ALERTDon appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions. Show
Limit negative pressure for suctioning to −60 mm Hg to −80 mm Hg of negative pressure.undefined#ref2">2 Limit the duration of each suction pass to no more than 10 seconds with 5 seconds of applied suction.1 A longer duration is associated with increased risk of hypoxemia and bradycardia.3 Do not perform routine suctioning in neonatal patients.3 Suction only when a clinical assessment of the patient indicates that secretions are obstructing the airway.3 OVERVIEWWhen a neonatal patient suffers from respiratory distress, supporting respiratory function may require the insertion of an ET tube and ventilator support. Intubation causes an increase in the production of secretions, which neonates are unable to clear. The purpose of suctioning the ET tube is to remove secretions that may accumulate and to maintain a patent airway. Successful removal of secretions helps promote oxygenation and ventilation. The frequency of suctioning is determined according to each patient’s needs. Suctioning can be performed with either the closed suctioning technique, which involves a sterile, closed, inline suction catheter attached to the ventilator circuit or the open suctioning technique, which involves disconnection from the ventilator circuit or oxygen source. The closed suctioning technique allows passage of the suction catheter into the airway without disconnection from the ventilator. Advantages of the closed suctioning technique include:3,4
ET suctioning is a noxious procedure that may stress vulnerable neonatal patients and should not be a routinely scheduled intervention. Suctioning is appropriate when a clinical assessment of the patient indicates that secretions are obstructing the airway. Indications for suctioning include audible or visible secretions in the ET tube, coarse breath sounds, coughing, increased work of breathing, oxygen desaturation, and bradycardia.3 In addition to the listed indications, the nurse should assess for suctioning needs with these findings:1
An exception to suctioning when secretions are visible in the ET tube or breath sounds are coarse is the length of time following the instillation of artificial surfactant. To ensure maximal benefit from the artificial surfactant, tracheal suctioning is avoided immediately following surfactant administration if ventilation is adequately maintained. Avoiding suctioning for 1 to 2 hours following surfactant delivery is preferable unless ventilation or oxygenation is compromised.2 One strategy to minimize the risks associated with suctioning is to control the depth of catheter insertion. With deep suctioning, the catheter is inserted until resistance is met. Current evidence suggests that deep suctioning can damage the carina; therefore, shallow suctioning is recommended.3 With shallow suctioning, the catheter is inserted no farther than the sum of the ET tube length and adapter. Suctioning may result in hypoxia or hyperoxia. No available evidence suggests that preoxygenation is a safe practice with premature neonatal patients.2,3 Hyperoxia in the preterm neonate can result in retinopathy of prematurity and chronic lung disease. Current evidence suggests that increasing the inspired oxygen concentration before suctioning must be individualized based on the patient’s response. To prevent hyperoxia, avoid increasing the fraction of inspired oxygen (FIO2) more than 10% to 20%3 above baseline. For the extremely low-birth-weight neonate, avoid increasing the FIO2 more than 2% to 5%.3 Monitoring oxygen saturation levels is essential to protect the neonate from hypoxia and hyperoxia. Risks associated with ET tube suctioning include:3
Recommendations and parameters for suctioning the neonatal patient:
EDUCATION
ASSESSMENT AND PREPARATIONAssessment
Preparation
PROCEDURE
MONITORING AND CARE
EXPECTED OUTCOMES
UNEXPECTED OUTCOMES
DOCUMENTATION
REFERENCES
Elsevier Skills Levels of Evidence
What is the maximum time the nurse apply suction when performing endotracheal suctioning?Do not suction too long! The maximum suction time should only be 15 seconds. After suctioning, re-oxygenate the patient.
What is the maximum time for suctioning?Each suction attempt should be for no longer than 10 seconds. Remember the person will not get oxygen during suctioning. Ideally, hyper oxygenate before any suction attempts to eliminate that oxygen loss.
How long do you suction endotracheal tube?In patients not at risk for suction-related complications, insert the catheter into the artificial airway until resistance is met and then pull it back 1 to 2 cm (deep suctioning). Ensure that each suction pass lasts less than 15 seconds to minimize decreases in oxygen saturation.
How long should the nurse suction?Do Not Suction Too Long. Prolonged suctioning increases the risk of hypoxia and other complications. Never suction a patient for longer than 15 seconds. Rather than prolonged suctioning, withdraw the catheter, re-oxygenate the patient, and suction again.
|