COLLEGE OF NURSING, INSTITUTE OF LIVER AND BILIARY SCIENCES

NEW DELHI

DEMONSTRATION
ENDOTRACHEAL SUCTIONING

SUBMITTED TO SUBMITTED BY
Ms. Sarita Mr. Dil Raj
Lecturer M.Sc. (N) 1 st year
CON, ILBS CON, ILBS

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 Demonstration on Endotracheal Suctioning

Subject Clinical Speciality

Class group M.Sc. (N) 1st year

Date/Time

Duration 30 minutes

Method of teaching Demonstration on Endotracheal suctioning

Media of teaching Demonstration

Name of Moderator Ms. Sarita

Name of student teacher Mr. Dil Raj

The student group have some knowledge regarding Endotracheal suctioning.

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GENERAL OBJECTIVES
At the end of demonstration, students will be able to gain knowledge and skills regarding endotracheal suctioning and will be able to apply the
knowledge and skills in future

SPECIFIC OBJECTIVES
At the end of the demonstration, group will be able to –
- Describe endotracheal suctioning.
- Enlist purpose of Endotracheal suctioning.
- Enumerate indications for study.
- Enlist equipment required for ET Suctioning.
- Demonstrate steps of endotracheal suctioning.
- Discuss expected outcomes of ET Suctioning.
- Describe documentation after ET Suctioning.
- Discuss complications post suctioning.

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S.No Time Specific objective Content Teaching Learning Evaluation
Activity

1. 30 sec To introduce self to Good morning to

the group all, I, Dil Raj
student of M.Sc.
Nursing 1st year
will discuss about
Endotracheal
suctioning.

2. 2 mins To describe INTRODUCTION- Student teacher What is endotracheal tube?

Endotracheal describes the
intubation Endotracheal intubation: - endotracheal
It is passing of endotracheal tube through the mouth and intubation
nose into Trachea, it provides patent airway for those who
cannot maintain adequate airway on their own or respiratory
distress cannot be treated with simpler methods
(supplemental oxygen).

Definition

 Endotracheal Tube (ETT): An airway catheter

inserted into the trachea (windpipe) via the mouth or
nose in endotracheal intubation.
 Endotracheal Intubation: The placement of a tube
into the trachea in order to maintain an open airway
in patients who are unable to breathe on their own or
maintain their own airway
 ETT Suction: The process of applying a negative
pressure to the distal ETT or trachea by introducing a
suction catheter to clear excess, or abnormal,

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 secretions
 Oropharyngeal Suction: A suction catheter through
the mouth to clear secretions
 Nasopharyngeal Suction: A suction catheter is
passed through the nose to clear secretions
 Open Suction: Suction is performed by means of
disconnecting the patient ETT from the ventilation
device during the procedure and then reconnecting it
following the procedure.
 Closed Suction: An in-line suction catheter is
connected to the ventilation circuit and ETT suction
procedure can be performed without disconnecting
the patient from the ventilation circuit.
 ET CO2: End Tidal Carbon Dioxide monitoring is
the level of carbon dioxide in exhaled air which
gives an assessment of ventilation

ENDOTRACHEAL INTUBATION SUCTIONING

 ET suctioning is a component of bronchial hygiene

therapy and mechanical ventilation that involves the
mechanical aspiration of pulmonary secretions from
a patient with an artificial airway in place.
 It is also defined as the procedure to remove
pulmonary secretion mechanically from the patient’s
airway passages via nose or mouth where ETT
(Endotracheal tube) is in place.
 Suctioning (endotracheal, oropharyngeal,
nasopharyngeal and tracheostomy tube) is the
method of clearing tracheal/oral nasal secretions by
the application of negative pressure using an
appropriate size catheter

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  Suctioning may be a part of emergency situation or it
can be done in planned care.
 It is a sterile procedure and the Suction catheter
should be discarded after every 8 hours. The amount
of negative pressure is 100-120 mm Hg

2. 1 min2 To enlisted the Student teacher What can be important

purposes for ET PURPOSES FOR ET SUCTIONING enlisted purposes point for ET Suctioning
Suctioning  To maintain patent airway for ET Suctioning. regarding its purposes ?
 To remove secretions from respiratory tract
 To improve oxygenation and reduce efforts for
breathing
 Collect secretions for diagnostic procedures.
 Stimulate the cough reflex
 Prevent infection and reduce risk of aspiration
 Prevent atelectasis from tracheobronchial secretions.

