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
- Pulmonary haemorrhage/bleeding
- Elevated intracranial pressure
- nterruption of ventilation (Non Invasive Ventilation/IPPV)I
- Hypotension (AACN guideline for clinical practice 1992)
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.
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
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.
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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