AIRWAY SUCTION

Each day the normal person generates an

average of 100 ml of bronchial
secretions.if the normal mechanisms such
as ciliary action are compromised,alveolar
ventilation may be impaired.
 Suction may be indicated to remove these
secretions
 INDICATIONS:
 1)very sick,spontaneously breathing patient.may
not able to cough and expectorate.
 2)Some patients, are unable to cough effectively
due to confusion,pain or fear.
 3)Patient who are deeply unconscios or because
their respiratory muscles have been paralysed by
disease or drugs.
 When we should give suction?
 1)Whenever secretions can be heard in an intubated
patient.
 2)for retained secretions in the spontaneously breathing
patient who is not able to cough and expectorate
efficiently.
 3)Before and during the release of the cuff on a
tracheostomy tube.
 4)If the inflation pressure of the ventilator suddenly
rises.this indicate the persence of large plug of mucus in
one of the large bronchi or within the endotracheal or
tracheostomy tube.
 If the minute volume drops,this may indicate retained
secretions.
 SUCTION EQUIPMENT
 1)suction pumps.
 2)suction tubing.
 3)connections.
 4)catheter.
 5)suction trolley.
 Various types of apparatus are available to produce
vacuum or suction force necessary to aspirate
substances.
 The power is provided by a large motor.
 There is an on/off switch,control dial to increase or
decrease the negative pressure.a manometer displays
the pressure used.
 It is -50mmHg, -100mmHg,-300mmHg.
 Portable suction is also available powered by
rechargeble batteries.
 All suction pumps have at least one suction
bottle,the electrically operated pumps often have
two.these act as a receiver for aspirate and
should be partially filled with some antiseptic
solution.
 The most modern suction bottels contain a
disposable inner bag with which to collect the
secretions.
 Suction tubing:these leads frome the suction
bottel to the suction catheter.
 It is made from clear plastic for easy viewing of
secretions,and is disposable,but sometimes
rubber tubing is used still.
 CONNECTIONS:These are usually plastic and
either clear or semitransparent.to view the
secretions being aspirated.most connections
have three holes,one at either end and a third at
the side used as the control port.
 CATHETERS:many types of catheter are
available but all come in standard size.
 They are made from soft,clear plastic and
are disposable.
 Commonly used size for the adult patient
are 10,12,14,and16 French Gauge(FG)
and are usually colour coted for size.
 It is vital that the correct size of catheter
is used for each patient.
 It should not exceed half the diameter of the
endotracheal or tracheostomy tube.
 Too large cathter may cause alveolar collapse
when suction is applied.
 Soft rubber catheter are also used,they are not
disposable and must be sterilised after use.
 They are perticularly useful for nasopharyngeal
suction as they cause less trauma because they
are softer and more flexible then the plastic
cathers.
 All catheters should be used once only and then
thrown away if disposable or if rubber collected
for sterilisation.
 SUCTION TROLLY:
 All the equipment needed for airway suction
should be there in suction trolly.that is…
 1)sterile plstic gloves-disposable.
 2)suction catheter-appropriate size for the
patient.
 3) Lubricating jelly-water based only,not
oil based,for used in nasopharyngeal
suction.
 4)Bowl of sodium bicarbonate or sterile
water-to flush the secretions through the
catheter and tubing.
 5)forceps(if used)
 6)Plastic bag for collection of disposables.
 7)Bowl of antiseptic solution for the
collection of items to be sterilised.
 SUCTION TECHNIQUE
 Sterile suction technique should be used
because there is high risk of introducing
infection into the respiratory tract.
 Before use,the equipment should be checked
for efficent suction.
 The appropriat vaccum pressure selected it is -
100 to-120mmHg is ideal for most patients.
 Up to 200mmHg may be needed for thick
secretions.
 Therapist should wash her
hands,throughly,explain the procedure to
the patient and then select the
appropriate size of catheter.
 MODE OF ENTRY
 1)NASOPHARYNGEAL SUCTION:
 It is very unpleasent experience for the
conscious patient and should only be used when
absolutely necessary.
 The patient’s neck should be extended and
tongue should be protruded,to avoid entry in to
the oesophagus.
 The catheter should be inserted during the
inspiratory phase.
 The lubricated catheter is held between the
finger and thumb of the gloved hand and
introdused into the nose.
 It is directed slightly upward and backward until
the tip reaches the posterior naris where a little
resistece may be felt.Gentel rolling of the
catheter at this point usually allow the
advancement of the catheter into the pharynx.
 Nasopharyngeal suction should not be used for
the patient with head injuries where there is a
leak of CSF into the nasal passages.
 OROPHARYNGEAL SUCTION:
 A lubricated plastic airway is needed to prevent
the patient biting the catheter.
 It is inserted with its tip directed towards
the roof of the mouth and then rotated so
that the tip lies over the back of the
tonge.
 SUCTION VIA TUBE:
 The catheter is introdused into an
endotracheal,tracheostomy or mini
tracheostomy tube.
 SUCTION
 While introducing the catheter no suction
pressure is applied because it causes
mucosal trauma.
 The catheter should be pinched or
disconnected from the tubing during
introduction.
 The catheter should be introdused until
either a cough reflex is elicited or some
resistance in the trechea is feel.
 The suction is then applied by removing the
pinch,the catheter must be withdrawn 1 cm
before suction is applied. simultaneously the
catheter is slowly withdrawn,with gental rolling
the catheter between finger and thumb to
minimise tracheal trauma.
 Always use Interrupted suction to avoid a
maximum build up of negative pressure.
 Under no circumstances the thromboning
methed is used,that is vigorous up and down
movement of the catheter.
 Duration of the suction is 10 to15 seconds.the
disconnection and reconnection of the patient to
the ventilator should be completed within 10 to
15 seconds.
 After suction the patient must be reconnected
immediately to the ventilater or oxygen supply.
 During the suction procedure it is important to
observe the patient for signs of hypoxia.if it
occurs,administer oxygen or ventilation
immediately.
 If it is difficult to loosen and clear tenacious
secretions on suction,normal saline is used.it is
used upto 5ml of normal saline (0.9%).but
occasionally it is used in large volumes to
remove large plug occluding the endotracheal
tube.
 Where possible the patient should be suctioned
in side lying or with the head rotated to one side
to avoid aspiration of gastric contents.
 Appropriate pressure that is used for the
patient is-For
 1)preterm baby:80-100mmHg
 2)Baby to 1 year:80-100mmHg
 3)Preschooler:100-120mmHg
 4)School age:100-120mmHg
 5)Adolescent/adult:120-150mmHg.
 CONTAINDICATIONS

