Suctioning of Home Ventilator Patients
A Simple Guide to Suctioning the Patient's Airway at Home
Jul 1, 2009
When a patient has an artificial airway, whether it is an endotracheal tube or tracheostomy tube, the ability to cough and clear the lungs is impaired, especially if the patient has a weak cough. Suctioning the airway clears the only breathing passage available to the patient and allows adequate oxygenation and ventilation to occur.
Equipment Needed for Suctioning
Suctioning an artificial airway requires certain equipment which the home care company will provide for a mechanically ventilated patient at home. Before beginning the procedure, it is best to have all equipment readily accessible. These include:
- Suction catheters of the appropriate size.
- An electric suction machine with a gauge that tells the user how much suction is being generated. The machine will come with suction tubing and a bottle to collect the secretions.
- Clean or sterile plastic gloves
- Sterile, distilled or boiled water to flush the catheter.
- A manual resuscitator bag.
- An oxygen source.
- A device to suction the mouth, such as a tonsil-tip or yankauer suction device.
- Sterile normal saline, normally provided in pink 3, 5, or 10 cc vials, or "bullets."
When to Suction the Patient
Most patients on mechanical ventilation at home will have a tracheostomy tube. While some patients have a very strong cough and will need suctioning infrequently, some patients, such as those with neuromuscular disease or the inability to cough effectively, will need suction more often.
Patients need suctioning when:
- They are unable to clear their secretions by coughing.
- Coarse sounds known as rhonchi or wheezing are heard in the chest.
- Secretions are seen in the airway or circuit of the ventilator.
- The ventilator is alarming because of increased inspiratory pressure.
- The patient is receiving decreased volumes from the ventilator.
Suctioning the Patient
Following a few easy steps will go a long way toward making the suction event flow smoothly.
- Assemble the supplies on a nearby table.
- Turn on the suction and check the pressure gauge to assure the pressure is set appropriately for the age of the patient.
- Pour the water for rinsing the catheter into a basin or cup.
- Open the packages containing the suction catheter and gloves.
- Open a vial of sterile saline if secretions appear abnormally thick, or if the patient usually requires saline to stimulate a cough.
- Put on the plastic gloves. Keep one hand "clean" and use the other hand to touch the suction tubing to attach it to the end of the suction catheter.
- Pre-oxygenate the patient if the patient's oxygen saturation drops during suctioning.
- Advance the tip of the suction catheter into the airway. Advance the catheter only to the appropriate depth, depending on the size of the tracheostomy or endotracheal tube.
- Apply suction by occluding the small hole at the end of the suction catheter, slowly withdrawing the catheter while maintaining suction. Some practitioners advise twirling the catheter while withdrawing.
- At this point, if the secretions appear thick, squeeze a little saline from the pink vial into the airway, Give the patient several breaths with the resuscitator bag, or put him back on the ventilator to distribute the saline and break the secretions. If the patient coughs strongly, this may not be necessary.
- When secretions are thick, sterile water can be suctioned through the catheter to clear it.
- During suction events, oxygenate the patient and give him time to recover before repeating.
Precautions to Take While Suctioning
Suctioning a patient is an invasive skill, and one that needs to be approached with care and a concern for safety. Certain precautions should be taken during the procedure, as serious complications can arise if performed incorrectly.
- Always be aware of the need to eliminate or minimize the risk of infection to the patient. Wash hands before and after suctioning, even when gloves are worn. Suctioning at home is considered a clean procedure, not necessarily sterile, but every effort should be made to eliminate the introduction of bacteria into or near the artificial airway.
- Watch the patient's response carefully. Suction can cause a severe drop in heart rate or blood pressure. Oxygen saturation levels can fall dramatically.
- Suction the airway gently. Do not force the catheter if an obstruction is felt. The home care professional should disclose what the "safe" number is for suctioning a specific artificial airway. The suction catheter has numbers on it to guide the user on how far to advance the catheter.
- Bleeding and hemorrage can occur from the artificial airway if trauma occurs while suctioning. Suction only when necessary. It is not advisable to suction the patient merely because it has been four hours since the last time.
- Make sure the pressure generated from the suction machine is appropriate. Pressure that is too high can cause serious damage to the airway.
- Keep the equipment clean. According to the American Association of Respiratory Care, suction catheters used in the home can be re-used for 24 hours if they are flushed with sterile water, followed by suctioning air to dry the interior, then wiping the outer surface with alcohol or hydrogen peroxide. Wash equipment in detergent and water, then soak in an acceptable solution for disinfecting. Ask the home care company to recommend a product.
Although suctioning an artificial airway can be intimidating, it will soon become second nature to even the most timid care-giver. Practice with a health care professional, set up the equipment at home, develop a routine, and be sure to call the home care company for any questions or problems that arise.
Sources: American Association for Respiratory Care Clinical Practice Guidelines
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