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PROTOCOL FOR ORAL, NASAL AND ENDOTRACHEAL TUBE SUCTIONING

Purpose​

To remove secretion from the upper respiratory tract, and accumulation of secretion in the endotracheal tube, this to ensure airway patency.

Responsible​

Doctors and nursing staff.

Procedure​

SUCTION MUST BE PERFORMED ON AN INDIVIDUAL BASIS, NEVER ON A ROUTINE BASIS.
There should always be two nurses present when suctioning. One to perform the procedure, the other to assist and comfort the baby. Control the suction machine, suction pressure are not to exceed a pressure of 100 mm of Hg. When selecting catheter size, select the smallest size possible. Always start with the endotracheal tube before suctioning the mouth. Perform nasal suctioning last.

Equipments​

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

Open suctioning in endotracheal tube​

  1. Wash or disinfect your hands.
  2. Assess the need for administration of Dextrose 10 % for pain relief.
  3. Measure tube distance, catheter tip are never to touch carina.
  4. Open new catheter and gloves package without touching the sterile content.
  5. Put on sterile gloves and attach sterile catheter to suction tubing.
  6. Disconnect the tube from ventilator with the nondominant hand.
  7. Gently pass catheter down endotracheal tube to right position. Do no suction for more than 3-5 seconds before you withdraw the catheter.
  8. 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.
  9. If required, rinse the catheter with normal saline in-between suctioning attempts.
  10. Discard the catheter and your gloves.
  11. Wash or disinfect your hands.

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

Remember

There are many complications associated with endotracheal suctioning; hypoxia, hypoxemia, alterations in heart rate, blood pressure and cerebral blood flow, tissue damage, atelectasis, pneumothorax, infections and unplanned extubation

Dripping normal saline in the endotracheal tube before suctioning is not recommended as mucus is not mixable and therefore do not thin or liquefy secretions.

Oral and nasal suctioning​

  1. Wash or disinfect your hands.
  2. Assess the need for administration of Dextrose 10 % for pain relief.
  3. Estimate the length of the suction by measuring the distance between the tip of the nose and the tip of the ear lobe.
  4. Open catheter and gloves package without touching the sterile content.
  5. Put on sterile gloves and attach sterile catheter to suction tubing.
  6. Start with oral suction. Do not go further down than the measured distance.
  7. Gently insert the tube upwards and back into the nares, never forced.
  8. Do not suction for more than 3-5 seconds.
  9. If the baby require more than one suctioning asses the tolerance of the procedure before the next attempt is preformed.
  10. If required, rinse the catheter with normal saline in-between suctioning attempts.
  11. Discard the catheter and gloves.
  12. Wash or disinfect your hands.
warning

Frequent nasal suction creates trauma and edema. Never suction vigorously as it can cause apnoea and arrhythmias 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, by Deorari, Paul, Singhal, Scotland and McMillan, Third Edition (2010) and Essential Newborn Nursing for Small Hospitals, Participatory Module-Bassed Learning, 2nd Ed (2009)

Document Information​

Archived Version

Version: 1.0 (Archived)
Published: August 3, 2015
Contributors: Senior Neonatal Teaching Nurse: Helene Bjornstad
View: Current Version