How to perform open tracheal suction via an endotracheal tube

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Rationale and key points

This How to module provides nurses with information on how to perform open tracheal suction via an endotracheal tube.
Tracheal suction involves the removal of pulmonary secretions from the respiratory tract using negative pressure under sterile conditions. Practitioners should be aware of the indications for, and risks associated with, open tracheal suction via an endotracheal tube.
  • Respiratory assessment of the patient should be carried out to identify when tracheal suction is required.
  • A suction pressure of 80-120mmHg is recommended, and suction should last no longer than 15 seconds
  • Reassurance and support should be given to the patient to minimise any discomfort and distress that might result from tracheal suction.
clinical procedures, clinical skills, endotracheal tube, pulmonary secretions, respiratory, suctioning, tracheostomy, tracheal suction, tracheostomy tube

Learning objectives

After reading this module you should be able to:
  • List the preparation steps and equipment required to perform open tracheal suction via an endotracheal tube.
  • Describe the procedure for performing open tracheal suction in a safe, effective and patient-centred manner.
  • Discuss the signs and symptoms that indicate the need for open tracheal suction, as well as the risks associated with the procedure.
  • Understand the evidence to support open tracheal suction.
Procedure
  1. Put on an apron and protective glasses. Wash your hands and put on non-sterile gloves.
  1. Pre-oxygenate the patient using 100% oxygen for 30-60 seconds.
  1. Select the appropriate size of suction catheter. The following formula may be used to determine the appropriate size catheter: suction catheter size (French) = 2x (size of endotracheal tube (mm) -2).
  1. Open the suction catheter packaging and attach the suction catheter end to the suction tubing, ensuring the catheter remains in its sterile packaging.
  1. Turn on the suction unit and re-check the unit is at a pressure of 80-120mmHg.
  1. Put a sterile glove on the hand you are going to use to hold the suction catheter. Remove the catheter from the packaging, ensuring it remains sterile.
  1. Disconnect the endotracheal tube from the ventilator.
Figure 2
Figure 2. Open tracheal suction via an endotracheal tube|©Peter Lamb
Figure 1
Figure 1. Position of the carina|©Peter Lamb
  1. Advance the suction catheter gently into the endotracheal tube until resistance is felt when the catheter reaches the carina (Figures 1 and 2) and withdraw the catheter by 1-2cm.
  1. Apply suction by occluding the suction port located at the proximal end of the suction catheter. Suction should be applied continuously rather than intermittently.
  1. Withdraw the suction catheter slowly and maintain suction. This should be a smooth withdrawal and take no longer than 15 seconds.
  1. Reconnect the ventilator.
  1. Dispose of the suction catheter in a clinical waste disposal bag as per local guidelines. Dispose of any personal protective equipment. Wash your hands immediately after the procedure.
  1. Assess the effectiveness of the procedure, for example by observing the patient’s respiratory rate and oxygen saturations, and reassure the patient. Should a further suction attempt be required, a new suction catheter and new sterile glove is used each time.
  1. Document the procedure in the patient’s notes.
learningpoints

Learning points

  1. Before undertaking the procedure, the practitioner should carry out a comprehensive respiratory assessment of the patient to identify when open tracheal suction is required.
  2. It is important to select the appropriate sized suction catheter and pre-oxygenate the patient using 100% oxygen for 30-60 seconds.
  3. A suction pressure of 80-120mmHg is recommended, and suction should last no longer than 15 seconds.
  4. The patient’s respiratory rate and oxygen saturations should be observed following the procedure.

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