NClip

Airway Suctioning Procedure

3 min read

Airway Suctioning Procedure

Key Points

  • Suction only when clinical signs indicate retained secretions or airway obstruction risk.
  • Emergent suctioning to maintain airway patency may proceed immediately; routine suctioning follows provider order/policy.
  • Preoxygenate with 100% FiO2 before lower-airway suctioning.
  • Keep each suction pass under 15 seconds and allow 30-60 seconds recovery between passes.

Equipment

  • Suction source with adjustable pressure
  • Appropriate catheter system (Yankauer, sterile open catheter, or closed in-line catheter)
  • Personal protective equipment and sterile gloves for open/nasotracheal suctioning
  • Pulse oximetry and routine vital-sign monitoring setup

Procedure Steps

  1. Confirm clinical indication for suctioning and assess baseline oxygenation and respiratory status.
  2. Explain the procedure to awake interactive patients and prepare bedside equipment; for patients with tracheostomy who cannot vocalize, facilitate communication with writing tools or other alternative methods.
  3. For tracheostomy suctioning, verify bedside emergency backup equipment is present (replacement tracheostomy tube, obturator, bag-valve mask, and suction catheter setup).
  4. For tracheostomy suctioning, assess the stoma for redness or drainage before suctioning.
  5. Preoxygenate with 100% FiO2 before lower-airway suctioning; in open tracheostomy suctioning, many protocols use 30-60 seconds preoxygenation with bag-valve-mask support as needed.
  6. Set suction pressure for age group per route and policy:
    • for oropharyngeal/nasopharyngeal workflows, do not exceed approximately 150 mm Hg in adults/adolescents, 120 mm Hg in children, 100 mm Hg in infants, and 80 mm Hg in neonates
    • for lower-airway systems, follow unit policy/device protocol (many use narrower ranges)
  7. For open/nasotracheal technique, don sterile gloves and maintain sterile handling of the catheter.
  8. Choose correctly sized catheter (less than 50% of artificial airway internal diameter when suctioning ETT/tracheostomy).
  9. Insert catheter to the target depth without suction:
    • for tracheostomy shallow suctioning, insert to tracheostomy tube length
    • for tracheostomy deep suctioning, advance until resistance then withdraw about 1 cm before suctioning
    • do not force insertion
  10. For nasopharyngeal suctioning, guide catheter along floor of naris toward pharynx (commonly around 5-6 inches in adults); for oropharyngeal suctioning, advance along side of mouth toward pharynx (commonly around 3-4 inches).
  11. During nasopharyngeal or nasotracheal suctioning, use mild head extension as tolerated to help align the airway path.
  12. Apply suction only during withdrawal while rotating catheter; keep each pass under 15 seconds and follow route-specific policy for intermittent versus continuous suction.
  13. Flush catheter per setup policy, allow 30-60 seconds recovery, and reassess oxygenation/clinical response between passes.
  14. For open tracheostomy suctioning, stop immediately if bradycardia or dysrhythmia occurs; if respiratory status does not improve or worsens after limited repeat attempts (often maximum two insertions), activate emergency assistance per policy.
  15. If sputum culture/cytology is ordered during suctioning, collect using a sterile specimen trap (for example Lukens trap) and maintain closed sterile transfer.
  16. Avoid routine saline instillation through the endotracheal tube.
  17. Reattach baseline oxygen delivery setup, reassess respiratory status and SpO2, then provide oral hygiene after suctioning when appropriate.
  18. Document indication, pre/post assessments, pressure setting, number of passes, secretion characteristics (amount/color/odor/consistency), patient tolerance, and any interruption/escalation actions (for example suctioning stopped for bradycardia with emergency team notification).

Common Errors

  • Performing routine suction without clinical indication → unnecessary mucosal trauma and hypoxemia risk.
  • Excessive suction duration or pressure → airway injury and oxygen desaturation.
  • Advancing catheter too deeply → bleeding and tracheobronchial trauma risk.
  • Breaks in sterile technique during open suction → increased contamination and infection risk.

Graph View