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Suction

Each patient requires individual assessment and constant re-assessment to ascertain the frequency of suction required.  The lowest possible vacuum pressure should be used to reduce complications which includes atelectasis (Regan 1988, Rosan et al 1962).

Indications for suctioning

  • Coarse breath sounds on auscultation or “noisy” breathing
  • Patients inability to generate an effective spontaneous cough
  • Visible secretions in the airway
  • Suspected aspiration of gastric or upper airway secretions
  • Clinically apparent increased work of breathing
  • Deterioration of arterial blood gases
  • Radiological changes consistent with retention of pulmonary secretions
  • The need to maintain patency and integrity of the artificial airway
  • The need to stimulate a cough in patients unable to cough effectively secondary to changes in mental status or the influence of medication
  • Presence of pulmonary atelectasis or consolidation, presumed to be associated with secretions retention (AACN guideline for clinical practice 1992)
  • Patient requests suctioning
  • During cuff deflation
  • Low oxygen saturations

Risk associated with suctioning

  • Tissue trauma to the bronchial and tracheal mucosa
  • Cardiac arrest
  • Respiratory arrest
  • Cardiac arrhythmia
  • Pulmonary atelectasis
  • Bronchoconstriction/bronchospasm
  • Infection
  • Pulmonary haemorrhage/bleeding
  • Elevated intracranial pressure
  • nterruption of ventilation (Non Invasive Ventilation/IPPV)I
  • Hypertension
  • Hypotension (AACN guideline for clinical practice 1992)

Suction Techniques

Closed suction system with t-piece attatched.

Staff should decide which is the most  appropriate method of suctioning for their patients.  The chart below gives guidance on which method of suction to consider.

Click here for instruction on how to apply tracheal suction to the pateint with a tracheostomy tube, these are generic to all patients when preparing for suctioning via a tracheostomy tube.

OPEN SUCTION
  • Suitable for patients on low or no additional oxygen, who do not desaturate on disconnection for short periods of time with minimal uninfected secretions who pose no infection control risk

Click here for instructions on how to apply tracheal suction to the patient with a tracheostomy tube using an open suction technique, follow the instructions above in preparation

Closed Suction
  • Suitable for patients who require IPPV, who require high FiO2, who desaturate quickly when oxygen is disconnected or who have copious or infected secretions or who pose an infection control risk.
Click here for instructions on how to apply tracheal suction to the patient with a tracheostomy tube using a closed suction technique, follow the instructions above in preparation

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