3. 2.5 min To enumerate the Student teacher What will be the

indications for ET CLINICAL INDICATIONS FOR ET SUCTIONING enumerated indications for ET
Suctioning indications for ET Suctioning ?
 Increase in respiratory rate Suctioning
Aspiration prophylaxis
 Desaturations
 Bradycardia
 Tachycardia
 Absent or decreased chest movement
 Visible secretions in ETT
 Coarse or decreased breath sounds
 Blood pressure fluctuations
 Recent history of large amounts of thick / tenacious

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 secretions.

Points to Remember

 Gather all the equipment before procedure

 Suction should be performed 'as needed' rather than
on a routine basis
 Each insertion should not exceed 10 seconds
 Observe the condition of the patient carefully
 Provide comfort during the procedure
 Maintain proper asepsis throughout the procedure
 Explain the patient about the procedure before
suctioning
 Communicate with the patient during the procedure
even though the patient is unconscious.
 Do not apply suction while inserting the catheter
 Suction should not be done immediately after
meal/feed
 Use rounded tip catheter for tracheostomy and oral
suctioning
 The catheter size for adult should be 12-16 Fr and
for children it should be 8-10 Fr
 Observe patient while suctioning for the following
signs or symptoms: Cyanosis, increased or decreased
heart rate, aspiration, mucosal damage,
bronchospasm, coughing, bleeding, and/or
respiratory distress or arrest. Immediately stop
suctioning should any of the above symptoms
occur.

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4. 2.5 min To enlist the Student teacher What are the items
EQUIPMENTS REQUIRED
equipment required enlisted required for ET
for suctioning equipment’s for ET Suctioning?
 Laryngoscope
Suctioning
 Magill’s forceps
 AMBU bag and mask
 Stethoscope
 Suction apparatus with tubing’s
 Syringe (10ml – to inflate et tube)
 Pressure manometer
 Source for ventilation
 Endotracheal tube of sizes
0-1 yr. = 2.5-3.5mm (plain)
6-10yrs = 6-7mm
Adult female = 7 mm
Adult male = 8 mm

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 Laryngoscope handle, No. 3 Macintosh (curved) blade,
and No. 3 Miller (straight) blade.

A study has shown that single use metal blades have

resulted in a lower failed intubation rate than did
reusable metal blades. (Amour, 2010)

Other equipment:
-Portable or wall suction with tubing and reservoir
-100% oxygen source
-Resuscitation trolley
5. 12 mins To demonstrate the Student teacher Mention steps for ET
steps for ET demonstrated steps Suctioning.
Suctioning STEPS OF PROCEDURE: for procedure

 Pre-procedural steps:

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 Assess secretions in airway with or without the
stethoscope and the rate and depth of respiration to
determine the need for Suctioning.
 Check vital signs. Suctioning may lead to hypoxia
during the procedure.
 Explain the procedure to the patient and the relatives
regarding the need for suctioning. It prevents undue
anxiety amongst the patient and the attendant.
 Gather all the articles at bedside to prevent any hassle
during the procedure.
 Check the functioning of the suction machine to
prevent any disturbance during the procedure
 If patient is on mechanical ventilator put patient on
100% oxygen.

 Intra-procedural steps:
 Explain the purpose of the procedure to the patient
and family/caregivers and offer them reassurance.
Explain that the procedure is likely to be little
uncomfortable.

Semi- fowler

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 Lateral position

 Assist the patient to a Semi Fowler's position if

conscious. It will allow optimum lung expansion and
will also allow the patient to cough and breathe more
easily. This position will also aid in the insertion of
catheter because of gravity. As unconscious patient
should be placed in the lateral position, It will
prevent the tongue falling backwards and thus
prevent the airway from getting obstructed. This
position also facilitates drainage of secretions from
the pharynx and prevents the possibility of
aspiration.

 Open the sterile supplies, i.e. sterile catheter from

the catheter pack and sterile gauze pieces into the
sterile tray.
 Pre-oxygenate the patient with 100% oxygen to
prevent hypoxia.
 Keep the dominant hand sterile and the non-
dominant hand clean. Pick up catheter with
dominant hand (sterile hand) and the connecting
tube with non-dominant hand.
 Disconnect the patient from ventilator or any other

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 oxygen source
 Turn on the suction source
 Pinch the catheter and insert it into the endotracheal
tube (during inspiration when glottis open) without
applying suction. Using suction while inserting
catheter can cause trauma to mucosa and removes
oxygen from the respiratory tract.
 Advance catheter about 6-8 inches or until you feel
resistance. This usually means the catheter tip has
reached the bifurcation of the trachea. Withdraw the
catheter 1-2 cm before applying suction to avoid
damage to this area.
 Apply suction by releasing thumb from 'Y' port
 Gently rotate the catheter with the thumb and index
finger of the sterile gloved hand
 Limit suctioning time to 10 seconds per suction
episode to prevent hypoxia.
 Clean the catheter in between each suction by
dipping the catheter into the normal saline

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  Repeat the suctioning until the airway is clean. The
patient should be re-assessed after each pass of the

catheter to assess hypoxia and distress. Suctioning

should not be more than four times per suction
episode to prevent complications.

o For Oral secretions.

