evidence & practice / CPD / airway management | PEER-REVIEWED |

Principles of suctioning in infants, children

and young people
Earlroy Edwards

Citation
Edwards E (2018) Principles of
suctioning in infants, children
and young people. Nursing
Children and Young People.
doi: 10.7748/ncyp.2018.e846
Abstract
Suctioning to clear airway secretions is an important part of the nursing care for children with
respiratory conditions. While the principles of safe suctioning are known widely, they are not closely
adhered to. The adverse effects of suctioning can easily be overlooked to the detriment of the
patient. Careful risk assessment and patient observation are needed to ensure that suctioning is
performed only when necessary and the risks to the patient are minimised.

Peer review Author details

This article has been subject to Earlroy Edwards, senior lecturer, Society & Health Faculty, Buckinghamshire New University, Uxbridge,
open peer review and has been Middlesex, England
checked for plagiarism using
automated software Keywords
adolescents, babies, child health, infants, respiratory, tracheostomy, tracheostomy tube
Correspondence
E.Edwards@bucks.ac.uk

Conflict of interest Aim and intended learning outcomes
None declared The aim of this article is to explore the nursing
considerations that should be made before
Accepted and while suctioning a normal or long-term
15 January 2018 artificial airway in children and young people.
After reading this article and completing the
Published online time out activities, you should be able to:
June 2018 »»Identify the process and function of secretion
production in the airway.
»»Summarise the indications for suctioning
infants, children and young people.
»»Describe the principles of best practice when
suctioning a normal or artificial airway.
»»Describe the hazards associated
with suctioning.
»»Discuss the psychological effects of routine
airway suctioning on the child and family.
Introduction
The structure of the respiratory tract is
conserved by bones and cartilage to maintain
its shape and patency. Ciliated columnar
epithelium containing goblet cells lines the
surface of the airway and secretes mucus.
In normal conditions the presence of
mucus in the airway acts as a lubricant by
saturating inspired air with water. As part
of the body’s normal defence mechanism an
inflammatory response is triggered in reaction
Permission to a respiratory airway infection (Ward and
To reuse this article or Linden 2013). Mucus and upper airway
for information about
reprints and permissions, secretions are overproduced to neutralise
please contact and mobilise pathogens from the respiratory
permissions@rcni.com tract. However, this overproduction of mucus
in the airway can cause partial or complete
obstruction if the cross-sectional area of the
airway is reduced significantly. Inadequate
airway patency may lead to the child becoming
hypoxic, triggering a respiratory arrest and
a cardiopulmonary arrest if appropriate airway
management is not introduced (Bloxham et al
2009, Akers 2015).
The patency of the respiratory tract must
be maintained to allow atmospheric air to
reach the alveoli where the absorption of
atmospheric oxygen and the excretion of
carbon dioxide can take place. Suctioning
is a useful method to maintain airway
patency, particularly in the absence of an
effective cough.
In the UK suctioning of the oral and
nasopharyngeal airway is practised widely and
recognised as an essential and important part
of the nursing care for infants and children
with a respiratory condition (Macqueen et al
2012). However, the hazards associated with
suctioning need to be considered to ensure
the well-being and safety of infants, children
and young people.
Nurses are responsible for keeping up
to date with knowledge that is needed for
clinical practice (Savage and Moore 2004;
Nursing and Midwifery Council 2015). While
suctioning is practised widely in the home and
in hospital settings in the UK, recent research
on suctioning a normal or artificial airway is
sparse, particularly in children. Much of the
evidence used to guide practice in the children’s

