Respiratory - Tracheal Suctioning SECTION: 9.18 Strength of Evidence Level: 3 - RN - RT - LPN/LVN - HHA Purpose

Respiratory – Tracheal Suctioning SECTION: 9.
18
Strength of Evidence Level: 3 __RN__RT__LPN/LVN__HHA
PURPOSE: 11. During performance of this procedure, the patient

To maintain oxygenation by removing the secretions should be observed for:
from the trachea to prevent occlusion of the airway. a. Hypoxia.
b. Bronchospasm.
CONSIDERATIONS: c. Cardiac arrhythmias.
d. Bloody aspirations.
1. Whenever possible, the patient should be
e. Hypotension.
encouraged to clear airway by directed cough or
12. To avoid damage to the airways and hypoxia,
other airway clearance technique. The need for
suction should be applied intermittently for periods
suctioning procedure needs to be established (i.e.,
not to exceed 5 to 10 seconds. Suction catheter
coarse breath sounds, noisy breathing, etc.).
should not be left in trachea for longer than 10
2. Tracheal suctioning may be accomplished by
seconds. Suction should be set at <120 mmHg.
means of a suction catheter inserted through mouth,
Intermittent suction is applied as catheter is
nose, tracheal stoma, tracheostomy or endotracheal
withdrawn only. Reoxygenate between attempts.
tube.
Maximum number of attempts should be 2 suction
3. Nasotracheal and oral-tracheal suctioning are clean
passes/episode.
procedures. Tracheostomy suctioning is generally a
13. Suction catheter size should be no more than 1/2
clean procedure. If tracheostomy is new (within 4 to
(one-half) the internal diameter of the artificial
6 weeks) or patient is immuno-compromised, sterile
airway to avoid greater negative pressure in the
technique should be used. If both oral/nasal tracheal
airway and potentially minimize the PaO2.
suctioning must be done during the procedure,
14. DO NOT force the suction catheter into the airway
begin with tracheal suctioning then continue with
beyond resistance.
oral/nasal suctioning.
4. Suctioning removes not only secretions but also
EQUIPMENT:
oxygen. If patient has oxygen ordered, patient
should be hyperoxygenated with 100% oxygen Oxygen source, if patient has oxygen ordered
before and after suctioning. Be sure to return Suction machine and suction catheter
oxygen to previously prescribed liter flow and
Distilled water
concentration after procedure is completed.
5. If patient has a tracheostomy tube, keep extra Gloves
sterile tracheostomy tubes of the same size and Clean suction catheter with control valve or Y connector
obturator on hand in case of accidental expulsion or (diameter should be no larger than half the diameter of
blocked tube. tracheostomy tube)
6. If patient has a cuffed tracheostomy tube, deflation Clean solution container
prior to suctioning is not required.
7. Indications that the patient requires suctioning Impervious trash bag
include: Sterile, water-soluble lubricant, if catheter is to be
a. Noisy, moist respirations. inserted through the nasal passage
b. Increased pulse. Tissues
c. Increased respirations.
d. Non-productive coughing. PROCEDURE:
e. More frequent or congested sounding coughs. 1. Verify physician's order for suctioning.
f. Visible secretions. 2. Adhere to Standard Precautions.
g. Increased shortness of breath. 3. Explain procedure to patient.
8. Avoid unnecessary suctioning as the tracheal 4. Prepare suction machine according to
mucosa may become irritated and infection may be manufacturer’s instruction.
introduced. 5. Set suction pressure between 100-120 mm Hg.
9. If the patient is receiving nasotracheal suctioning, 6. Evaluate lung fields by auscultation.
he/she should be instructed to take deep breaths as 7. Place patient in semi-Fowler's position to promote
the catheter is advanced. lung expansion.
10. Tenacious secretions may be liquified by instilling 3- 8. Prepare suction catheter:
5 mL of normal saline into the trachea, if ordered by a. Set up clean work field.
the physician. Humidification of the airway is b. Obtain clean suction catheters.
essential to keeping secretions loose and easily c. Pour distilled water or sterile saline into clean
removed. Keeping the patient well hydrated will also solution container.
assist in maintaining loose secretions. Adequate d. Put on gloves.
humidification in the home environment is also e. Connect suction catheter to suction machine
important. and turn on machine.
387 Last Update 9/10

