and is currently in the hospital using a mechanical ventilator. The nurse is preparing to suction the client. Prior to starting the suction procedure, which of the following should the nurse do first?

  • Question 2 of 6

A patient is recovering from surgery in the ICU and requires a ventilator for breathing assistance. The nurse performs suctioning of the endotracheal tube to clear secretions. Which of the following practice essentials does the nurse employ regarding suctioning of the client’s airway?

  • Question 3 of 6

A nurse is caring for a client who is unconscious after a head injury. The client is breathing on his own but has increased oral secretions that require frequent suctioning. The nurse prepares to suction secretions from his mouth and nose. Before starting the suction process, the nurse turns on the suction machine and sets the pressure at which of the following?

  • Question 4 of 6

Which of the following steps should the nurse include as part of tracheostomy suctioning?

  • Question 5 of 6

A nurse is caring for a client with right-sided paralysis who has excess oral secretions. The nurse must frequently use a suction catheter to clear the client’s secretions. Which action best demonstrates that the nurse is using suction safely?

  • Question 6 of 6

A nurse has used evidence-based practice to identify a new method of endotracheal suctioning that can be implemented into practice standards on a hospital unit. Which of the following actions best demonstrates that the nurse is utilizing performance improvement principles when implementing this new standard?

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