1272 Unit 10 Promoting Physiological Health
The following techniques are used to minimize or decrease these
complications:
• Suction only as needed. Because suctioning the client with an ETT
or tracheostomy is uncomfortable for the client and potentially
hazardous because of hypoxemia, it should be performed only
when indicated and not on a fixed schedule.
• Sterile technique. Infection of the lower respiratory tract can oc-
cur during tracheal suctioning. The nurse using sterile technique
during the suctioning process can prevent this complication.
• No saline instillation. Instilling normal saline into the airway has
been a common practice and a routine part of the suctioning pro-
cedure. It was thought that the saline would facilitate removal of
secretions and improve the client’s oxygenation status. Research,
however, has shown that saline instillation does not facilitate
removal of secretions and causes adverse effects such as hypox-
emia and increased risk of pneumonia (Ntoumenopoulos, 2013;
Pierson, 2013).
• Hyperinflation. This involves giving the client breaths that are
greater than the tidal volume set on the ventilator through the
ventilator circuit or via a manual resuscitation bag. Three to five
breaths are delivered before and after each pass of the suction
catheter.
• Hyperventilation. This involves increasing the number of
breaths the client is receiving. This can be done through the venti-
lator or using a manual resuscitation bag.
• Both hyperinflation and hyperventilation help prevent suction
hypoxemia; however, they should be used with caution because
they can cause injury as a result of overdistention of the lungs
(Hess, MacIntyre, Mishoe, Galvin, & Adams, 2012).
• Hyperoxygenation. This can be done with a manual resuscita-
tion bag or through the ventilator and is performed by increasing
Client connection
T piece
Irrigation port
Suction
catheter and
sleeve
Figure 50–30   A closed airway suction (in-line) system.
the oxygen flow (usually to 100%) before suctioning and between
suction attempts. This is the best technique to avoid suction-
related hypoxemia.
To prevent hypoxia when tracheostomy and endotracheal suc-
tioning are administered, the outer diameter of the suction
catheter should not exceed one half the internal diameter of the
tracheostomy or ETT (Nance-Floyd, 2011). A rule of thumb to
determine suction catheter size is to double the millimeter size
of the artificial airway. For example, an artificial airway (e.g.,
tracheostomy) diameter of 8 mm × 2 = 16. A size 16 French
suction catheter would be the largest size catheter that would be
safe to use.
The nurse uses sterile techniques to prevent infection of the
respiratory tract (Skill 50–3). The traditional method of suction-
ing an ETT or tracheostomy is sometimes referred to as the open
method. If a client is connected to a ventilator, the nurse discon-
nects the client from the ventilator, suctions the airway, reconnects
the client to the ventilator, and discards the suction catheter. Draw-
backs to the open airway suction system include the nurse needing
to wear personal protective equipment (e.g., goggles or face shield,
gown) to avoid exposure to the client’s sputum and the potential
cost of one-time catheter use, especially if the client requires fre-
quent suctioning.
With the closed airway/tracheal suction system (in-line suctioning)
(Figure 50–30 ), the suction catheter attaches to the ventilator tub-
ing and the client does not need to be disconnected from the ventila-
tor. The nurse is not exposed to any secretions because the suction
catheter is enclosed in a plastic sheath. The catheter can be reused as
many times as necessary until the system is changed. The nurse needs
to inquire about the agency’s policy for changing the closed suction
system.
Ventilator connection
Labels
0.9% sodium chloride vials
Suction connection
Control valve