Airway suctioning is a therapeutic procedure that is performed to remove secretions, mucus, or debris from the patient’s airway. It is an important part of respiratory care and is often performed on patients who are unable to clear their own airways.

In this article, we will provide an overview of airway suctioning, including its indications, contraindications, and techniques. We also provided helpful practice questions on this topic for you to test your knowledge.

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What is Airway Suctioning?

Airway suctioning is a technique that involves the use of negative pressure to remove secretions from a patient’s airway. It is performed with the use of a catheter, which is inserted into the patient’s airway through the nose or mouth.

The negative pressure generated by the suctioning device pulls secretions and mucus from the airways, through the catheter, and into a collecting tube or chamber.

Airway suctioning is an important part of respiratory care and is often performed on patients who are unable to clear their own airways.

Indications

Airway suctioning is most often indicated in patients who are unable to clear their own airways. This includes patients who are:

  • Unconscious or sedated
  • Paralyzed
  • Intubated
  • Have a tracheostomy

Suctioning may also be indicated for diagnostic purposes. For example, suctioning may be used to collect a specimen for analysis in a patient with a suspected airway infection.

Contraindications

There are no absolute contraindications for airway suctioning. However, there are some instances when it should not be recommended.

For example, if a patient is able to clear their own airway via coughing, it should be encouraged as opposed to suctioning. Additionally, suctioning should not be performed if it would cause undue distress to the patient.

airway suctioning catheter device

Suctioning Equipment

The process of airway suctioning requires the use of specialized tools and equipment, including the following:

  • Sterile suction catheter
  • Vacuum source
  • Connecting tubing
  • Collection chamber
  • Sterile gloves
  • Personal protective equipment
  • Sterile water
  • Sterile saline
  • Supplemental oxygen source
  • Pulse oximeter
  • Stethoscope
  • Sterile sputum trap

Each item listed above plays an important role in the suctioning process in order to protect both the patient and the caregiver.

Types of Suctioning

There are four primary types of airway suctioning:

  1. Nasal suctioning
  2. Oral suctioning
  3. Pharyngeal suctioning
  4. Deep suctioning

Each type involves a different procedure, as well as the use of different tools and equipment.

Types of Airway Suctioning

Nasal Suctioning

Nasal suctioning involves the passage of a catheter through the nostril in order to remove secretions from the nasal cavity. This is a type of superficial suctioning that is useful in removing secretions that are blocking the nasal passage.

Oral Suctioning

Oral suctioning involves the use of a Yankauer, which is a suction catheter made of hard plastic with a curved tip. This type is performed by inserting the catheter into the patient’s mouth in order to remove secretions from the oral cavity.

Pharyngeal Suctioning

Pharyngeal suctioning involves the passage of a suction catheter through the patient’s mouth or nose to remove secretions from the back of the throat.

During nasopharyngeal suctioning, the catheter is inserted through the nose. During oropharyngeal suctioning, the catheter is inserted through the mouth.

Deep Suctioning

Deep suctioning is a type of suctioning that involves the insertion of a catheter beyond the tip of the endotracheal tube into the patient’s airways. During this type, the suction catheter is inserted until resistance is met at the carina and mainstem bronchi.

Other Types of Suctioning

Aside from the primary types of suctioning, there are some other types worth mentioning, including the following:

  • Endotracheal suctioning
  • Nasotracheal suctioning
  • Bulb suctioning
  • Oropharyngeal suctioning
  • Nasopharyngeal suctioning
  • Tracheostomy suctioning

The procedure for each type of suctioning is slightly different, depending on the needs of the patient.

Endotracheal Suctioning

Endotracheal suctioning is indicated for patients who have an endotracheal tube in place. This type of suctioning requires the use of a sterile suction catheter, which is inserted through the patient’s endotracheal tube and into their airway.

The suction catheter is then connected to a vacuum source, and suction is applied. The negative pressure generated by the suction pulls secretions and mucus from the airways and into a collection chamber.

