Airway_Suctioning_Updated_Guidelines_2025.pptx

Airway suctioning

1. For Critical Care, Anesthesia & Respiratory Therapy Learners Airway Suctioning: Updated Evidence‑Based Practice (2025)

2. Learning Objectives By the end of this class, you will be able to: Identify indications & contraindications for airway suctioning Select catheter size, negative pressure, and technique by age group Perform open vs. closed suction safely (step-by-step) Apply infection prevention & patient monitoring best practices Adapt care for special populations: tracheostomy, pediatrics, neonates Document, audit, and troubleshoot complications

3. Core Principles (What’s New & Important)

4. Key Updates to Know (AARC 2022; NRP 8th Ed. 2021) Suction ONLY when clinically indicated (not routine). Either open or closed system acceptable in most adults; closed is logical in peds /neonates and for high PEEP/FiO2 needs. Avoid routine saline instillation; consider selective use for thick secretions with caution. Use the LOWEST effective negative pressure; keep suction pass ≤ 10–15 seconds. Pre‑oxygenate if risk of desaturation; monitor SpO2, ECG, BP, ventilator waveforms. NRP (2021): Do NOT routinely suction non‑vigorous infants with meconium; prioritize effective ventilation.

5. Indications Do suction when you observe: Visible/auscultated secretions; coarse breath sounds; decreased SpO2 Increased PIP/plateau or saw‑tooth pattern on flow/volume waveform Acute ventilator alarms (high pressure), suspected tube obstruction Routine suctioning is NOT recommended when: Airway is clear and patient stable without signs of secretion burden

6. Contraindications (Relative) & Precautions Use caution / prepare mitigation strategies for: Severe hypoxemia or hemodynamic instability Raised ICP; head injuries (pre‑oxygenate, limit duration) Bronchospasm/reactive airways (premedicate as per protocol) Coagulopathy/mucosal injury risk (gentle technique, correct catheter size)

7. Assessment & Preparation

8. Pre‑Suction Assessment Review vital signs, SpO2, ventilator settings/waveforms, recent ABG Auscultate; inspect ETT/tracheostomy; evaluate secretion amount/consistency Evaluate need for analgesia/sedation; explain to conscious patients Check suction unit, pressure, catheter size, sterile supplies, PPE

9. Catheter Size Selection (Rule of 1/2 – occlude < 50% ETT ID) Adults: Catheter (Fr) ≈ (ETT ID mm × 2) + 2; typically 12–14 Fr Pediatrics: Use smaller sizes (8–12 Fr) to keep occlusion < 50% Neonates: 5–8 Fr; confirm fit and resistance before insertion

10. Negative Pressure (Use Lowest Effective) Adults: 80–120 mmHg (can increase cautiously for thick secretions up to 150 mmHg if policy allows) Pediatrics: 80–100 mmHg Neonates: 60–80 mmHg Verify on manometer before each pass; continuous monitoring during suction.

11. Technique

12. Open Suction Technique (ETT/Tracheostomy) Steps (sterile): Perform HH; don PPE (gloves, gown, mask/eye protection) Pre‑oxygenate 30–60 s if indicated; consider hyperinflation per protocol Disconnect ventilator; insert catheter without suction until carina depth minus 1–2 cm Apply suction while withdrawing with gentle rotation ≤ 10–15 s Reconnect ventilator; reassess, re‑oxygenate; repeat only if needed Pros: simplicity, low cost. Cons: derecruitment, hypoxemia risk, loss of PEEP.

13. Closed (In‑Line) Suction Technique Steps: HH & PPE; ensure closed system integrity and suction set‑up Pre‑oxygenate if indicated; maintain ventilation/PEEP Advance in‑line catheter without suction; target depth (markings) Apply suction while withdrawing with rotation ≤ 10–15 s Flush catheter, maintain sterility; reassess and repeat only if needed Advantages: maintains PEEP/FiO2, less desaturation & hemodynamic swings, reduces aerosolization.

14. Special Considerations

15. Oropharyngeal & Nasopharyngeal Suction (Y‑ankauer/soft catheter) Indications: visible secretions, gurgling, aspiration risk Technique: avoid trauma to posterior pharyngeal wall; intermittent suction; oral care bundle Avoid blind deep nasopharyngeal suction in coagulopathy or skull base fractures

16. Tracheostomy Suctioning Key points: Stabilize flange/tube; use sterile technique Use appropriate catheter size/pressure; avoid deep suctioning beyond stoma unless indicated Assess for cuff pressure, tube obstruction, need for inner cannula cleaning/change

17. Pediatrics & Neonates Use smallest effective catheter and lowest pressure; limit passes; strict thermoregulation Avoid routine saline; consider humidification optimization first NRP 8th Ed. (2021): No routine tracheal suctioning for non‑vigorous meconium-stained newborns Priority is effective ventilation; suction only if airway obstruction suspected

18. Infection Prevention & Safety

19. PPE & Asepsis Hand hygiene before/after; sterile gloves for open suction; clean/aseptic for closed in‑line Mask/eye protection (aerosol risk). Follow institutional transmission‑based precautions Single‑use catheters for open suction; maintain closed system integrity; change per policy

20. When to Pre‑oxygenate / Hyperoxygenate If baseline SpO2 < 92%, high PEEP/FiO2, pulmonary hypertension, raised ICP Avoid excessive FiO2 in neonates (risk of hyperoxia ); use target SpO2 ranges

21. Saline Instillation: Not Routine May transiently worsen oxygenation and increase infection risk Consider only for thick, tenacious secretions after other measures (humidification, hydration)

22. Monitoring, Complications & Troubleshooting

23. Continuous Monitoring SpO2, HR, ECG rhythm, BP; observe ventilator waveforms/pressures Stop if severe desaturation, brady/tachyarrhythmia, hypotension, bronchospasm

24. Potential Complications Hypoxemia, derecruitment/atelectasis, hemodynamic instability Mucosal trauma, bleeding, bronchospasm, infection, raised ICP Accidental extubation or loss of tracheostomy tube—always secure and support

25. Troubleshooting If no secretions retrieved: verify catheter size/depth, suction pressure, humidification If repeated thick plugs: consider mucolytics per policy, bronchoscopy consult If persistent desaturation: switch to closed system, optimize PEEP, limit passes

26. Documentation, Audit & Competency

27. What to Document Indication, pre‑assessment findings, technique (open/closed), catheter size & pressure Number/duration of passes, secretion amount/character, patient response Post‑procedure vitals/SpO2, complications, changes to ventilator/oxygen therapy

28. Checklist (Quick Use) Before: Indication confirmed • Monitoring on • PPE • Equipment ready • Pressure set During: ≤ 10–15 s per pass • Gentle rotation • Maintain PEEP if possible After: Reassess • Re‑oxygenate • Document • Adjust humidification/therapy