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Oral, Nasal and Endotracheal Tube Suctioning

To ensure airway patency, secretions should be suctioned from the upper respiratory tract and endotracheal tube.

Responsible​

Doctors and nursing staff.

PROCEDURE​

Suction should be performed after assessment of the baby, not on routine basis.

  • There should always be two nurses present when suctioning. One to perform the procedure, the other to assist and comfort the baby.
  • Suction pressure should not exceed 100 mm Hg in infants.
  • Select appropriate size suction catheter.
  • Always start with the endotracheal tube before suctioning the mouth. Perform nasal suctioning last.

Equipment​

  • Suction catheters of appropriate size (6Fr/ 8Fr/ 10Fr/ 12Fr)
  • Sterile gloves
  • Normal Saline
  • Dextrose 10 %/ Sucrose 25%
  • Manual ventilation bag (for resuscitation if necessary)

ENDOTRACHEAL TUBE SUCTIONING​

  • Wash or disinfect your hands.
  • Assess the need for administration of Dextrose 10 % for pain relief.
  • Open new suction catheter and gloves package without touching the sterile content.
  • Put on sterile gloves and attach sterile suction catheter to suction tubing.
  • Check the endotracheal tube insertion length (cm.) and mark the suction catheter to the same distance. Catheter tip should never touch carina.
  • Disconnect the endotracheal tube from ventilator with the non-dominant hand.
  • Gently pass catheter down endotracheal tube with sterile hand to the marked position while blocking the suction of the catheter. Open suction pressure and withdraw the catheter over a period of 3 - 5 seconds.
  • If the baby is in need of more suctioning, put the baby back on ventilator and assess the tolerance of the procedure before next attempt is preformed.
  • If required, rinse the catheter with normal saline in-between suctioning attempts.
  • Discard the catheter and your gloves. Wash or disinfect your hands.
tip

Some babies can benefit from pre-oxygenation to avoid hypoxia. Increase FiO2 by 10% to 20% above baseline before procedure.

Complications associated with endotracheal suctioning includes hypoxia, alterations in heart rate, blood pressure and cerebral blood flow, tissue damage, atelectasis, pneumothorax, infections and unplanned extubation.

warning

Injecting normal saline in the endotracheal tube before suctioning is not recommended.

ORAL AND NASAL SUCTIONING​

  • Wash or disinfect your hands.
  • Assess the need for administration of Dextrose 10 % for pain relief.
  • Put on gloves and attach sterile catheter to suction tubing.
  • For oral suction, turn the baby's face to one side and perform suctioning on the dependent site to a depth of 2-3 cm.
  • For nasal suction, gently insert the tube into the nares.
  • Do not suction for more than 3-5 seconds.
  • If the baby require more than one suctioning asses the tolerance of the procedure before the next attempt is preformed.
  • If required, rinse the catheter with normal saline in-between suctioning attempts.
  • Discard the catheter and gloves. Wash or disinfect your hands.
warning

Frequent nasal suction creates trauma and edema. Never push against resistance.

danger

Never suction too deep as it can cause apnea and arrhythmia due to vagal stimulation.

References​

  • Neonatal Intensive Care by Merenstein and Gardner (2011) Comprehensive Neonatal Nursing Care by Kenner and Lott (2014)
  • Practical Procedures for the Newborn Nursery, A Manual for Physicians & Nurses. Deorari, Paul, Singhal, Scotland and McMillan, Third Edition (2010)
  • Essential Newborn Nursing for Small Hospitals, Participatory Module-Based Learning, 2nd Ed (2009)

Document Information​

Current Version

Version: 2.0
Published: August 20, 2015
Revised by: Dr Chetan Meena
Contributors: Senior Neonatal Teaching Nurse: Helene Bjornstad
Previous Versions: v1.0