PROCEDURAL GUIDELINES (to accompany Chapter 21)
Performing Tracheal Suction
Equipment (as needed)
•  Suction catheters
•  Gloves
   (sterile and nonsterile), gown, mask, and goggles   •  Manual resuscitation bag with supplemental oxygen
for eye protection
Implementation
Nursing Actions
1. Assess the patient’s lung sounds and oxygen saturation via
pulse oximeter.
2. Explain the procedure to the patient before beginning and
offer reassurance during suctioning.
3. Perform hand hygiene. Put on nonsterile gloves, goggles,
gown, and mask.
4. Turn on suction source (pressure should not exceed 120 mm
Hg for an open system and 160 mm Hg for a closed system).
5. Open suction catheter kit.
6. Fill basin with sterile water.
7. Put sterile glove on dominant hand.
8. Ventilate the patient with manual resuscitation bag and high-
flow oxygen for about 30 seconds or turn on suction mode of
ventilator (if available) to hyperoxygenate the patient. Ventila-
tion or preoxygenation may not be required for a long-term
tracheostomy patient who is not acutely ill.
9. Pick up suction catheter in sterile gloved hand and connect to
suction.
10. Insert suction catheter at least as far as the end of the tube
without applying suction, just far enough to stimulate the
cough reflex.
11. Apply suction while withdrawing and gently rotating the
catheter 360° (no longer than 10 seconds).
12. Reoxygenate and inflate the patient’s lungs for several breaths
with manual resuscitation bag, or allow ventilator to reoxygenate
patient for several breaths using suction mode.
13. Rinse catheter by suctioning a few milliliters of sterile water
solution from the basin between suction attempts.
14. Repeat steps 8–13 until the airway is clear.
15. Suction oropharyngeal cavity after completing tracheal
suctioning.
16. Rinse suction tubing and discard catheter, gloves, and basin
appropriately. Dispose of PPE as directed by facility’s policies.
17. Assess the patient’s lung sounds and oxygen saturation via
pulse oximeter after procedure.
18. Document the amount, color, and consistency of secretions.
Adapted from Morris, L., Whitmer A., & McIntosh, E., (2013). Tracheostomy care and complications in the intensive care unit. Critical Care Nurse,
33(5), 18–31; Woten, M., & Pilgrim, J. (2016). Tracheostomy tubes: Suctioning using an open system. In D. Pravikoff (Ed.) Nursing practice and
skill. Glendale, CA: CINAHL Information Systems.
From Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 14th Edition. All Rights Reserved.
LWBK1592-CH21_online_03.indd 1
•  Basin for sterile normal saline solution for irrigation
•  Suction device and source
Rationale
1. Assessment data indicate the need for suctioning and allow
the nurse to monitor the effect of suction on the patient’s
level of oxygenation.
2. The patient may be apprehensive about choking and about
an inability to communicate.
3. Hand hygiene reduces bacteria on hands. Nonsterile gloves,
goggles, gown, and mask serve as personal protective
equipment (PPE) because they protect the clinician from
becoming infected with pathogens.
4. Suction pressure should be set high enough to be effective
without causing trauma to the tissues.
5. Having equipment ready prevents interruption of the procedure.
6. This provides sterile solution for clearing suction catheter of
secretions.
7. Equipment that will contact the patient’s lower airway must
remain sterile to prevent infection.
8. This prevents hypoxia during suctioning.
9. This prevents contamination of sterile catheter.
10. Inserting the catheter without applying suction permits
insertion without causing trauma to the tissues.
11. Prolonged suctioning may result in hypoxia and dysrhyth-
mias, leading to cardiac arrest.
12. This prevents hypoxia during procedure and restores oxygen
supply.
13. This keeps suction catheter patent.
14. This ensures removal of all tracheal secretions.
15. This avoids contamination of trachea with oropharyngeal
secretions and organisms.
16. Safe disposal of equipment avoids cross-contamination.
17. Assessment provides information about effectiveness of
procedure.
18. Documentation allows monitoring of patient’s status over time.
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