Are you ready to learning about Suctioning in Respiratory Care? I sure hope so because that is what this study guide is all about. As a Respiratory Therapist, it goes without saying that you absolutely must know the ins and outs of how to suction a patient.

But the thing is, you have to know the indications suctioning and proper technique. You can’t just go shoving catheters down patients throats, am I right?

And that is exactly why we created this guide — to be an all-in-one resource to teach you everything you need to know about suctioning. Are you ready to get started?

What is Suctioning?

Suctioning is a method of removing retained secretions or other semi-liquid fluids from the patient’s airways. It works via the application of negative pressure to the airways through a collecting tube or catheter.

Suctioning can be applied to either the upper airway (oropharynx) or the lower airway (trachea and bronchi). With that being said, access to the lower airways is performed with a flexible suction catheter through the nose or artificial airway. We will discuss each of these methods in further detail below.

What Equipment is Needed for Suctioning?

To perform suctioning properly, it’s important to have the right equipment. You will need the following:

  • Vacuum source
  • Collection bottle
  • Connecting tubing
  • Disposable sterile gloves
  • Sterile suction catheter
  • Sterile water
  • Goggles, mask, etc.
  • Supplemental Oxygen source
  • Pulse oximeter
  • Stethoscope
  • Sterile sputum trap

What is the Normal Suctioning Pressure?

In order to suction a patient effectively, you need to set the proper suctioning pressure to ensure that a) it’s strong enough to remove the secretions, and b) it’s not dangerously strong enough to cause damage to the airway.

A general rule of thumb: The suction pressure should be set at the lowest effective level.

  • For adults, the suction pressure should be set from 120 to150 mm Hg.
  • For children, the suction pressure should be set from 100 to 120 mm.
  • For infants, the suction pressure should be set from 80 to 100 mm Hg.

How to Estimate the Proper Size of a Suction Catheter?

Here’s how to properly estimate the size of which suction catheter to use with a given airway tube:

Multiply the tube’s inner diameter by 2. Then use the next smallest size catheter.

It’s that simple!

For example, let’s say you have a size 8-mm endotracheal tube.

8 x 2 = 16.

So you would use the next smallest suction catheter (in French units), which would be a size 14F.

Suctioning Practice Questions:

1. How do we prevent hypoxemia in suctioning?
Preoxygenate the patient at 100 percent O2 for 1 to 2 minutes.

2. Why do we hyperinflate the patient prior to suctioning?
It helps to avoid hypoxemia and vagal stimulation in patients on the ventilator.

3. How far should you insert the catheter during suctioning?
8 to 10 inches or until the patient coughs.

4. How long do we suction a patient for?
The application of the vacuum should be no longer than 15 seconds.

5. What is a whistle tip catheter?
The tip is cut at an angle and has one or more eyes or ports cut in the side.

6. What is the advantage of an eye or port in a catheter?
It keeps the vacuum from harming mucosal during suctioning.

7. Besides convenience, why is a closed suction system used?
It is primarily used as a faster and more convenient way to deep suction in a sterile manner. It also helps to keep the patient’s VT, FIO2, and PEEP levels up. It is cheap and there is less contamination.

8. What is a rigid tonsillar?
It is also known as a Yankauer. It’s a hard plastic catheter specifically for oropharynx suctioning.

9. What is a suction regulator?
It reduces the high negative pressure to a manageable and safe physiological level.

10. What is the normal suction pressure for adults?
-100 to -120

11. What is the normal suction pressure for peds?
-80 to -100

12. What is the normal suction pressure for neonates?
-60 to -80

13. What are the contraindications of suctioning?
Occluded nasal passages, nasal bleeding, epiglottis or croup, acute head face or neck injury, bleeding disorder, laryngospasm, irritable airway, and upper respiratory tract infection.

14. What is a Lukens trap?
It is a specimen trap that can be placed in a vacuum circuit to collect sputum.

15. What is the only suction catheter that can go down the left bronchus?
Coude tip catheter.

16. What is the biggest hazard of suctioning?
Hypoxia or hypoxemia.

17. What are the hazards of suctioning?
Mechanical trauma, laceration of nasal turbinate, bleeding, tracheitis, hypoxemia, cardiac dysrhythmia bradycardia, hyper or hypotension, respiratory arrest, uncontrolled cough, gag, vomit, laryngospasm, bronchospasm, pain, infection, and atelectasis.

18. How can suctioning cause atelectasis ?
The catheter is too big or the suction pressure is top high.

19. How can you perform an assessment of the need for suctioning?
Auscultation and the patient’s effectiveness of cough.

20. Why can suctioning cause bradycardia?
Touching the carina with the catheter can stimulate the vagus nerve.

21. When suctioning, what should the assessment of outcome be?
Improved breath sounds and removed secretions.

22. Patient monitoring during suctioning should include what?
Breath sounds, skin color, breathing pattern and rate, pulse, rhythm, sputum, bleeding or evidence of trauma, patient subjective response, cough, SPO2, and ICP (if available).

