ENDOTRACHEAL TUBE SUCTIONING

Definition: is the suctioning of respiratory secretions in patients who have been intubated or who have undergone tracheostomy.
When patients are unable to mobilize their secretions, due to neuromuscular disease, defects in neuromuscular systems that
control breathing, injury to chest and several lung diseases, respiratory distress, respiratory failure. sedation or neurological
deficits, such as a CVA. In addition, patients with an artificial airway, such as those who have been intubated, usually require
suctioning while they are on a ventilator. They may need suctioning of the secretions from the oropharynx and/or trachea to
maintain their airway.

Purpose

1. To clear secretions and to maintain airway patency.

2. To optimize oxygenation and ventilation in a ventilated patient.
3. to maximize the amount of secretions removed with minimal adverse effects associated with the procedure.

Assessment
1. Desaturations.
2. Bradycardia.
3. Tachycardia.
4. Absent or decreased chest movement.
5. Visible secretions in ETT.
6. Increased ETT CO2 or transcutaneous CO2
7. Irritability.
8. Decreased breath sounds.
9. Coarse crackles auscultated over trachea
10. Increased peak inspiratory pressure during volume control ventilation
11. Decreased tidal volume during pressure-controlled ventilation
12. Deterioration in oxygen saturation and/or arterial blood gas values
13. Patient’s inability to generate an effective cough
14. Acute respiratory distress
15. Suspected aspiration of gastric or upper airway secretions

Equipment

1. Sterile suction kit containing:

 Fr 12 or 14 Fr catheter is appropriate for most adults.
 Sterile gloves
 Self-inflating bag for resuscitation.
 A suction canister and connective tubing.
 Sterile saline
 Water resistant disposal bag
 facial tissue
 If performing nasal-tracheal suctioning, lubricant will also be necessary
2. Suction device is hooked up correctly and set at an appropriate level. For adults, the suction vacuum should be set at 80
to 120 mmHG. For pediatric patients, suction vacuums should be between 60 and 80mmHG.
 PROCEDURES/STEPS RATIONALE
1. Verify the physician order and identify the client.  Prevents potential errors

2. Wash your hands  Hand washing prevents transmission of

microorganisms

3. Explain procedure and purpose to client.  Explanations reduce anxiety and encourage
cooperation with procedure ( If client is
conscious and alert).
4. Gather all the materials needed or equipment  Organization facilitates accurate skill
performance, to save the time and promote
required
effective care.

5. Use of personal protective equipment including an  Will protect the user against health hazard or
eye shield is highly recommended. safety risks at work

6. Perform sterile technique procedure  In order to reduce the risk of nosocomial

infection.

4. Position the client

a. Position the conscious client with an  The semi-Fowler's position helps prevent
intact gag reflex in a semi-Fowler's aspiration of secretions.
position.

b. Position the unconscious client in a  A side-lying position facilitates drainage of

side-lying position facing you. secretions by gravity and prevents aspiration.
 PERFORMANCE CHECKLIST
GRADING CRITERIA: LEGEND:

Performance Of Task:
1. Performs task correctly & accurately. 5 - Excellent (E) 2 - Needs Improvement (NI)
2. Performs task systematically. 4 - Very Satisfactory (VS) 1 - Incorrectly Performed (IP)
3. Finishes procedure on time. 3 - Satisfactory (S) 0 - Not Performed (NP)
4. Performs task with ease & confidence.
5. States correct rationales/terms.
Time allotment: _________

Suctioning an Endotracheal Tube E VS S NI IP NP

Meets Meets Meets Meets Meets Not
all at at at at Per-
criteria least least least least formed
5 4 3 2 1 0
1. Turn on the suction device and adjust suction to
appropriate pressure.
a. 50 to 75 mm Hg; adults
b. 100 to 120 mm Hg; infants and children
2. Hyperoxygenate the patient by giving them a few
breaths with 100% oxygen. FI02 100% in 1 full
minute.

3. Open and prepare sterile suction catheter kit

a. Unfold sterile cup, touching only the outside.
Place on bedside table.
b. Pour sterile saline into cup.

4. Don sterile gloves

5. Pick up catheter with dominant hand. Pick up

connecting tubing with nondominant hand. The
nondominant hand is now considered clean rather
than sterile. Attach catheter to tubing without
contaminating sterile hand.

7. Place catheter end into cup of saline. Test

functioning of equipment by applying thumb from
nondominant hand over open port to create suction
Note:Lubrication makes catheter insertion easier
and ensures proper functioning of suction
equipment.

8. Insert the catheter through the endotracheal tube.

Do not be aggressive when inserting the tube.

9. Once the catheter has been inserted to the

appropriate depth. If the tracheostomy tube is 4
cm long, place the catheter 4 cm into the
tracheostomy tube.

10. Apply intermittent suction and slowly withdraw

the catheter, using a twirling motion as the
catheter is withdrawn.
11. Suctioning attempts should be limited to 10
seconds maximum of 15 seconds..

12. If suctioning more than once, allow the patient

time to recover between suctioning attempts.
During catheter extraction 20 to 30
seconds between passes.

13. Hyperoxygenate and hyperinflate using manual

resuscitation bag for a full minute between
subsequent suction passes. Encourage deep
breathing. Replace oxygen if applicable.

14. During the procedure, monitor oxygen levels and

heart rate to make sure the patient is tolerating the
procedure well.

15. Rinse catheter and tubing by suctioning saline

through.

16. Repeat Steps 6 to 11 until airway is clear, limiting

each suctioning to three passes.

17. Remove gloves by holding catheter with dominant

hand and pulling glove off inside-out. Catheter
will remain coiled inside the glove. Pull other
glove off inside-out .Dispose of in trash
receptacle.

18. Turn off suction device

19. Assist client to comfortable position. Offer

assistance with oral and nasal hygiene. Replace
oxygen device if used.

20. Dispose of disposable supplies.

21. Wash your hands

22. Ensure that sterile suction kit is available at head of

bed.

23. Documentation

Time Started:______________ Time Finished:______________

Significant Observation: Date:______________

___________________________________________________________________________________________

__________________________________________________________________________________________

Total Score and Grade:___________

CI’S Name and Signature:_________________ Student’s Signature: ________________