46 / July 2018 / volume 30 number 4 nursingchildrenandyoungpeople.co.uk

| PEER-REVIEWED |
setting has been based on the findings of
healthcare practitioners looking after adult
patients. While the principles applied to
suctioning will be similar regardless of the
person’s age, the differences in the anatomy
and physiology of the paediatric and adult
airway must be acknowledged. Recognition
of the differences must be central to the risk
assessment needed to minimise the potential
adverse effects associated with suctioning. To
promote best outcomes for infants, children
and young people requiring airway clearance,
suctioning should only be performed when
necessary. When suctioning is indicated the
risks to the infant, child and young person
should be identified and minimised by ensuring
the correct preparation, equipment and
techniques are used (Dawson et al 2012).
The respiratory tract
The respiratory tract comprises the upper and
lower airway (Figure 1). The upper airway
includes the organs that meet atmospheric air
and are located outside of the thorax, while
the organs of the lower respiratory tract sit
predominantly within the thorax (Thibodeau
and Patton 2007). Organs of the upper airway
consist of the mouth, nasal cavity and pharynx,
which can be divided into the oropharynx,
nasopharynx and laryngopharynx. The
function of the upper airway is to warm,
humidify and filter atmospheric air entering
the lungs. The lower respiratory tract is
primarily responsible for the diffusion of
oxygen into the bloodstream and the removal
of carbon dioxide through upper airway
expiration. The lower airway consists of the
larynx, trachea, main bronchus (right and left)
and bronchioles.
The upper airway also protects the lower
airway. The production of mucus and the
action of tiny filament hairs called cilia trap,
transport and omit fragments of material
alien to the normal airway. This material is
discarded through coughing and sneezing
and is expelled through the pharynx or the
gastrointestinal tract and the small intestine
if swallowed and excreted.
Respiratory tract in infants
and young children
The dimensions and structure of the
respiratory system in infants and young
children differ from that of adults. First, the
infant’s highly compliant airway, as found
in the soft and cartilaginous trachea, makes
it vulnerable to distension and compression,
leading to occlusion or collapse in response to
a build-up of airway secretions. In addition,
nursingchildrenandyoungpeople.co.uk
peripheral airways tend to close in infancy
during tidal breathing as a consequence
of a highly compliant chest wall (Hammer
2013). Infants and young children who Revalidation
experience an increase in airway resistance Prepare for revalidation:
will struggle to breathe and will increase read this CPD article,
respiratory effort to overcome the resistance answer the questionnaire
of air travelling down the respiratory tract. and write a reflective
account. For more
The infant’s diaphragm is the main muscle of information, go to rcni.
ventilation; in times of increased respiratory com/revalidation
effort this muscle is prone to fatigue. This
fatigue is further compounded as the infant’s
respirations cannot be made more efficient
because the horizontal positioning of the ribs
does not allow a transverse increase in the
diameter of the chest during respiration to
increase tidal volume.
Second, the smaller diameter of nasal
passages, trachea, bronchus and bronchioles
allows a significant proportion of the airway
diameter to be lost when a relatively small
amount of airway secretions is present.
Small changes in the diameter of the airway
will significantly increase airway resistance.
Up until the first four to six months of life,
infants are preferential nose breathers and will
experience respiratory distress if the nostrils
become occluded with secretions.
The alveoli are thick walled at birth with
only 10% of the number of alveoli present
in comparison to an adult (Baatz and Ryan
Figure 1. The respiratory tract
Sinus
Pharynx
Larynx
Epiglottis
Trachea
Left lung
Bronchi
Alveoli
Diaphragm
volume 30 number 4 / July 2018 / 47
evidence & practice / CPD / airway management
2017). The efficacy of gaseous exchange at this
stage in development is clearly limited.
Lung volume doubles by six months of
age and triples by the infant’s first birthday.
The length and diameter of the neonatal
trachea are approximately 4cm and 4mm,
compared with approximately 12cm and
25mm respectively for an adult (Baatz and
Ryan 2017). The previously highly compliant
chest wall becomes less compliant. It is not
until eight years of age that a child’s airway
displays characteristics of the adult airway in
terms of anatomy and physiology.
Production of mucus
Mucus production occurs in two distinct
regions: by goblet cells in the epithelium on the
surface of the airway and in the seromucous
glands located on the mucosal epithelium
(Martini et al 2011). Mucus production is
essential for the normal functioning of the
airway and usually goes undetected, apart from
during illness. Excessive mucus production
through goblet cell hyperplasia, submucosal
gland hypertrophy and a change in mucus
normally signals the onset of an underlying
pathological cause. The excessive production
of mucus occurs in response to the initiation
of the inflammatory response (Figure 2).
The inflammatory response involves the
ERRATUM – 7/8/18 overproduction of mucus to engulf invading
This article has been bacteria and serves as a barrier to the transfer
updated to state that the of pathogenic bacteria further down the
length of the trachea in respiratory tract.
neonates is approximately
4cm and the length
Mucus contains the antibacterial enzyme,
of the adult trachea lysozyme, which destroys bacteria in the
approximately 12cm. airway. Furthermore, mucus serves as a barrier
Figure 2. The inflammatory response
» Increased production of airway mucus
