Endotracheal/ Tracheal Suctioning Procedure

OBJECTIVES: The nurse performs endotracheal and tracheotomy suctioning to: 1. Maintain a patent airway.
2. Improve oxygenation and reduce the work of breathing. 3. Remove accumulated trachiobronchial secretions using sterile technique. 4. Stimulate the cough reflex.

5. Prevent pulmonary aspiration of blood and astric fluids. 6. Prevent infection and atelectasis. EQUIPMENT: Sterile normal saline Suction source Ambu bag connected to 100% O2 clear protective goggles/mask or face shield Sterile gloves for open suction Clean gloves for (in-line) closed suction Sterile catheter with intermittent suction control port or in-line suction catheter PROCEDURE:
1. Wash hands. Reduces transmission of microorganisms. 2. Access the need for suctioning. Since endotracheal can be hazardous and

causes discomfort, it is not recommended in the absence of apparent need:

a. Course breath sounds b. Coughing ; increased respirations

c. Increased PIP on ventilator

3. don goggles and mask or face shield. Potential for contamination. 4. Turn on suction apparatus and set vacuum regulator to appropriate negative

pressure. Recommended is 80-120mmH; adjust lower for children and elderly. Significant hypoxia and damage tracheal mucosa can result from excessive negative pressure.
5. Prepare suction apparatus. Secure one end of connecting tube suction machine,

and place another end in a convenient location within reach.

6. Use in-line suction catheter or open sterile package (catheter size not exceeding

one half of the inner diameter of the airway) on a clean surface, using the inside of the wrapping as a sterile field.
7. Prepares catheter and prevents transmission of microorganisms. Catheters

exceeding one half of the diameter increases the possibility of suction induced hypoxia and atelectasis.
8. Prepare catheter flushed solution with in-lined catheter use sterile saline bullets

to flush catheter.
9. With in-line suction catheter, use clean gloves. With regular suction, don sterile

gloves. Maintain sterility. Use universal precautions. Dominant hand must remain sterile troughout the procedure.
10. Pick up suction catheter, being careful not to touch unsterile surfaces. With non-

dominant hand, pick up connecting tubing. Secure suction catheter to connecting tubing to maintain catheter sterility. Connect suction catheter and connecting tubing.
11. Ensure equipment function. Check equipment for proper functioning by

suctioning a small amount of sterile saline from the container. (skip this step in inline suctioning.)
12. Remove or open oxygen or humidity device to the patient with non-dominant

hand (skip this in in-line suctioning) opens artificial airway for catheter entrance. Have second person assist when indicated to avoid unintentional extubation.
13. Replace O2 delivery device or reconnect patient to the ventilator.

Hyperoxygenate and hyperventilate via three breaths by giving patient additional manual breaths on the ventilator before suction. Hyperoxygenate with 100% O2 is used to offset hypoxemia during interrupted oxygenation and ventilation. Pre oxygenation offsets volume and O2 loss with suctioning. Patients with PEEP should be suctioned through an adapter on the closed suction system.

14. Without applying gently but quickly insert catheter with dominant hand. Inspirate

until resistance is met; then pull back 1-2 cm. Catheter is now on tracheobronchial tree. Application of suction pressure upon insertion increases hypoxia and results in damage to the tracheal mucosa.
15. Apply intermittent suction by placing and releasing dominant thumb over the

control vent of the catheter. Rotate catheter between the dominant thumb and forefinger as you slowly withdraw the catheter. With in-line suction, apply continuos suction by depressing suction valve and pull catheter straight back. Time should not exceed 10-15 seconds. Intermittent suction and catheter rotation prevent tracheal mucosa when using regular suctioning methods. Unable to rotate in closed-suction method.
16. Replace oxygen delivery device. Hyperoxygenate between passes of catheter

and following suctioning procedure. Replinishes O2. Recovery to base. PaO2 takes 1-5 minutes. Reduces incidents of hypoxemia and atelectasis.