7 - Suctioning

suctioning

removal of secretions to maintain airway patency

types of suctioning

• oropharyngeal __ (Yankauer)

• nasopharyngeal __ (flexible catheter)

• endotracheal __ (closed/in-line vs. open)

• tracheostomy __

indications for suctioning

• increased airway secretions

• visible/audible secretions

• hypoxemia (low S_pO₂)

• increased WOB

• ineffective cough

• rhonchi/coarse breath sounds

contraindications and complications of suctioning

• airway trauma

• hypoxia due to prolonged suctioning

• bradycardia due to vagal response

• mucosal damage/bleeding

suction equipment and setup

• catheter sizes

• adults: 12-16 Fr

• pediatrics: 8-10 Fr

• neonates: 5-8 Fr

suction equipment and setup

• pressure settings

• adults: 100-150 mmHg

• pediatrics: 80-120 mmHg

• neonates: 60-80 mmHg

suction equipment and setup

• infection control

• hand hygiene and PPE (gloves, goggles, mask)

• sterile/clean technique

• disinfection of equipment

suction equipment and setup

• sizing calculations

• Egan’s

  • ID × 2 → 1 size smaller

    • ex: 8 mm × 2 = 16 → 14

• Kettering

  • (ID ÷ 2) × 3

    • ex: (8 mm ÷ 2) × 3 = 12

suctioning techniques

• oropharyngeal (Yankauer)

1. explain procedure to patient

2. position patient (semi-Fowler’s or upright)

3. use Yankauer catheter to clear secretions

4. avoid deep insertion to prevent gag reflex

5. monitor oxygenation during procedure

suctioning technique

• nasopharyngeal (flexible catheter)

1. pre-oxygenate patient as needed

2. gently insert lubricated catheter through nare

3. apply suction while withdrawing catheter

4. monitor patient’s S_pO₂, HR, and respiratory effort

suctioning technique

• endotracheal tube and tracheostomy (open/closed)

1. assess need for suction (breath sounds, E_TCO₂, secretions)

2. pre-oxygenate with 100% O₂ for 30-60 seconds

3. insert catheter without suction applied

4. apply suction intermittently while withdrawing catheter (max 10 seconds)

5. allow patient to recover for 30-60 seconds before repeating, if needed

tracheal lavage

flushing trachea with sterile solution to remove secretions or obtain sample for analysis

indications for tracheal lavage

• suspected infection in lower respiratory tract

• need for sputum sample in non-expectorating patients

• thick secretions resistant to standard suctioning

• airway clearance in mechanical ventilation

tracheal lavage procedure

1. prepare equipment

   • sterile saline/water

   • suction catheter and Luken trap (if getting sample)

   • bag-valve mask (BVM) or ventilator for oxygenation

   • suction setup

2. pre-oxygenate patient

   • 100% O2 for 30-60 seconds before procedure

3. instill lavage solution

   • 2-5 mL sterile saline/water into trachea via ET/tracheostomy tube

4. suction secretions

   • apply intermittent suction while withdrawing catheter

   • limit suctioning to no more than 10 seconds

5. monitor patient response

   • watch for destruction, ↓HR, distress

   • reoxygenate as needed

complications and considerations for tracheal lavage

• hypoxia due to airway disruption

• bradycardia due to vagal response

• airway trauma from suctioning

• risk of aspiration/infection

• ensure infection control and sterility

sputum collection techniques

• spontaneous expectoration

  • patient coughs into container

• induced

  • hypertonic saline nebulizer to induce coughing

• ET aspirate

  • from intubated patients

types of sputum tests

• Gram stain

• culture and sensitivity (C&S)

• acid-fast bacilli (AFB)

• cytology

Luken traps

containers that collect sputum samples via suctioning

• connected between suction catheter and tubing

• allows direct collection of secretions from airway without contamination

• used in patients who are unable to expectorate or are mechanically ventilated

• ensures proper handling for analysis

• must be labeled and transported immediately to prevent sample degradation

bronchoscopy

examination of airways using flexible/rigid bronchoscope

• sedation and local anesthesia required for flexible bronchoscopy

indications for bronchoscopy

• airway evaluation (tumors, bleeding, infection, foreign bodies)

• secretion clearance in intubated patients

• lavage for cytology/microbiology testing

• bronchial biopsies

• research

complications of bronchoscopy

• bronchospasm

• bleeding

• hypoxemia

• pneumothorax