» Release of chemical messengers
» Mast cells release chemical mediators (histamine and prostaglandin), bradykinin and nitric
Stage 1 oxide to trigger inflammation
» Activation of mast cells, phagocytes and macrophages, which release chemical mediators
(histamine and prostaglandin) to trigger inflammation. Vasodilation and the stimulation of
Stage 2 pain receptors (nociceptors) also occur
» Phagocytosis of pathogens occurs by T lymphocytes (T cells)
» Leucocytes increase body temperature to make inhospitable environment for the survival
of pathogens
Stage 3 » Mucus and white blood cells engulf debris and microbes
(Adapted from Ward and Linden 2013)
48 / July 2018 / volume 30 number 4
| PEER-REVIEWED |
to the passage of bacteria and debris further
down the airway, which may disrupt gaseous
exchange in the alveoli. However, if excessive
amounts of mucus are produced this may result
in airway occlusion. In cystic fibrosis a faulty
cystic fibrosis transmembrane regulator gene
leads to the impairment of the transport of
water across the membrane that produces
mucus (Quon and Rowe 2016).
Children and adults with cystic fibrosis
produce abnormally thick mucus that
provides a hospitable environment for
respiratory infections, which over time can
impair the person’s respiratory function.
The consequences of immobile secretions
include increased risk of lung infections
and impaired lung function over time
(Bloxham et al 2009).
Respiratory conditions such as asthma,
bronchiolitis and cystic fibrosis are all
associated with mucus hypersecretion as
the condition is exacerbated as part of
an inflammatory response to a pathogen
(Figure 2); therefore early detection and
clearance of these secretions are important
aspects of the healthcare management plan
(Rogers 2007, Barnes et al 2009).
The inflammatory response is triggered
by airway irritation and the presence of
infection in the airway and works by reacting
to signals of infection and injury in the body.
Increased mucus production and the release
of chemical mediators protect the body
against injury and mobilise white blood cells
to fight infection (Figure 2). Detection of an
inflammatory response may indicate airway
infection, which may be confirmed by testing
of a cough swab, sputum sample or airway
secretions (Coyne et al 2010).
TIME OUT 1
Tracheostomy care
Pause now to consider what respiratory functions and
structures are bypassed when a child has a tracheostomy.
Why might their subsequent secretions become drier and
need more frequent suctioning?
Artificial air way – tracheostomy
Children diagnosed with bronchomalacia or
tracheomalacia have floppiness in that part of
the airway, which causes a degree of occlusion.
Children who are unable to maintain
normal respiratory function may require
a tracheostomy (artificial airway) to bypass
damaged or malformed features of the upper
airway (Wood et al 2012).
Children with an artificial airway are more
susceptible to possible secondary airway
occlusion and may find it difficult to maintain
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| PEER-REVIEWED |
patency of their airway for a number of
reasons (Rogers 2007).
Walsh et al (2011) suggest that children
with an artificial airway have increased
production of secretions due to irritation
caused by the tracheostomy tube coming into
direct contact with their own airway. This
artificial airway also bypasses the natural
humidification and filtering action of the upper
airway leading to the production of thicker
secretions. Davies and Moores (2010) explain
that the reduced humidification in the airway
also inhibits mucociliary transport achieved by
the movement of tracheal cilia.
The expulsion of debris located in the lower
airway is further inhibited if the cough reflex
becomes less effective. Having a tracheostomy
in place may mean that it is difficult to
produce a strong cough as its position
prevents closure of the larynx by the glottis,
which is needed to produce a significant
increase in airflow velocity (Morrow and
Argent 2008). Increased airflow velocity
generates enough force to clear secretions
and matter from the upper airway. Children
with a tracheostomy normally require regular
suctioning to help clear airway secretions
(Argent 2009).
All children with a tracheostomy must have
access to a suction machine to clear airway
secretions always. Parents are taught how to
use a suction machine as part of their child’s
discharge plan before leaving hospital.
TIME OUT 2
Suctioning
Write a one paragraph case study summary of a child
who required suctioning, noting what prompted you to
suction the child. Was suctioning solely mandated by
the child’s condition (vital signs), level of comfort or
parental concern?
Knowledge and skills associated
with suctioning
In the past nurses have displayed a deficit in
knowledge and skills along with a lack of
awareness of the inherent risks associated with
suctioning (Macmillan 1995, Day et al 2002).
More recently, Kelleher and Andrews (2008)
and Argent (2009) found vast variations in
practice and poor adherence to guidelines
detailing best practice for suctioning. Since
Argent’s (2009) article, there has been little
research in this area. While there are perceived
benefits of suctioning, such as maintaining
airway patency, contraindications include
atelectasis, hypoxia and localised trauma.
Argent (2009) suggests that the risks
associated with suctioning are not always
nursingchildrenandyoungpeople.co.uk
immediately apparent and may be overlooked, FURTHER RESOURCES
particularly as suctioning is a common and The author has made a
familiar nursing practice. Knox (2011) video to accompany this
CPD. It can be viewed at
warns that this overfamiliarity could lead to
youtu.be/yRfjn_K7SBs
complacency in technique and insufficient
risk assessment before the procedure.
Walsh et al (2011) examined children’s
airway maintenance and clearance and
