Suctioning

Suctioning clears the airway when the client can't — but incorrect technique causes hypoxia, vagal bradycardia, or mucosal trauma in seconds. Knowing the rules prevents you from becoming the problem.

Suctioning removes secretions from the airway when cough is ineffective. Two main routes exist: oropharyngeal/nasopharyngeal (Yankauer or flexible catheter) and endotracheal/tracheal (sterile, closed or open system). Before suctioning, hyperoxygenate the client with 100% O₂ for at least 30 seconds to build an oxygen reserve — suctioning itself removes air along with secretions. Insert the catheter without suction applied; apply intermittent suction only during withdrawal using a rotating motion. Each suction pass should last no longer than 10–15 seconds to prevent hypoxia and mucosal damage. Limit to two to three passes per suctioning episode. Catheter size matters: it should occlude no more than half the internal diameter of the artificial airway (for adults, typically 12–14 Fr for an endotracheal tube). Suction pressure for adults is 100–150 mmHg. Normal saline instillation before suctioning is no longer recommended — it does not thin secretions and may worsen oxygenation. Monitor heart rate, SpO₂, and respiratory status throughout. Vagal stimulation during tracheal suctioning can trigger bradycardia or even cardiac arrest — stop immediately if the heart rate drops. Post-procedure, reassess breath sounds and document color, amount, consistency, and odor of secretions.

Key Distinctions

Don't confuse oropharyngeal suctioning (clean technique, Yankauer, no depth limit issue) with endotracheal suctioning (sterile technique, measured catheter depth, strict time limits). Students often apply continuous suction on insertion — suction is applied only on withdrawal. The 10–15 second limit is per pass, not total; exceeding it on a single pass causes more hypoxia than doing an extra pass with re-oxygenation between.

Clinical Pearl

Insert clean, withdraw dirty: catheter goes in with no suction, comes out with suction and rotation. If the heart rate drops, pull out immediately.