Suctioning is an important part of respiratory care for patients who are unable to clear their own airways effectively. It involves inserting a suction catheter into the airway to remove secretions and maintain a patent airway. Determining the appropriate duration of suctioning is essential to provide effective treatment while avoiding potential complications. In general, suctioning should be done for the minimum amount of time necessary to adequately clear secretions from the airway. Recommendations on suctioning duration vary depending on the clinical situation.
Recommended Suctioning Duration
During Routine Suctioning
For routine suctioning of intubated patients, most experts recommend limiting suction passes to 10-15 seconds at a time. Generally, a suction pass involves inserting the catheter, applying negative pressure as the catheter is withdrawn, and then removing the catheter from the airway. This allows for removal of secretions without prolonged airway occlusion or trauma.
The typical recommendation is to pre-oxygenate the patient prior to suctioning and allow the patient to rest and recover with ventilation between passes. This cycle can be repeated as needed until secretions are cleared, with some sources recommending no more than 3 passes per event. The duration may be adjusted based on factors like the quantity and viscosity of secretions.
When suctioning through a bronchoscope, longer duration suction passes may be utilized since the suction catheter occupies less of the airway lumen. Suction passes of up to 20-30 seconds can be performed during bronchoscopy before allowing the patient to rest and recover.
For neonatal and pediatric patients, shorter suctioning duration is recommended. Suction passes should be limited to 5 seconds or less. Their smaller anatomies increase the risk of airway occlusion and mucosal injury with prolonged suctioning.
During Emergency Situations
In emergency situations where copious secretions must be removed quickly, suctioning may need to be performed for longer durations. In cases of complete airway obstruction or cardiopulmonary resuscitation, suctioning for up to 30 seconds may be required to open the airway. However, this should be minimized as much as possible to avoid potential harm.
Key Considerations in Determining Suction Duration
Several key factors should be considered when determining appropriate suctioning duration:
The duration of suction passes should be adjusted based on patient toleration and physiologic response. Signs of poor toleration like hypoxemia, bradycardia, hypotension or arrhythmias are indications to shorten suction time and allow the patient to recover.
Type of Suctioning
Open suction systems use single-use catheters and allow application of negative pressure only when withdrawing the catheter. Closed systems utilize multi-use catheters and allow continuous suction during insertion and withdrawal. Open systems are preferred for most routine suctioning as they limit airway occlusion.
Quantity of Secretions
If copious or very viscous secretions are present, slightly longer suction passes may be beneficial to adequately clear the airway. However, the risk of trauma or occlusion should be minimized by allowing the patient time to rest between passes.
Patient Age and Size
As noted above, shorter duration is recommended for neonates and infants due to their smaller airway anatomy. The duration may be adjusted upward for larger pediatric or adult patients.
Artificial Airway Size
The size of an artificial airway like an endotracheal tube or tracheostomy tube impacts the occlusion caused by suctioning. Smaller tubes are more easily occluded, so shorter suction duration should be utilized.
The negative pressure applied during suctioning should be the minimum needed to effectively remove secretions without damaging the mucosa. Recommended pressures vary based on age, airway size and other factors. Excessive pressures increase the risk of complications.
Potential Complications of Excessive Suctioning Duration
Prolonged or frequent suctioning beyond the minimum necessary can result in several possible complications:
– Hypoxemia – Suctioning interrupts ventilation and oxygenation, risking hypoxemia especially with longer duration. Pre-oxygenation and close monitoring of SpO2 is necessary.
– Bradycardia – Stimulation of the airway during extended suctioning may trigger vagal nerve reflexes, causing bradycardia.
– Bronchospasm – Airway irritation can trigger bronchospasm and wheezing, which may require bronchodilator treatment.
– Trauma – Increased mucosal abrasion, bleeding, and ulceration may result from extended suctioning.
– Hypertension or arrhythmia – Stimulation with extended suctioning may induce cardiac effects like hypertension or ectopy.
– Atelectasis – Collapse of alveoli can occur with repeated and prolonged airway occlusion.
– right ventricular strain – Increased pulmonary vascular resistance from atelectasis can strain the right ventricle.
– Infection – Mucosal damage from suction trauma raises infection risk. Open suction systems and aseptic technique help minimize this risk.
– Electrolyte imbalance – Excessive loss of electrolyte-containing airway fluids can lead to imbalances.
Suctioning duration should be the minimum required to adequately clear secretions from the airway. For routine suctioning of an intubated adult, most experts recommend limiting suction passes to 10-15 seconds. The duration should be adjusted based on patient tolerance, age, airway size, type of suction system, and quantity of secretions. Prolonged suctioning substantially increases the risk of complications like hypoxemia, trauma, arrhythmias, and infection. Careful assessment of therapeutic benefit versus risk is needed to optimize suctioning practice. With thoughtful technique, suctioning can be performed effectively while avoiding potential harm to the patient.