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Aim of Suctioning
To remove excessive secretions to maintain a patent airway and promote effective ventilation and oxygenation.
Indications for Suction
- Visable or audible secretions i.e. bubbling sounds.
- Feeling secretions in the chest - during chest physio
- Change of colour – Cyanosis, Pallor, Clammy.
- Irregular respiratory pattern – breathing increased or decreased
- Appearance – Anxious / Restless
- Decreased oxygen saturation levels
- Coughing – irritation of a build up of secretions.
- Changes in secretions – excessive, presence of foreign body, secondary infection, inadequate humidification.
- Increased airway pressure when ventilated.
Complications of Suction
- Hypoxia - suction induces arterial oxygen de – saturation [ Pao2 less than 50mmHg.]
- Cardiac Arrhythmias – particularly bradycardia is attributed to vagul stimulation due to the introduction of the suction catheter or movement of the tracheostomy tube.
- Damage to the posterial wall if correct inner cannula is not in place prior to the suction procedure.
- Bronchospasm is the result of stimulation of the airways with the suction catheter.
- Ulceration / Necrosis of the trachea.
- Infection
- Airway trauma occurs with impaction of the catheter in the airways and when excessive negative pressure is applied to the catheter.
- Anxiety – suctioning can be an uncomfortable procedure for the resident and they my resist treatment
- Pneumothorax.
Suction Catheter Sizing
As a guide to calculate the appropriate suction catheter size;
Divide the tracheostomy tube internal diameter by 2, then multiply this by three to obtain the appropriate suction catheter.
For example: Size 8 Tracheostomy tube;
8 divide by 2 = 4 [ external diameter of the tube.]
4 x 3 = 12 [ French gauge.]
Therefore the appropriate catheter size is 12.
Size 10 = 14Fg
Size 9 = 14Fg
Size 8 = 12Fg
Size 7 = 10Fg
Size 6 = 8Fg.
Size 5 = 7Fg
Size 4 = 6Fg
Procedure
Suctioning is a clean/sterile procedure and is only performed when the patient needs it and not as a routine procedure.
- Explain and reassure the resident prior to commencement of procedure.
- Wash hands and wear disposable gloves [ follow hand hygiene protocol.] Wear two gloves on suctioning hand.
- Put on plastic apron.
- Before suctioning it is essential to know which type of tube is insitu, if fenestrated the inner cannula is coloured therefore you must change to a plain unfenestrated inner cannula to prevent tracheal trauma.
- Check the suction unit is set at the appropriate pressures between 100 – 150mmHg or 20kPa.
- Administer oxygen if patients O2 saturations are below 90%.
- Open the end of the suction catheter pack and use the pack to attach the catheter to the suction tubing, keep the rest of the catheter in the packet.
- Introduce the catheter quickly and gently until resistence is felt or if the patient coughs, then withdraw approximately 1cm before suction is applied, then place thumb over suction port control and continue to withdraw gently.
- Suction should be continuous limiting the duration of each suction to 10 – 15 seconds maximum. [ prolonged suction may result in hypoxia.]
- When catheter is removed wrap catheter around dominant hand then pull glove over catheter and discard into clinical waste.
- If patient is on continuous oxygen therapy reapply the oxygen at the administered level.
- Flush the suction tubing using a receptacle of clean water.
- If procedure is to be repeated fresh gloves and a new sterile catheter will be needed to repeat the procedure [Please ensure a clean catheter is used for each suction.]
Suctioning should be limited to three times during each episode to minimise any complications. [see above.]
Insert photos for each stage.
References
Griggs A 1998 Tracheostomy : Humidification Nursing standard.
Moore T [2003] Suctioning techniques for the removal of respiratory secretions, nursing standard.