found that greater awareness was needed
of the indications and contraindications for
suctioning to maintain patient safety and
maximise the effectiveness of this intervention.
Indications for suctioning
Suctioning is indicated and generally accepted
in response to audible and visible secretions,
diminished breath sounds on auscultation
and a reduction in oxygen saturations
(Ireton 2007). Many other indicators have
been presented in the literature (Box 1).
What remains unclear is if suctioning
should take place in response to one or all
these indicators. Cockett and Day (2010)
suggest that the presence of secretions alone
is not an adequate signal of the need for
oropharyngeal suctioning.
A decision must be made about the
child’s respiratory function by reviewing
excessive coughing, chest movement, breath
sounds, respiratory rate and a drop in
oxygen saturations with an increase in heart
rate. These indicators suggest a decline in
respiratory function that would warrant
further assessment of airway patency.
The accumulation of bronchial secretions
that cannot be cleared by the child can
Figure 3. Preparing to undertake nasopharyngeal suctioning
volume 30 number 4 / July 2018 / 49
evidence & practice / CPD / airway management
potentially occlude the airway, precipitate
respiratory failure from the resultant
impairment of gaseous exchange and present
a ventilation-perfusion mismatch (Barnes et al
2009, Hough 2014).
To minimise the need for suctioning
the following causes of increased mucus
production must be excluded or treated:
infection, dehydration, hypoxia and reduced
humidity (Everitt 2016). Regular patient
repositioning, fluid balance monitoring,
ensuring the patient is well hydrated and using
nebulisers can be incorporated into care to
help increase the mobility of secretions and
prevent airway consolidation and the blockage
of an artificial airway (Walsh et al 2011).
TIME OUT 3
Hazards of suctioning
Make a list now of what you believe to be the potential
hazards associated with oral, nasopharyngeal and
tracheal suctioning
Hazards
Suctioning is a recognised technique for the
clearance of airway secretions but it must be
used with caution. Although suctioning of
the upper airway is warranted for children
who cannot clear their own airway, Knox
(2011) suggests that nurses first make a risk
versus benefit assessment using an evidence-
based approach.
The principle of primum non nocere (first do
no harm) and practice that has been proved to
be beneficial to the recipient are recommended
(Beauchamp and Childress 2013). By
adhering to evidence-based guidelines the risk
potentiated of suctioning can be minimised.
There are many potential hazards associated
with suctioning (Box 2) that should be
considered before the procedure.
In the past it has been argued that nurses
were concerned that failure to clear secretions
may lead to the blockage of an artificial airway
and may have suctioned more frequently than
BOX 1. Indicators for suctioning
»»Visible secretions
»»Diminished breath sounds
»»Pulmonary atelectasis
»»Respiratory consolidation
»»Palpation of chest secretions (tactile fremitus)
»»Suspected aspiration
»»Increased work of breathing
»»Reduction in oxygen saturations
»»To obtain a sputum/nasopharyngeal sample
»»Onset of dyspnoea
(Donaldson and Holliday 2007)
50 / July 2018 / volume 30 number 4
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indicated by patient assessment (White 1997).
Nurses may continue to be overzealous in
their attempts to keep the patient’s airway
patent. Consequently, if suitable guidance
is not made available to nurses involved in
airway clearance, poor unsupported practices
may be adopted.
TIME OUT 4
Minimising risk
Think now of a patient that you have cared for who
required the use of suctioning. Make a note of the
measures that you took to minimise risk to the child. How
did you explain your approach to the parent or guardian
who witnessed the care that you gave?
Careful patient assessment is required
before suctioning (Dixon 2006, Walsh et al
2011). According to Kelsey and McEwing
(2008) suctioning should not be performed
at set time intervals, but when clinically
indicated. Consideration must be made to
determine if less invasive procedures such as
repositioning, postural drainage, gentle chest
percussion or the use of saline nebulisers
will help mobilise secretions. Less invasive
manoeuvres should always be considered
unless the patient’s condition deteriorates and
immediate intervention is required (Trigg and
Mohammed 2006).
Mucosal and tracheal damage may occur
if the suction catheter touches the surface
of the airway, causing direct trauma. When
suctioning a patient’s mouth, a Yankauer
(wide bore diameter) suction catheter can be
used. This allows for thick secretions to be
removed from the nasal and oral cavity. Direct
BOX 2. Hazards associated with
suctioning
Oral and nasopharyngeal
»» Trauma to nasal/oral mucosa
»» Tracheal
»» Hypoxaemia
»» Raised intracranial pressure
»» Bronchospasm
»» Atelectasis
»» Trauma to tracheal mucosa
Nasopharyngeal and tracheal
»»
»»
Cardiac arrhythmias
»»
Pain and discomfort
»»
Desaturation
»»
Hypertension
»»
Hypotension
»»
Increased mucus production
»»
Bleeding
Laryngospasm – if the larynx is touched
(Dixon 2006, Morrow and Argent 2008)
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| PEER-REVIEWED |
visualisation of the catheter tip throughout
suctioning will help to prevent trauma to
the oral cavity. Suctioning of the oral or
nasopharyngeal routes using a suction catheter
requires measurement of the suctioning
catheter to ensure that it does not extend or
touch the larynx to prevent laryngeal spasm
(Coyne et al 2010). Pre-measurement of
the suction catheter from the mouth to the
suprasternal notch (oral pharyngeal) or nose to
the suprasternal notch (nasopharyngeal) will
prevent this from occurring (Donaldson and
Holliday 2007; Coyne et al 2010).