Nasotracheal Suctioning

Nasotracheal suctioning involves the insertion of a flexible catheter through the nose in order to access the trachea to remove secretions. This type of suctioning is indicated for patients who are unable to clear secretions on their own but require frequent suctioning.

Bulb Suctioning

Bulb suctioning is a type of suctioning that uses a small, hand-held suction bulb to remove secretions from the upper airway. This type of suctioning is typically used on newborns or infants who have accumulated excess secretions in their mouth or nose.

The procedure for bulb suctioning is relatively simple. First, the suction bulb is squeezed to remove any air from inside the bulb. The bulb is then inserted into the patient’s nostril or mouth and released. The suction created by the release of the bulb will help remove secretions.

bulb suctioning

Oropharyngeal suctioning

Oropharyngeal suctioning is a type of suctioning where the catheter is inserted into the mouth and into the pharynx in order to remove secretions from the throat.

This type is helpful in removing secretions from the upper airway in patients with an absent cough reflex.

Nasopharyngeal suctioning

Nasopharyngeal suctioning is a type of suctioning where the catheter is inserted through the nose into the pharynx in order to remove secretions from the back of the throat.

This type of suctioning is indicated for patients who have a blocked upper airway due to the inability to cough on their own.

Tracheostomy Suctioning

Tracheostomy suctioning is a type of suctioning that is performed on patients who have a tracheostomy tube in place. A tracheostomy is a surgical procedure where a small incision is made in the patient’s neck to facilitate the insertion of a tube directly into the trachea.

This type requires the use of a sterile suction catheter, which is inserted through the tracheostomy tube in order to help remove secretions from the airway.

Airway Suctioning Practice Questions:

1. How can you prevent hypoxemia during suctioning?
Pre-oxygenate the patient with 100% oxygen for 1-2 minutes before applying suction.

2. What factors indicate the outcome of suctioning was beneficial?
Decreased WOB, sputum removal, improved heart rate, and improved respiratory rate

3. How far should you insert the catheter during suctioning?
The catheter should be inserted approximately 8-10 inches, or until the patient coughs.

4. How long should you suction a patient?
The application of vacuum should be no longer than 15 seconds.

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

6. What is the advantage of a catheter that has a port?
It keeps the vacuum pressure from harming the mucosal during suctioning.

7. Why is a closed suction system recommended?
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 tidal volume, FiO2, and PEEP in the optimal range.

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

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 mmHg

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

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

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 a sputum sample.

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

16. What is the biggest hazard of suctioning?
Hypoxemia

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

18. How can suctioning cause atelectasis?
Atelectasis can occur if the catheter is too big or if the suction pressure is too high.

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

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

21. What are the best patient outcomes of suctioning?
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

23. What level should the manual resuscitator flow be set at prior to suctioning?
10-15 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, and lubricant jelly

26. What are the indications for using a closed suction system?
PEEP greater than 10, inspiratory time greater than 1.5 seconds, FiO2 greater than 60, MAP greater than 20, or if a respiratory infection is present

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

28. How much saline can be instilled in the artificial airway if secretions are thick?
Approximately 3 cc

29. How often should you oxygenate patients when suctioning down an artificial airway?
Between each pass

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

31. What is likely the problem when a respiratory therapist is ready to suction the patient, but there is no suction pressure?
There could be a leak, the canister could be full, or the suction pressure may not be turned on.

32. What should you do if the patient has a premature ventricular contraction during suctioning?
Stop the treatment, provide 100 % oxygen, and notify the physician

33. How can you reduce trauma to the mucosa during suctioning?
Rotate the catheter and do not exceed the recommended pressure

34. What is an absolute contraindication for suctioning?
There is no absolute contraindication for suctioning; however, it may not be recommended if a patient is diagnosed with epiglottitis or croup.