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  Without applying suction, insert the catheter gently
along the side of the mouth. Advance to oropharynx.
Suction the oropharynx in rotating manner.
 Replace the oxygen mask.
 Rinse the catheter with normal saline/water until the
tubing are cleared off secretions.
 Turn off the suction machine. Disconnect the
catheter from the suction tubing.

For close suctioning/ In line suctioning

Close suctioning refers to In-line suctioning, multiple-use

suction catheter inside a sterile plastic sleeve is inserted
through a special diaphragm attached to the end of the
endotracheal or tracheostomy tube.

This technique decreases the risk for aerosolization of

tracheal secretions during suction-induced coughing and
may reduce hand and equipment cross contamination

Indications:

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  -Patients who experience cardiopulmonary
instability during suctioning with the open technique
 High levels of positive end-expiratory pressure
(PEEP; > 10 cm H2O) or inspired oxygen (> 80%)
 -Grossly bloody pulmonary secretions
 Have airborne transmission of disease, such as active
pulmonary tuberculosis.

6. 1 mins To discuss
expected outcomes Student teacher What can be expected
of ET Suctioning discussed the outcomes of ET
Procedure expected outcomes Suctioning?
 Connect the suction tubing to the closed system of ET Suctioning
suction port
To describe the  Hyper-oxygenate the patient for at least 30 seconds
7. 1 min documentation after  Press the suction hyper-oxygenation button on the Student teacher What can be the
ET Suctioning ventilator described the documentation to be done
 Increase the baseline Fi o2 level on the mechanical documentation to be after suctioning?
ventilator done after ET
Suctioning

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  Remove the ventilator circuit or self-inflating
manual resuscitation bag-valve device
 Suction catheter open to air, gently but quickly insert
the catheter with the dominant hand into the artificial
airway until resistance is met, then pull back 1–2 cm
before applying suction
 Maintain PEEP during suctioning.
 Allow longer recovery intervals between suction
passes.
 Rinse the catheter and connecting tubing with sterile
8. 2 mins To discuss saline in syringe until clear.
complications post Student teacher What all will be
suctioning Expected Outcomes discussed the complications post
complications after suctioning?
 Removal of secretions from the large airways suctioning
 Improved gas exchange
 Airway patency

Documentation
1. Documentation should include the following: •
Patient and family education
2. Pre-suctioning assessment, including clinical
indication for suctioning
3. Suctioning of endotracheal or tracheostomy tube
4. Size of endotracheal tube and suction catheter
5. Pain assessment, interventions, and effectiveness
6. Volume, colour, consistency, and odour of secretions
obtained
7. Any difficulties during catheter insertion or hyper-
oxygenation
8. Nursing interventions
9. Post-suctioning assessment

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 Complications Post Suctioning

Respiratory arrest
Cardiac arrest
Cardiac dysrhythmias (premature contractions,
tachycardia bradycardia, heart blocks)
Hypertension or hypotension
Decreases in mixed venous oxygen saturation
Increased intracranial pressure
Bronchospasm
Pulmonary haemorrhage or bleeding
Pain and anxiety
Tracheal mucosal damage

SUMMARY

Endotracheal tube (ETT) suction is necessary to clear

secretions and to maintain airway patency, and to optimise
oxygenation and ventilation in a ventilated patient.
It is a common procedure carried out on intubated patients
also helpful in early weaning off from ventilator. The goal
of ETT suction should be to maximise the amount of
secretions removed with minimal adverse effects associated
with the procedure.

BIBLIOGRAPHY
Blackwood B. Normal saline instillation with endotracheal suction: primum non nocere (first do no harm). J Adv Nur 1999:29(4),928-34
Caruso P, Denari S, Soraia AL, Ruiz RT, Demarzo SE, Deheinzelin D. Saline instillation before tracheal suctioning decreases the incidence of
ventilator-associated pneumonia. Crit Care Med. 2009;37:32-8.

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Griggs A. Tracheostomy: suctioning and humidification. Nursing Standard. 1998;13(2):49-56.
Oropharyngeal, Nasopharyngeal, nasotracheal and tracheostomy tube suctioning. Evidence-Based Clinical Procedures Manual. Chapter 12,
Policy 1. EBCPM 12.01, Accessed on 2.6.17

The Royal Children’s hospital melbourne. The Royal Children’s Hospital Melbourne. (n.d.).
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/endotracheal_tube_suction_of_ventilated_neonates/

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