 1)unexplained Heamoptysis.
 2)laryngospasm.
 3)Basal skull # or cerebrospinal fluid
leakage via the ear.
 4)Sever bronchospasm.
 5)Recent oesophageal or tracheal
anastomoses.
 6)Occluded nasal passage.
 7)Nasal bleeding.
 8)compromised cardiovascular system.
 9)Acute neck,facial or head injury.
 10)Haemodynamic instability.
 HAZARDS OF SUCTIONING
 1)Risk of infection.
 2)Mucosal trauma.
 3)Hypoxia.
 4)Cardiac arrhythmias.
 5)Atelectesis.
 6)Rised intacranial pressure.
 7)Fluctuating in BP.
 8)Respiratory arrest/apnoea.
 9)Gagging/vomiting
 10)Aspiration.
 11)Pain.
 12)Misdirection into oesophegus.
 13)patient distress and discomfert.
 PEDIATIC SUCTIONING
 The trach tube is suctioned to remove
mucus from the tube and trachea to allow
for easier breathing. Generally, the child
should be suctioned every 4 to 6 hours
and as needed. There may be large
amounts of mucus with a new
tracheostomy. This is a normal reaction to
an irritant (the tube) in the airway .
 The heavy secretions should decrease in a few
weeks. While a child is in the hospital, suctioning
is done using sterile technique, however a clean
technique is usually sufficient for most children
at home. If your child has frequent respiratory
infections, trach care and suctioning techniques
may need to be addressed. Frequency of
suctioning will vary from child to child and will
increase with respiratory tract infections. Try to
avoid suctioning too frequently. The more you
suction, the more secretions can be produced.
 CARE TECHNIQUES