Measurement of the diameter of the suction
catheter is based on an estimation of the size
needed to pass easily into the nasal cavity while
allowing thicker secretions to be suctioned. As
a guide, suction catheters size 5-6 French gauge
(Fg) are used in infants, size 6-8 Fg in children
and size 8-10 Fg in adolescents (Table 1)
(Dawson et al 2012).
For patients who require frequent
suctioning through these routes, the use of
a nasopharyngeal airway is recommended to
prevent further trauma to the nasal mucosa
(Macqueen et al 2012). A nasopharyngeal
airway is a non-permanent sheath that is
inserted easily into the nasal cavity using
a water-based lubricant. It provides a conduit
to protect and maintain the shape and integrity
of the nasopharyngeal space. This device
enables suctioning of the nasopharynx without
damaging the nasal mucosa.
To minimise direct trauma to the airway
for patients with an established tracheostomy,
the suction catheter should not project past
the end of the tracheostomy tube (Coyne et al
2010). It is good practice to have the length of
the tube measured on a template for reference.
This template can be used to premeasure the
length of the tube that is to be inserted into
the child’s airway.
Reducing suction pressures (Table 1), using
suction catheters that are equal to or less than
the internal diameter of the tracheostomy’s
inner tube and limiting the number of times
that a patient is suctioned to a maximum of
three in quick succession will also help to
minimise hypoxia and trauma. In addition,
the duration of each suctioning attempt should
be no longer than ten seconds (Dawson et al
2012). Walsh et al (2011) advocate that the
patient’s baseline readings return to normal
before subsequent attempts are made.
Damage to the mucous membranes and
transfer of microorganisms from the upper to
the lower respiratory tract are possible sources
for the development of respiratory infections
(Kelsey and McEwing 2008).
nursingchildrenandyoungpeople.co.uk
In a review of the potential hazards Online archive
associated with tracheobronchial suctioning, For related information,
Macqueen et al (2012) found that the visit nursingchildren
andyoungpeople.
advancement of the suction catheter too co.uk and search using
far could cause bradycardia and cardiac the keywords
arrhythmias due to vagal nerve stimulation,
with patients in a hypoxic state being more
likely to experience heart rhythm changes
(Coyne et al 2010).
There are mixed messages in the literature
about the use of saline as an irrigate for
artificial airways. Proponents for the use
of saline report that its use is advisable
after consultation with medical colleagues
(Dawson et al 2012). However, the use
of saline is contraindicated as it has been
found not to reduce the viscosity of mucus
(Wang et al 2017). Its use has also been
seen to reduce the diffusion of oxygen
in the lungs while increasing blood and
intracranial pressure. The use of saline
may potentially cause the proliferation of
bacteria in the lower airway (Cockett and
Day 2010). With most of the saline not being
recovered through suctioning the potential
harms associated with this technique should
not be overlooked. The use of nebulised
saline is preferred to the instillation of
saline, as it provides a more uniform
distribution of saline across the lung fields
(Klockare et al 2006).
TIME OUT 5
Saline
You see a colleague inserting saline into a tracheostomy
tube before suctioning. Is that person doing anything
wrong? If so, how would you challenge your colleague on ERRATUM – 7/8/18
their justification for this technique? The sentence reading
‘Pre-measurement of the
suction catheter from the
Nursing considerations nose to the suprasternal
The work of breathing is increased in the notch (oral pharyngeal)…’
presence of varying degrees of airway has also been changed to
obstruction and gas exchange involving the read ‘Pre-measurement
of the suction catheter
alveoli can become inefficient. Narrowing from the mouth to the
of the airway can leave the alveoli poorly suprasternal notch
ventilated during tidal breathing. This (oral pharyngeal)…’
TABLE 1. Recommended catheter sizes and suction pressures
Age of patient Size of suction catheter in Suction pressure
patient without artificial airway
Infant <1 year 5–6 French gauge (Fg) 60–80mmHg
Child 6–8 Fg 80–100mmHg
Adolescent 8–10 Fg Maximum 120mmHg
(Dawson et al 2012)
volume 30 number 4 / July 2018 / 51
evidence & practice / CPD / airway management
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| PEER-REVIEWED |
Despite the physiological effect on the child
of being suctioned psychological considerations
also need to be addressed. If administered
incorrectly, for example, if the suction catheter
encounters the airway mucosa, suctioning
can be a painful and distressing procedure.
Limiting suctioning attempts, reduced duration
of suctioning and decreased suction pressure
can help to reduce the painfulness of the
procedure. Informing the patient and providing
comfort afterwards can also reduce the
discomfort associated with this procedure.
Documentation of the reasons for suctioning
and the consistency and colour of the
secretions obtained can provide valuable
information on the presence of infection,
disease progression or the likelihood of airway
occlusion. Parents who routinely provide
suctioning for their child at home need to
be kept informed of changes to established
practice as recommendations are continually
updated. Good hand hygiene, single catheter
use, the use of personal protective equipment
and the disposal of used equipment in
a clinical waste bag will help to minimise the
risk of infection to the child and caregiver
(Credland 2016).
Day T, Farnell S, Haynes S et al (2002) Tracheal Everitt E (2016) Caring for patients with a
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nursingchildrenandyoungpeople.co.uk
| PEER-REVIEWED |

