Care and Suctioning of Tracheal Tubes

Objectives

• Describe the proper care of the ET tube and

tracheostomy tube.

• Describe the steps of proper suctioning technique.

• List common tube complications.

• Demonstrate safe suctioning.

 Suctioning

• Suctioning is an essential component of maintaining

a patient’s airway.

• Both soft flexible and rigid suctioning catheters are

available.

• Follow the steps of safe oropharyngeal and tube

suctioning.
 Daily Care of the ET tube
Observe for:
• Soiled and loose tape
• Pressure sores on lips and corner of mouth
• Excess oral and nasal secretions
• Measure cuff pressure
• Record size and depth of tube
• Record time of tube placement
 Complications of ET Tube

• Malpositioning

• Ventilator Associated Pneumonia

• Laryngeal injury

• Vocal cord paralysis

• Tracheal stenosis

• Swallowing impairment
 Care of tracheostomy tube

• Observe for soiled dressings and ties

• Record type of tracheostomy and size

• Pressure cuff same as ET tube

 Complications of tracheal tubes

• Bleeding

• Infection

• Tracheal stenosis

• Tracheoesophageal fistula/granulomas
 Suctioning

Types

Open circuits

Close circuits

Steps of suctioning

Monitor HR, RR, SpO2.

Select the catheter size

Follow sterile technique

 Suctioning

• Pre-oxygenate 100% for 2 min

• Occlude the suction catheter tube
• Gently insert the catheter tube to desired length
• Apply suction and withdraw gradually twisting or
rotating motion
• Do not apply suction >10 sec
• Avoid hypoxia
 Suction devices

Suction devices consist of both portable and wall-

mounted units:
• Portable suction devices:
• Easy to transport but may not provide adequate
force (-80 to -120 mmHg).
• Wall-mounted suction units:
• Can provide vacuum of more than -300 mmHg if
necessary.
• Adjust the amount of suction force for use in children
 Soft vs. Rigid Catheters

• Soft flexible catheters may be used in the mouth or

nose.
• Aspiration of thin secretions
• Performing intratracheal suctioning
• Suctioning through an in-place airway (i.e. NPA)
• Rigid catheters (e.g. Yankauer) are used to suction
the oropharynx.
• Provides for more effective suctioning of the
oropharynx, particularly if there is thick
particulate secretions
 Oropharyngeal Suctioning Procedure

Follow the steps below (ACLS 2020):

• 1. Measure the catheter before suctioning and do
not insert it any further than the distance from the tip
of the nose to the earlobe. Gently insert the suction
catheter beyond the tongue.
• 2. Apply suction while withdrawing with a rotating
or twisting motion. If using rigid device, advance by
pushing the tongue down to reach the oropharynx if
necessary.
 ETT Suctioning Procedure

Follow the steps below (ACLS 2020):

• 1. Use sterile technique.
• 2. Gently insert the catheter. Be sure suction is not
on during insertion.
• Insertion beyond ET tube is not recommended, it may injure mucosa
or stimulate coughing or bronchospasm.
• 3. Apply suction while withdrawing catheter with a
rotating or twisting motion.
• Suction attempts should not exceed 10 seconds.
 Safety points

• Monitor the patients heart rate, pulse, oxygen

saturation and clinical appearance during suctioning.
• If bradycardia develops, oxygen saturation drops or
clinical appears deteriorates, interrupt suctioning at
once.
• Administer high-flow oxygen until the heart rate
returns to normal and clinical condition improves.
Prevent VAP

• Oral intubation preferable to

nasal.
• Use a new ventilator circuit
for each patient
• Keep patient in semi-
recumbent position
• Head of bed 30° to 45°
Prevent VAP

• Perform regular antiseptic oral

care:
• Once patient is ventilated, change
circuit if it is soiled or damaged
but not routinely.
• Periodically drain and discard
condensate in tubing.
• Use in-line closed suction
system.
Prevent VAP: the circuit

• In adults, change heat and

moisture exchanger when
malfunctions, soiled, wet or
every 5-7 days.
• Consider specialized
endotracheal with subglottic
suctioning devices:
• Limit aspiration of
oropharyngeal secretions.
• Perform daily, coordinated
SBT.
 Nursing responsibilities
Prevention of Ventilator-Associated Pneumonia (VAP)
“Ventilator Bundle”

• Keep the head of the bed elevated 30 to 45 degrees at all times, if

patient condition allows.
• Everyday, provide sedation “vacations”.
• Everyday assess readiness to extubate. Perform daily, coordinated
SBT.
• Provide peptic ulcer disease prophylaxis.
• H-2 blocker such as ranitidine
• Proton pump inhibitor
 “Ventilator Bundle” cont’d
• Provide deep vein thrombosis prophylaxis, such as with an
intermittent compression device.

• Perform oral and ET tube care daily.

• Extubate the patient as soon as patient is ready.

• Performing range-of-motion exercises, patient turning and

positioning to prevent the effects of muscle disuse. Have the patient
sit up when possible to improve gas exchange.

• Provide appropriate nutrition to prevent a catabolic state.

 Key points

• Proper tube care (suctioning, repositioning, stabilization)

will require two people to perform.

• ET tubes must be repositioned/taped every 24 hours.

• Watch for ulceration areas while repositioning ET tube.

• Follow steps to perform any suctioning of oropharynx or

ET/tracheostomy tubes.
 Key Points continued

• Monitor cuff pressure to minimize risk of tracheal

necrosis and aspiration.

• Follow strict aseptic technique.

• Pre and post oxygenation with 100% for 2 minutes.

• Do not suction for > 10 seconds.

• Monitor vital signs before and after procedure.

 Questions

• ______ people are required to do _______.

• ET tube should be ____/____ every ____ hours.

• Monitor cuff pressure to prevent tracheal _____ and

risk of aspiration.

• Do not suction for more than ______ seconds.

• Pre and post oxygenate for _____ minutes.