Airway suctioning: oral, nasal and artificial airways

What it is

Suctioning removes secretions that the patient cannot clear and that block the airway. It can be done through the mouth, the nose, an endotracheal tube or a tracheostomy. Each pass also removes oxygen and can irritate the mucosa or trigger arrhythmias, so suctioning is done only when indicated, at the lowest effective pressure and in short passes. In hospital, nasal and tracheal suctioning uses sterile technique: the sterile dominant hand handles the catheter and the other hand controls the valve.

Indications

• Secretions in the mouth or tracheostomy that the patient cannot clear.
• Gurgling secretion sounds in the airway or rhonchi on auscultation.
• Desaturation or increased work of breathing attributable to secretions.
• An ineffective cough from weakness, reduced consciousness or after surgery.
• Obtaining a sputum sample from a patient who cannot expectorate.

Contraindications and precautions

• Do not suction routinely: each pass causes hypoxaemia and mucosal trauma.
• Never suction through a fenestrated tracheostomy tube without first inserting a non-fenestrated inner cannula.
• Caution with clotting disorders, facial or basal skull trauma (nasal route) and bronchospasm.
• At home and in the community clean technique may be used; in hospital the nasal and tracheal routes are sterile.
• Wear eye protection and a mask: suctioning generates droplets and aerosols.

Equipment

• A suction source (wall or portable), a collection canister and connecting tubing.
• A sterile suction catheter of suitable size and a rigid oral suction tip.
• Sterile and clean gloves, a mask, eye protection and a gown if splashing is likely.
• Sterile saline in a container, water-soluble lubricant and a towel.
• A pulse oximeter, an oxygen source and a bag-valve-mask.

Step by step (and why)

1. Assess secretions, sounds, saturation, heart and respiratory rate — it confirms the indication and gives the baseline.
2. Explain and place in semi-Fowler's (or on the side, facing you, if unconscious) — it protects the airway and helps coughing.
3. Set and test suction: in adults 100 to 150 mmHg — higher pressure damages the mucosa and causes atelectasis.
4. Pre-oxygenate per protocol and ask for deep breaths if able — it offsets the oxygen removed by suction.
5. With sterile technique, insert the lubricated catheter without applying suction — suction on the way in injures the mucosa.
6. In a tracheostomy, advance until resistance and withdraw 1 cm — so the catheter does not strike the carina.
7. Suction only while withdrawing, intermittently and rotating, 10 to 15 seconds at most — it limits hypoxaemia and trauma.
8. Let the patient rest and reoxygenate 30 seconds to 1 minute before another pass, three at most — saturation can recover.
9. Rinse the tubing with saline, discard the catheter and record secretions and response — the record shows whether the airway improved.

Complications

• Hypoxaemia during or after suctioning.
• Bradycardia and arrhythmias from vagal stimulation; in severe cases, arrest.
• Bleeding and trauma of the nasal, pharyngeal or tracheal mucosa.
• Laryngospasm and bronchospasm.
• Atelectasis from excessive pressure or long passes, and healthcare-associated infection.

Next step: when to call for help

• Stop and call for help if saturation falls and does not recover, if cyanosis appears or breathing difficulty worsens.
• Stop and report if bradycardia or an arrhythmia appears.
• Report bloody, purulent or foul-smelling secretions, or a major change in them.
• Report if suctioning is needed more and more often or the airway does not improve.

Test yourself

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Connections

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Nursing Skills, 12.4: Oropharyngeal and Nasopharyngeal Suctioning Checklist and Sample Documentation (Open RN, Chippewa Valley Technical College (via LibreTexts), 2021); Nursing Skills, 12.5: Checklist for Tracheostomy Suctioning and Sample Documentation (Open RN, Chippewa Valley Technical College (via LibreTexts), 2021); Nursing Skills, 12.3: Assessments Related to Airway Suctioning (Open RN, Chippewa Valley Technical College (via LibreTexts), 2021).

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