The procedural pain associated with using suctioning only when necessary. In the Write for us
suctioning may evoke a distressing and fearful absence of new research detailing the best For information about
reaction in children and can be psychologically practice related to the suctioning of the normal writing for RCNi
journals, contact
upsetting (Rokach 2016). Preterm babies who and artificial airway, it is important to review writeforus@rcni.com
were suctioned through an artificial airway and update local policies regularly according to
experienced changes in cerebral blood flow the available evidence guiding practice. More For author guidelines,
(Grunau 2013). Younger children may find research in this area is needed. go to rcni.com/writeforus
it difficult to understand that this familiar Families of children who require regular
procedure is essential and is intended to suctioning at home need to be educated on
benefit them (Rokach 2016). Without this the indications, benefits and contraindications
understanding, a young child may resist being associated with suctioning as long-term poor
suctioned. In a study by DeRowe et al (2003) practice can adversely affect the integrity
the introduction of play therapy improved of the airway through repeated trauma.
concordance with treatment in a young girl with Close attention should be paid to monitor
a tracheostomy. The girl was given a doll with any psychological effects associated with
a tracheostomy tube to play with and to provide suctioning that are displayed by the child
tracheostomy care including suctioning. who may become distressed before or
during the procedure.
Conclusion
The use of suctioning to clear airway secretions TIME OUT 6
is an important adjunct in the management of
Reflective account
children with respiratory conditions who are Now that you have completed the article, you may want to
at risk of deterioration (Knox 2011). Nurses complete the multiple-choice quiz and write a reflective
using suctioning for airway management need account as part of your revalidation. Go to rcni.com/ncyp-
to be aware of the principles for best practice. reflective-account to find out more. You can also complete
A firm understanding of these principles will a multiple-choice quiz on page 54
ensure that they provide airway clearance

