Too much negative pressure can lead to both atelectasis and hypoxia. Because oral suctioning may cause hypoxia and hypoxemia, this procedure also places the patient at risk for developing dysrhythmias, especially bradycardia. In some patients, aggressive oral or tracheal suctioning triggers a vasovagal reflex, which may cause both bradycardia and hypotension. Additionally, failure to preoxygenate prior to suctioning increases the risk of hypoxia and hypoxemia and decreased perfusion to the heart.
This, in turn, may cause cardiac dysrhythmia. Airway tissue trauma and iatrogenic injury may occur with oral suctioning. This may range from mild irritation of the tissue to damage and tearing of the airway.
This complication may be difficult to recognize in patients who presented with traumatic injuries that required oral suctioning in the first place. Aspiration pneumonia is a threat to all patients with compromised airways and retained airway contaminates. To make things worse, positive pressure from assisted ventilation forces these contaminants deeper into the lungs.
However, this complication more commonly occurs as a result of ineffective oral suctioning and failure to quickly and efficiently remove these disease-causing airway contaminates.
Avoid using suction catheters larger than half the diameter of the airway. Increased diameter of suction catheters increases the negative pressure. Check the negative pressure of the portable suction unit prior to using it. Using a portable suction unit with outward-facing controls makes adjusting the negative pressure easy.
Keep suction attempts and passes under 15 seconds. Nevertheless, tachycardia rates remain high. Suctioning may also induce hypotension. This can be especially dangerous for patients suffering hemorrhages, cardiac failure, or conditions which make low blood pressure particularly risky. A number of strategies can reduce the risk of tachycardia.
In ventilated patients, nebulized atropine administered prior to suctioning may improve outcomes. In out-of-hospital settings, the following interventions can reduce the risk of cardiac arrhythmias:.
Having the right equipment enables first responders to quickly intervene in airway emergencies. Quality suction machines are compatible with a wide range of catheters, enabling you to choose equipment that is an appropriate size for the patient. Portable emergency suction means that first responders can tend to patients anywhere, in addition to meeting their legal requirements to treat patients within a yard radius of the hospital.
For help choosing the right machine for your agency, and for more expert suctioning insight, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device. Topics: Airway management , portable suction , airway obstruction. Sam D. Say has been involved in developing product for healthcare providers for over 35 years. This article has a correction. Please see: Correction - December 01, Introduction The presence of an artificial airway during mechanical ventilation makes coughing less effective or not possible.
QUICK LOOK Current knowledge Endotracheal suctioning is associated with various complications, ranging from discomfort to hemodynamic collapse, but the incidence and severity of these complications has not been systematically studied. What this paper contributes to our knowledge Adverse effects of suctioning, particularly oxygen desaturation and hemorrhagic secretions, were frequent and were reduced by the implementation of practice guidelines.
Study Design and Data Collection Endotracheal-suctioning-related adverse events were collected daily during the 2 3-month periods. Clinical Practice Guidelines for Endotracheal Suctioning The guidelines for endotracheal suctioning were as follows: Frequency of Endotracheal Suctioning. Incidence density, expressed per ventilator days, was calculated according to the formula: Dichotomous variables were compared with use of the chi-square test, and continuous variables with the Student t test.
Results We included subjects, and 9, suctioning procedures were recorded during a total of 1, ventilator days. View this table: View inline View popup Download powerpoint. Table 1. Subjects, Outcomes, and Number of Suctioning Procedures. Table 2. Univariate Analysis of Complications of Endotracheal Suctioning.
Table 3. Multivariate Logistic Regression Analysis. Discussion The main results of this study are that: Endotracheal suctioning was frequently complicated, mainly by oxygen desaturation and hemorrhagic secretions. Conclusions The adverse effects of endotracheal suctioning, particularly oxygen desaturation and hemorrhagic secretions, are frequent and can be reduced by the implementation of practice guidelines. The authors have disclosed no conflicts of interest. See the Related Editorial on Page References 1.
Cardiac arrhythmias resulting from tracheal suctioning. Ann Intern Med ; 71 6 : — OpenUrl PubMed. Bradycardic responses to endotracheal suctioning. Crit Care Med ; 16 11 : — Constant-flow insufflation prevents arterial oxygen desaturation during endotracheal suctioning.
Am Rev Respir Dis ; 2 : — A computed tomographic scan assessment of endotracheal suctioning-induced bronchoconstriction in ventilated sheep. Closed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation. Intensive Care Med ; 27 4 : — Prevention of endotracheal suctioning-induced alveolar derecruitment in acute lung injury. Effectiveness and side effects of closed and open suctioning: an experimental evaluation. Intensive Care Med ; 30 8 : — Physiologic impact of closed-system endotracheal suctioning in spontaneously breathing patients receiving mechanical ventilation.
Respir Care ; 54 3 : — American Association for Respiratory Care. Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways Respir Care ; 55 6 : — The effect of endotracheal suction on regional tidal ventilation and end-expiratory lung volume. Intensive Care Med ; 36 5 : — Maggiore SM , Volpe C. Endotracheal suctioning in hypoxemic patients.
The effect of endotracheal suctioning on arterial blood gases in patients after cardiac surgery. Heart Lung ; 7 6 : — Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients: a prospective randomised controlled trial. Intensive Care Med ; 29 3 : — A multisite survey of suctioning techniques and airway management practices.
Am J Crit Care ; 12 3 : — Closed tracheal suction systems versus open tracheal suction systems for mechanically ventilated adult patients. A Scandinavian survey of drug administration through inhalation, suctioning and recruitment maneuvers in mechanically ventilated patients. Acta Anaesthesiol Scand ; 53 6 : — Clinical Practice Guideline. Endotracheal suctioning of mechanically ventilated adults and children with artificial airways.
Respir Care ; 38 5 : — Jubran A , Tobin MJ. Use of flow-volume curves in detecting secretions in ventilator-dependent patients. Hit enter to search or ESC to close. No Comments Love 0.
While studies in the medical literature do not always agree on best practices to balance benefits over risks, respiratory therapists and researchers make the following recommendations: Suction only as needed: The literature does not agree on an appropriate frequency of suctioning, but one study in Intensive and Critical Care Nursing suggested it should be performed only when necessary due to its risks and adverse effects.
Use shallow suction depth when possible: While studies in neonates found no major differences in heart rate and oxygen saturation between deep or shallow suctioning, deeper suctioning can cause mucosal injury, bleeding, and even vagal stimulation and bradycardia.
Pediatr Crit Care Med. A comprehensive review of pediatric endotracheal suctioning: Effects, indications, and clinical practice. Pedersen, Carsten M. Intensive and Critical Care Nursing. Endotracheal suctioning of the adult intubated patient—What is the evidence?
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