Respiratory – Tracheal Suctioning SECTION: 9.18
Strength of Evidence Level: 3 __RN__RT__LPN/LVN__HHA
9. Place catheter tip in distilled water, occlude catheter 16. At conclusion of procedure, instruct patient to take
port with thumb and suction a small amount of water several deep breaths. Hyperoxygenate for several
through the catheter. minutes if a patient has oxygen ordered.
10. Encourage patient to take several deep breaths 17. Return oxygen liter and concentration rate to
prior to start of suctioning. normal, if patient is on continuous oxygen.
11. Suctioning procedure - Mouth, Throat: 18. Auscultate lungs; assess pulmonary status, skin
a. Dip catheter tip into sterile normal saline/sterile color, and vital signs. Monitor the patient for adverse
water to lubricate outside and facilitate reactions.
insertion. 19. Clear catheter and connecting tubing by aspirating
b. Insert catheter into mouth and/or back of throat. remaining water solution.
c. Cover suction catheter port with thumb and 20. Turn off suction. Disconnect catheter.
suction intermittently while rotating catheter. 21. Discard soiled supplies in appropriate containers.
d. Perform procedure intermittently until secretions
are cleared. AFTER CARE:
12. Suctioning procedure - Nasal insertion: 1. Disassemble suction catheter and solution container
a. Lubricate tip of catheter with sterile, water- and clean suction lines and reservoir bottle. (See
soluble lubricant. Cleaning and Disinfection of Respiratory Therapy
b. Remove oxygen delivery device, if applicable, Equipment.)
and insert catheter into the nares during 2. Clean hands per appropriate hand hygiene
inhalation and gently advance the catheter procedure.
without applying suction. 3. Document in patient's record:
c. Insert catheter about 20 cm in adults, 14-20 cm a. Patient's response to procedure.
in older children, 14-20 cm in young children b. Amount, viscosity, odor and color of secretions.
and 8-14 cm in infants. c. Findings of cardiopulmonary assessment before
d. Cover suction catheter port and suction and after treatment.
intermittently while rotating catheter. Apply d. Oxygenation before, during and after treatment.
intermittent suction while withdrawing the e. Instructions given to patient/caregiver.
catheter. f. Patient/caregiver understanding of instructions
e. Perform procedure until secretions are cleared. using the ‘teach back’ method.
Allow time between suction passes for g. Communication with physician.
ventilation and oxygenation. Avoid tiring patient
or precipitating hypoxia.
f. Rinse the catheter and connection tubing with
normal saline or water until cleared. Dispose of
the catheter once suctioning is completed.
13. Suctioning procedure - Tracheostomy:
a. Check tracheostomy tube to make sure it is tied
securely.
b. Dip catheter tip into sterile, normal saline to
lubricate outside and facilitate insertion.
c. Insert catheter into tracheostomy or trach tube.
d. DO NOT force catheter beyond point of
resistance.
e. Cover suction catheter port intermittently.
f. Slowly withdraw and rotate catheter to clear
secretions. DO NOT exceed 10 seconds.
g. Before reinserting catheter allow patient to rest
and encourage taking 2 or 3 deep breaths. Re-
oxygenate patient, if needed.
H If fenestrated tracheostomy, change inner
cannula without hole.
14. Rinse the suction catheter with distilled water
between insertions.
15. Monitor patient's respiratory status during
procedure. If patient becomes short of breath,
agitated, or hypoxic, discontinue suctioning and
oxygenate the patient.
388 Last Update 9/10

Respiratory - Tracheal Suctioning SECTION: 9.18 Strength of Evidence Level: 3 - RN - RT - LPN/LVN - HHA Purpose

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Respiratory – Tracheal Suctioning SECTION: 9.

PURPOSE: 11. During performance of this procedure, the patient

387 Last Update 9/10

388 Last Update 9/10

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