35. What is the cause of expiratory wheezing after suctioning?
Bronchospasm

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

37. How can you collect a sputum sample?
Attach the Lukens trap and perform suctioning as you normally would.

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

39. How can you prevent complications during suctioning?
Use the correct pressure setting, be gentle, hyperoxygenate the patient, and apply suction pressure for no longer than 15 seconds

40. When do you apply suction pressure?
Pressure should only be applied when you’re withdrawing the catheter. Never apply pressure during insertion.

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41. What is the purpose of suctioning?
To maintain a patent airway by removing secretions

42. When is a lavage needed?
To break up thick mucus

43. What is the most common solution used for a lavage?
Normal saline

44. What is a disadvantage of performing a lavage?
It can affect a sputum sample

45. When is the appropriate time to perform a lavage?
Right before suctioning

46. What types of patients require suctioning?
Those with nervous system depression, abnormal pulmonary mechanics, thick secretions, pain, and post-operation

47. What is the primary upper airway suction device?
Yankauer

48. What are the indications for tracheal suctioning?
Visible secretions in the airway, audible gurgling, increased tactile fremitus, prolonged cough, and a sudden increase in respiratory distress

49. How far can a catheter be inserted during deep suctioning?
It can pass beyond the trachea until it reaches the carina.

50. What is Ballard suctioning?
A Ballard suctioning catheter is an in-line suction catheter that is often used on patients who are intubated.

FAQ

What is the Normal Suction Vacuum Pressure?

Using proper levels of pressure when suctioning is important when it comes to the patient’s health and the effectiveness of therapy.

The key is to make sure that the pressure level is strong enough to remove the secretions but not so strong that it can cause damage to the patient’s airway. Here are the normal pressure levels for suctioning:

  • Adults: -100 to -120 mmHg
  • Children: -80 to -100 mmHg
  • Infants: -60 to -80 mmHg

In general, the suction pressure should be set at the lowest effective level for secretion removal.

normal suction pressure

How to Estimate Catheter Size for Suctioning?

When performing airway suctioning, it’s important to use a catheter that is properly sized for each individual patient. In order to select the right size, you can:

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

The process is that simple!

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

8 x 2 = 16

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

What are the Patient Outcomes of Airway Suctioning?

After performing airway suctioning, a practitioner may expect the following patient outcomes:

  • Decreased work of breathing
  • Improved blood pressure
  • Improved heart rate
  • Improved respiratory rate
  • Improved breath sounds
  • Increased oxygen saturation
  • Improved chest movement
  • Removed copious secretions

The primary goal of suctioning is to clear the airway of secretions, which can lead to one or more of the patient outcomes listed above.

What is Closed (in-line) Suctioning?

The closed or in-line suctioning technique involves the use of a catheter that is enclosed within a protective sheath. It is most commonly used in intubated patients who are receiving mechanical ventilation.

This type of suctioning is useful because a patient does not need to be disconnected from the ventilator. Instead, the suction catheter is attached directly to the artificial airway, which allows continuous ventilation while suctioning is performed.

How to Obtain a Sputum Sample?

A sputum sample can be obtained with the following steps:

  1. Gather all equipment
  2. Wash your hands thoroughly
  3. Explain the procedure to the patient to establish rapport
  4. Place the patient in the semi-fowler’s position
  5. Instruct the patient to rinse their mouth with water
  6. Place a linen or towel on the patient’s chest to avoid the spillage of secretions
  7. Put on a face shield or goggles for protection
  8. Instruct the patient to take a deep breath, cough, and expectorate into a sterile container
  9. Immediately close the container, label, and place in a biohazard bag
  10. Provide mouth care for the patient
  11. Wash your hands thoroughly
  12. Transport the sample to the lab for analysis

If the patient has an artificial airway in place, you must connect an in-line collection container to the suction tubing in order to obtain the sample.

sputum sample

What are the Risks and Hazards of Suctioning?