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Professional Standards Practice and Behaviour for
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physical experiences of hospitalized children.
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maintenance and clearance in the acute care
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instillation before suctioning: A meta-analysis of
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nursingchildrenandyoungpeople.co.uk volume 30 number 4 / July 2018 / 53

evidence & practice / multiple-choice quiz

Suctioning
TEST YOUR KNOWLEDGE BY COMPLETING THIS MULTIPLE-CHOICE QUIZ

 1. An organ of the upper airway is the:  6. An indicator for suctioning is: How to complete
 a) Larynx c  a) Increased breath sounds c this assessment
 b) Pharynx c  b) Visible secretions c This multiple-choice quiz will
help you test your knowledge.
 c) Trachea c  c) Increase in oxygen saturations c
It comprises ten multiple‑choice
 d) Bronchus c  d) Lack of coughing c questions broadly linked to
the previous article. There
 2. Which of the following statements is true?  7. Suction catheters of what size are used in children? is one correct answer
 a) The function of the upper airway is to cool air  a) 5–6 Fg c to each question.
entering the lungs c You can read the article before
 b) 6–8 Fg c
answering the questions or
 b) The pharynx is in the lower respiratory tract c
 c) 8–10 Fg c attempt the questions first, then
 c) The lower respiratory tract is responsible for diffusing  d) 10–12 Fg c read the article and see if you
oxygen into the bloodstream c would answer them differently.
 8. The duration of each suctioning attempt should be When you have completed
 d) Carbon dioxide is removed from the lower respiratory the quiz, cut out this page and
tract through osmosis c no longer than:
add it to your professional
 a) Three seconds c
portfolio. You can record the
 3. What percentage of alveoli are present at birth?
 b) Six seconds c amount of time it has taken you
 a) 5% c to complete it.
 c) Ten seconds c
 b) 10% c You may want to write
 d) 12 seconds c
 c) 15% c a reflective account.
 9. What maximum suction pressure should be used for Visit rcni.com/reflective-
 d) 20% c
account
an adolescent?
 4. Mucus contains the antibacterial enzyme:  a) 60–80mmHg c Go online to complete this
 a) Lactase multiple-choice quiz and
c  b) 90mmHg c
you can save it to your RCNi
 b) Lysozyme c  c) 80–100mmHg c portfolio to help meet your
 c) Polymerase c  d) 120mmHg c revalidation requirements.
Go to rcni.com/cpd/test-
 d) Trypsin c
your-knowledge
 10. At home, infection risks because of suctioning can
 5. A condition associated with mucus be minimised by:
This self-assessment
hypersecretion is:  a) Poor hand hygiene c questionnaire was compiled
 a) Asthma c  b) Multiple catheter use c by Lisa Berry
 b) Bronchiolitis c  c) Use of personal protective equipment c The answers to this quiz are:
 c) Cystic fibrosis c  d) Disposal of used equipment in household waste c 8. c, 9. d, 10. c
 d) All of the above c 1. b, 2. c, 3. b, 4. b, 5. d, 6. b, 7. b,

This activity has taken me minutes/hours to complete. Now that I have read this article and completed this assessment, I think my knowledge is:
Excellent  Good  Satisfactory  Unsatisfactory  Poor 

As a result of this I intend to: ___________________________________________________________________________________________

_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________

54 / July 2018 / volume 30 number 4 nursingchildrenandyoungpeople.co.uk