 Sterile Technique: sterile catheters and

sterile gloves
 Modified Sterile Technique: sterile
catheters and clean gloves
 Clean Technique: clean catheter and clean
hands
 SIZE OF CATHETER
 The size of the suction catheter depends
on the size of the tracheostomy tube. Size
6, 8 or 10 French are typical sizes for
neonatal and pediatric trach tubes. The
larger the number, the larger the diameter
of the suction catheter. Use a catheter
with an outer diameter that is about half
the inner diameter of the artificial airway
this will allow air to enter around it during
suctioning.
 You can also compute the catheter size
with this formula: Multiply the artificial
airways diameter in millimeters by two.
For example, 8 mm X 2 = 16, so a 16
French catheter.
 SUCTION DEPTHS

 Shallow Suctioning: Suction secretions at the opening of

the trach tube that the child has coughed up.
 Pre-measured Suctioning: Suction the length of the trach
tube. Suction depth varies depending on the size of the
trach tube. The obturator can be used as a measuring
guide.
 Deep Suctioning: Insert the catheter until resistance is
felt. (Deep suctioning is usually not necessary. Be careful
to avoid vigorous suctioning, as this may injure the lining
of the airway).
 Signs That a child Needs Suctioning

 Rattling mucus sounds from the trach

 Fast breathing
 Bubbles of mucus in trach opening
 Dry raspy breathing or a whistling noise
from trach
 Older children may vocalize or signal a
need to be suctioned.
 EQUIPMENT

 Suction machine
 Suction connecting tubing
 Suction catheters
 Normal saline
 Sterile or clean cup
 3cc saline ampules (“bullets”)
 Ambu bag
 Tissues
 Gloves
 PROCEDURE

 Explain procedure in a way appropriate for

child's age and understanding.
 Wash hands.
 Set up equipment and connect suction catheter
to machine tubing.
 Pour normal saline into cup.
 Put on gloves (optional).
 Turn on suction machine (suction machine
pressure for small children 50-100mm Hg, for
older children/adults 100-120mm Hg)
 Place tip of catheter into saline cup to moisten
and test to see that suction is working.
 Instill sterile normal saline with plastic squeeze
ampule into the trach tube if needed for thick or
dry secretions. Excessive use of saline is not
recommended. Use saline only if the mucus is
very thick, hard to cough up or difficult to
suction. Saline may also be instilled via a syringe
or eye dropper, which is less expensive than
single dose units. Recommended amount per
instillation is approximately 1cc.
 Gently insert catheter into the trach tube without
applying suction. (Suction only length of trach tube -
premeasured suctioning. Deeper insertion may be
needed if the child has an ineffective cough.)
 Put thumb over opening in catheter to create suction
and use a circular motion (twirl catheter between thumb
and index finger) while withdrawing the catheter so that
the mucus is removed well from all areas. Avoid
suctioning longer than 10 seconds because of oxygen
loss. Note: Some research has shown that by applying
suction both going in and then out of the tube takes less
time and therefore results there is less hypoxia. Also,
there are now holes on all sides of the suction catheters,
so twirling is not necessary.
 Draw saline from cup through catheter to clear
catheter.
 For trach tubes with cuffs, it may be necessary
to deflate the cuff periodically for suctioning to
prevent pooling of secretions above trach cuff.
 Let child rest and breathe, then repeat suction if
needed until clear (allow at least 30 seconds
between suctioning).
 Oxygenate as ordered (extra oxygen may be
given before and after suction to prevent
hypoxia).
Assisted Ventilation using Bag- valve-
mask
s
 Other suctioning Devices

 A newer suction technique, which is used most

often in hospitals for children on ventilator
support is a closed multiuse catheter system,
also called an "in-line" catheter. This closed
system allows suctioning without disconnecting
the ventilator. The catheter is protected inside a
sleeve and is usually changed only once a day.
IN-LINE CATHETER
 In addition to a stationary suction machine,
small, portable, battery-operated suction
machines are available for travel. The batteries
are rechargeable or the machine can be plugged
into a car cigarette lighter.
 The DeLee suction trap is a small plastic suction
device. The caregiver sucks on a tube to create
a negative suction pressure. (The secretions are
collected in a sputum trap and do not come in
contact with the caregiver) .
DeLee Suction trap
 The CoughAssist is an alternative to
traditional suctioning that is especially
helpful for those with an ineffective ability
to cough. The CoughAssist assists patients
in the removal of bronchial secretions from
the respiratory tract. This is a new,
vacuum-like, non-invasive technique .
COUGH ASSIST DEVICE
HAND OPERATED SUCTION SYSTEM