TRACHEOSTOMY
SUCTIONING
PREPARED BY : SDU 2019
OBJECTIVE
At the end the teaching participants will be able to :
Define tracheostomy suctioning
Enumerate the indication of tracheostomy
suctioning
Discuss the significance of appropriate cuff
pressure
Explain the suction techniques and steps of
procedure
ANATOMY
DEFINITION
Suctioning is a technique of aspirating secretion
through a catheter connected to a suction machine or
wall suction outlet.
Oropharyngeal / Nasopharyngeal Endotracheal /Tracheostomy
Suctioning Suctioning
Removes secretion from the upper Remove secretion from the
respiratory tract trachea and bronchi or the lower
respiratory tract
Suction Depths
Shallow Suctioning: Suctioning secretions(coughed up)
at the opening of the tracheal /ET tube
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).
SUCTION TECHNIQUE
Open system suctioning
Clearing the airways of a mechanically ventilated patient with a
suction catheter inserted into the endotracheal tube / tracheotomy
after patient has been disconnected from the ventilator circuit.
Closed system ( in line) suctioning
Safe method of removing secretions from tracheo-bronchial tree of
patient’s requiring mechanical ventilation without disconnecting
ventilator.
Types of tracheostomy tubes
Plastic Metal
Cuffed Uncuffed
Fenestrated Non Fenestrated
Single cannula Double cannula
Parts of Tracheostomy tube
Tracheostomy tube cuff
High volume-low pressure
Cuff inflated with air (blue)
Cuff inflated with foam(Red)
The foam cuff provides a continuous seal and can be used as
an alternative to air-filled cuffs when persistent air leaks occur
with mechanical ventilation
Low volume-high pressure
Cuff inflated with water(colorless)( tight to shaft)
Tracheostomy cuff pressure should be between
20mmHg and 25mmHg or 15 -30 cm of H2O
Higher pressure - cause tracheal mucosal damage.
Too low pressure- cuff fails to achieve an adequate seal
against the tracheal mucosa and risk of a severe air leak
causing hypoventilation.
If cuff pressures are equal to the recommended level and
an air leak persists, medical advice should be sought
before any further air is inserted into the cuff.
Procedure to check Cuff Pressure
Using Manometer
Connect the pilot balloon to the gauge
Depress the one way valve by pushing
the two together
Pressure can be adjusted using the
gauge
Note the pressure indicated on the gauge Cuff pressure to be
Disconnect
checked twice daily
TAKE CARE NOT TO DEFLATE THE
BALLOON DURING DISCONNECTION. If
this occurs re-inflate the cuff.
to avoid tracheal trauma due
TECHNIQUES to over inflation
1.Minimal Occluding Volume
Technique(MOV):
After deflating the cuff place a stethoscope just
below thyroid cartilage , then inflate until
hissing sound disappears, so that airway is sealed
to receive positive pressure ventilation.
2.Minimal Leak Technique(MLT): The same
procedure as above after the airway is sealed,
slowly withdraw a small amount of air, so that a
slight leak is heard at the end of inspiration.
SUCTION DEVICES
Portable suction devices
Minimum suction force of -80 to -120mmHg
Wall mounted suction unit
Provides vacuum of more than -300mmHg.
SUCTION PRESSURE:
Neonates : - 60 to - 80 mmHg
Children : -80 to -100 mmHg
Adult : - 80 to -120 mmHg
SUCTION CATHETERS
1.Soft suction catheters
Whistle- tip or Used to clear
French catheters thin secretions
Can be inserted in to the nares,
mouth, through an OPA or
NPA or through a
tracheostomy tube
Suction Catheters Contd…
2. Rigid suction catheters / Yankauer suction catheters.
Used to remove thick
secretions and
particulate matter from
the mouth and
oropharynx
Choosing Correct Suction Catheter
ET tube / Tracheostomy inner diameter ( ID ) X 2= suction
catheter Size (Fr). ET/Trach Tube (mm I.D) Catheter Size (Fr)
2.5 5.0
3.0 6.0
3.5 8.0
4.0 8.0
4.5 8.0
5-7 10
7.5-8 12
8-8.5 14
Suction Catheters Contd…
Age group Catheter Size
Adult 12-14 Fr
Pediatrics 8-10Fr
Neonates 6-8 Fr
INDICATIONS
Therapeutic
Coarse breath sounds ( Noisy Breathing)
Patients with copious, retained secretions who cannot
cough well due to loss of muscle tone, loss of adequate
cough reflex.