The risks and hazards associated with airway suctioning include the following:

  • Hypoxemia
  • Bleeding
  • Gagging
  • Vegas nerve stimulation
  • Mucosal trauma
  • Cardiac dysrhythmias
  • Increased intracranial pressure
  • Pain and other discomforts

Each patient will react differently to suctioning. However, these are some of the potential risks and hazards that could occur.

What is a Soft Suction Catheter vs Rigid?

A soft suction catheter is a long, thin tube that is used for suctioning and secretion removal. It is made of a soft, pliable material that has more maneuverability within the patient’s airway.

A rigid suction catheter is a shorter, stiffer tube that is also used for secretion removal. However, it is not as maneuverable; therefore, it is used for oral, nasal, and pharyngeal suctioning. An example of a rigid suction catheter is a Yankauer.

The Yankauer suction catheter is useful for removing oral secretions.

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What are the Complications of Suctioning a Patient?

The complications of suctioning a patient include the following:

  • Hypoxemia
  • Bradycardia
  • Arrhythmias
  • Laryngospasm
  • Increased intracranial pressure
  • Mucosal trauma
  • Vomiting
  • Aspiration
  • Cardiac arrest

Suctioning is a necessary medical procedure; however, it can also be dangerous if not performed correctly. These are some of the potential complications that could occur.

What is the Purpose of Suctioning?

The purpose of suctioning is to remove secretions from the patient’s airway. This can be done orally, nasally, or deeper into the trachea.

Suctioning is important because it helps to keep the airway clear and prevents secretions from pooling and causing respiratory distress.

How Long Should You Suction a Patient?

The length of time that you suction a patient will depend on the type of suctioning being performed.

However, in general, the maximum suction time for each attempt should be 15 seconds or less.

Why is Sterility Maintained During Suctioning?

It is important to maintain sterility during suctioning in order to prevent the spreading of an infection to the patient.

During suctioning, a catheter is inserted into the patient’s airway, which is a sensitive area. If the catheter is not sterile, it can introduce bacteria and other microorganisms into the airway, which can cause infection.

sterile hand washing

What is the Proper Technique for Suctioning the Oropharynx?

The proper technique for suctioning the oropharynx involves the insertion of a catheter into the patient’s mouth and throat.

The practitioner must keep their thumb off of the suction control port until the catheter is in the correct place. Then suctioning is performed with the use of negative pressure, which helps with secretion removal from the back of the throat.

What is a Coude Tip Suction Catheter?

A coude tip suction catheter is a tube used in airway suctioning that has an angled tip. This helps it navigate around obstacles in the airway and is useful for suctioning the left mainstem bronchus.

Final Thoughts

Suctioning is an important procedure in respiratory care. In order to reduce the risks and hazards associated with airway suctioning, it’s important to understand the proper technique for each of the different types.

Maintaining sterility during suctioning is also essential in preventing the spread of infections and microorganisms.

If you enjoyed this overview, we have a similar guide on the other airway management procedures that I think you’ll find useful. Thanks for reading!

Medical Disclaimer: This content is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Please consult with a physician with any questions that you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you read in this article. We strive for 100% accuracy, but errors may occur, and medications, protocols, and treatment methods may change over time.

References

The following are the sources that were used while doing research for this article:

  • Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020. [Link]
  • Pasrija, Divij. “Airway Suctioning – StatPearls – NCBI Bookshelf.” National Center for Biotechnology Information, U.S. National Library of Medicine, 2 June 2020, www.ncbi.nlm.nih.gov/books/NBK557386.
  • “Effects of Shallow and Deep Endotracheal Tube Suctioning on Cardiovascular Indices in Patients in Intensive Care Units.” PubMed Central (PMC), July 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4145490.
  • “Suctioning Adults with an Artificial Airway: A Systematic Review.” National Center for Biotechnology Information, U.S. National Library of Medicine, 2000, www.ncbi.nlm.nih.gov/books/NBK68375.

Disclosure: The links to the textbooks are affiliate links which means, at no additional cost to you, we will earn a commission if you click through and make a purchase.