An airway is a part of the body that conducts air to the lungs for breathing. The nose, the mouth and the trachea all form part of the airway. These parts of the airway clean, warm and moisten the air before it reaches the lungs. Show
People who are unwell might need an artificial airway. Artificial airways are plastic tubes that can pass through the nose, the mouth or the neck as a tracheostomy. When an artificial airway is in place, some of the important protective functions of the natural airway are bypassed. What is suctioning?Suctioning is a common procedure that removes oral and respiratory secretions from the airway and keeps it clear. Why do patients in Intensive Care need suctioning?When an artificial airway is in place, the tube needs to be kept clear so that air can pass into the lungs easily. Sometimes patients without an artificial airway may also need suctioning. Suctioning allows for rapid clearing of secretions and prevents the airway from becoming blocked. Suctioning usually leads to an improvement in breathing. What are the types of suctioning patients receive in Intensive Care?A small tube, also called a suction catheter, is attached to suction and placed into the airway to remove any secretions and maintain a clear airway. With an artificial airway, a suction catheter might be continuously attached. Otherwise, the suction catheter is used once then disposed of. Suction is a relatively quick procedure and each insertion of the suction catheter will not last more than 10-15 seconds. Patients will be given time to recover from any discomfort between each pass of the catheter. Suctioning may be required regularly but the timing will be different for every person and will depend on what they need. What are the risks?Suctioning is important but not without some risks. It is usually uncomfortable and will cause coughing. It is possible that there may be some injury to the airway tissues which can cause bleeding. More serious risks include decreased oxygen levels in the blood and a slow heart rate. These issues are often transient and can usually be easily managed by the clinical staff performing the procedure. Suctioning an airway, version 1. Author: Margherita Murgo, Patient Safety Officer, Clinical Excellence Commission, April 2016. The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.
Suction airways during mechanical ventilation only when clinically indicated and not as a routine, fixed-schedule treatment. If the patient develops respiratory distress or cardiac decompensation during the suctioning procedure, immediately withdraw the catheter, supply additional oxygen, and deliver manual breaths as needed. Suctioning can cause elevations in intracranial pressure (ICP) in patients with head injuries. Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions. OVERVIEWEndotracheal (ET) and tracheostomy tubes are used to maintain a patent airway and to facilitate mechanical ventilation. ET or tracheostomy tube suctioning is performed to maintain the patency of the artificial airway and to improve gas exchange, decrease airway resistance, and reduce infection risk by removing secretions from the trachea and mainstem bronchi. Suctioning also may be performed to obtain samples of tracheal secretions for laboratory analysis. ET and tracheostomy tubes prevent effective coughing and natural secretion removal, which necessitates the need for periodic suctioning to remove pulmonary secretions. In acute care situations, suctioning is always performed as a sterile procedure to prevent hospital-acquired pneumonia. Indications for suctioning include:
There are two basic methods of suctioning. In the open-suction technique, after disconnection of the ET or tracheostomy tube from any ventilatory circuit or oxygen sources, a sterile single-use suction catheter is inserted into the open end of the tube. In the closed-suction technique, also referred to as “in-line suctioning,” a multiuse suction catheter inside a sterile plastic sleeve is inserted through a special diaphragm attached to the end of the ET or tracheostomy tube (Figure 1) 100% oxygen should always be provided before and after each pass of the suction catheter into the ET tube, whether suctioning is done with the open- or the closed-suction method.undefined#ref3">3 The suction catheter should not be any larger than one half of the internal diameter of the ET or tracheostomy tube.3 Closed or in-line suction catheters are available in two lengths: a longer one for ET tubes and a shorter one for tracheostomy tubes. Adequate systemic hydration and supplemental humidification of inspired gases help thin secretions for easier aspiration from airways. Instillation of a bolus of sterile 0.9% sodium chloride solution is not a recommended routine practice.2 Complications associated with artificial airway suctioning during mechanical ventilation include:
Tracheal mucosal damage (e.g., epithelial denudement, hyperemia, loss of cilia, edema) occurs during suctioning when tissue is pulled into the catheter-tip holes. These areas of damage increase the risk of infection and bleeding. Suctioning is a necessary procedure for patients with artificial airways. No absolute contraindication to suctioning exists when clinical indicators point to the need for it. EDUCATION
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*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice. Elsevier Skills Levels of Evidence
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