Visible secretions in the airway
Decreased SpO2 & deterioration of arterial blood gas
values.
During special procedures Eg: Bronchoscopy &
Endoscopy.
Diagnostic
To collect sputum sample.
PROCEDURE
Assessment.
Preparation of patient and articles.
Implementation.
Evaluation.
Assessment
Patient should be monitored prior to during and after
procedure for following:
Breath sounds
Oxygen saturation
Respiratory rate & pattern
Cough effort
Sputum characteristics: (color, volume, consistency,
odor )
Ventilator parameters ( PEEP, FiO2, )
Preparation
Explain the procedure.
Pre oxygenate with 100% oxygen for at least 30 seconds
before & after suctioning.
Position the patient in semi fowlers position, if not
contraindicated.
Don’t apply suction while inserting the catheter. This can
increase the chances of injuring the mucus membranes.
Equipments needed for suctioning
Suction unit
Suction catheter
AMBU bag
Suction kit (gallipot and gauze)
Personal protective equipments
Sterile gloves
Normal saline & sterile water
5 ml syringe
Stethoscope
S.NO PROCEDURE
1 Identify indication for suctioning.
2 Review patient condition
3 Perform hand hygiene.
4 Assemble equipment (Suction catheter, suctioning set, sterile gloves, clean
gloves and Normal saline)
5 Identify the patient and explains the procedure.
6 Check the suction pressure
7 Position the patient appropriately.
8 Don personal protective equipments.
9 Disinfect hands.
10 Wear clean gloves.
11 Open the sterile suction set and pour normal saline into the gallipot.
S.NO PROCEDURE
12 Place the towel under the patient chin.
13 Open the suction catheter package exposing only the suction port
14 Attach the suction tube to the suction apparatus without removing it from
the cover.
15 Hyperventilate the patient.
16 Remove the gloves and Disinfects hands.
17 Wear sterile gloves on both hand.
18 Remove the suction tube cover and Moistens the catheter tip by dipping it
into the saline solution
19 Check the suction pressure by covering the suction control port with the
thumb
20 Insert the suction catheter into the ET tube until resistance is felt and then
withdraw one centimeter
21 Apply intermittent suction (don’t exceed 10 sec) while gently rotating and
withdraws the catheter
22 Rinse suction catheter and suction tubing in gallipots with normal saline.
S.NO PROCEDURE
23 Suction Oropharyngeal cavity.
24 Rinse suction catheter
25 Disconnect and discard the suction catheter enclosed into the gloves
26 Maintain sterile technique throughout procedure
27 Discard used supplies and gloves.
28 Hyperventilate the patient
29 Reassess the patient
30 Perform hand hygiene
31 Document necessary information
DOCUMENTATION
Type of suctioning Color
Nasal, oral ,ET, tracheostomy Clear, white, yellow, green,
red streaks (bloody)
Frequency
Thickness
Time
Thin, thick, frothy
Amount How the patient
None, scant, small, medium,
large, copious
tolerated the procedure
Cooperative, crying, resisting
Instillation:
The instillation of sterile 0.9% saline should not be done on a
routine basis but may be required for tenacious secretions..
May promote infection by washing bacteria from artificial airway
into lower airway tracts
If required, instill sterile 0.9% saline into the tube, during
inspiration:
Neonates : 0.3 – 1 ml
Infant : 0.5 – 1.5 ml
Child : 1.5 – 2 ml
Adult : 2 – 3 ml
COMPLICATIONS
Hypoxia
Tracheal / bronchial mucosal trauma
Cardiac/respiratory arrest
Pulmonary hemorrhage
Cardiac dysarrythmias
Pulmonary atlectasis
Bronchospasm
Hypotension
CAUTION
Suctioning is potentially harmful procedure if not carried
out properly.
Suctioning should be done when clinically necessary (not
routinely).
The need for suctioning should be assessed at least every
2 hours or more frequently as need arises.
Suction should not be applied for more than 10 seconds.
Ventilation and oxygenation should not be interrupted
more than 15 seconds in adults & pediatrics.