23. Manual resuscitator flow should be set at what prior to suctioning?
10 to 15 L/min

24. What does a suction kit include?
Sterile catheter, gloves, and basin.

25. Equipment preparation for suctioning includes what?
Manual resuscitator, suction kit, goggles or face mask, sterile normal saline, sterile distilled water, vacuum regulator, suction trap if needed, and ky jelly.

26. Sterile distilled water needs to be replaced how often?
Every 72 hours (be sure to record the date when opening).

27. What is the best position of the patient for suctioning?
Semi-fowler, sniffing, or supine if they are unable to get in the semi-fowler position.

28. How much saline is instilled in artificial airway if secretions are thick?
About 3 cc

29. How often do we oxygenate patients when suctioning artificial airways?
Between each pass.

30. How do you estimate the size of a suction catheter?
Multiply the ET tube ID size by 2, then go one size down.

31. The respiratory therapist is ready to suction the patient but there is no suction pressure. What might be problem?
There is a leak at suction trap or vacuum line, the canister may be full, or the suction is not turned on.

32. If the patient has PVC’s during suction, what should you do?
Stop, give 100 % O2, and notify the physician. Once they are stable, then you can continue suctioning.

33. How can you reduce trauma to the mucosa during suctioning?
Rotate the catheter, do not exceed the recommended pressure, use largest catheter possible without going over 1/2.

34. An absolute contraindication for suctioning is?
Epiglottitis and croup.

35. How can you tell if the suctioning has worked?
The patient has decreased WOB, improved breath sounds, and you removed secretions.

36. When should you perform suctioning?
Only on an as-needed basis. It should never be scheduled.

37. What kind of catheter is used for the left mainstem bronchus?
Directional or Coude.

38. What do you do to collect sputum?
Attach the Leuken’s trap and perform suction as you normally would.

39. What are some complications for suctioning?
Bronchospasm and vagal stimulation (bradycardia).

40. How to prevent complications during suctioning?
Correct the pressure set, be gentle, hyperoxygenate, make sure it’s quick (no more than 15 seconds).

41. When do you suction?
Only apply suction when you’re withdrawing the catheter. Never on the way in.

42. What is the purpose of suctioning?
To maintain a patent airway by removing secretions, blood, or foreign material.

43. When is suctioning performed?
Only when needed, visible secretions or audible gurgling, and when there is a sudden increase in respiratory rate.

44. The retention of secretions can cause what?
Increased WOB, atelectasis, hypoxemia, hypercapnia, pulmonary infection, increased airway resistance.

45. What happens when you cough?
Large inspiration, glottis closed, diaphragm moves up, pressure builds up in thorax, glottis opens, secretions move out.

46. What are the indications for suctioning?
Prolonged coughing, patients request, and patients with artificial airways.

47. What types of patients require suctioning?
Nervous system depression (intoxicated, sedated), abnormal pulmonary mechanics, thick secretions, pain, and post-surgical patients.

48. What are the upper airway suction devices?
Oropharynx; clean (not sterile) Yaunker, flexible plastic or rubber catheter.

49. When do you instill lavage?
Only after you are completely prepared to begin the insertion and suction.

50. What should you know about suctioning in the home?
Make sure it is clean as possible, the catheter can be used up to 24 hours, equipment washed in vinegar 9:1, and boil if permitted.

51. What is the purpose of the coude tip catheter?
It is a curved directional tip catheter which may help in guiding it into the right or left mainstem bronchi.

52. What is the purpose of a sputum trap?
Used for sputum collection.

53. What is the purpose of tracheal suctioning?
To maintain a patent airway by removing secretions, blood, or foreign material and facilitate pulmonary hygiene.

54. What are the indications for tracheal suctioning?
Visible secretions in airway or audible gurgling, increased tactile fremitus, sudden increase in respiratory distress/dyspnea, and increase in pressures that require ventilating with IPPB or mechanical ventilation, and a prolonged cough.

55. What are the complications associated with tracheal suctioning?
Hypoxia, vagal stimulation, trauma, dysrhythmias, hemoptysis, atelectasis, and bronchospasm.

56. What is the cause of expiratory wheezing after suctioning?
Bronchospasm; things get irritated so they tighten up and the wheezes gets vibrant.

57. When is lavage needed?
To break up hard thick mucus.

58. What are the types of solution used for lavage?
Normal saline, Mucomyst, and Na Bicarb.

59. What are the disadvantages of lavage?
If you need a sputum sample, it will have to much saline in it. Also, some might get stuck way down and could cause infection.

60. When is the appropriate time to instill lavage?
Right before suctioning.

61. What are the indications for the use of closed suction techniques?
PEEP greater than 10, inspiratory time greater than 1.5 seconds, FiO2 greater than 60, MAP greater than 20, and respiratory infections present.

62. What are the factors that indicate the outcome of suctioning was beneficial to the patient?
The show a decreased WOB, you got sputum out, their heart rate went close to normal, and their respiratory rate decreased.

Final Thoughts

Thank you so much for reading all the way through to the end of our study guide on suctioning. The fact that you’re putting in the work to learn this information now is going to pay off for you in a big way in the future.

Continue to go through this study guide (and these practice questions) and I know the information will stick — no pun intended.

Thanks again for reading and as always, breathe easy my friend.