EMS SKILL

AIRWAY EMERGENCY / AIRWAY MANAGEMENT

SUCTIONING - ENDOTRACHEAL TUBE
PERFORMANCE OBJECTIVES
Demonstrate competency in suctioning a patient with an endotracheal tube while maintaining aseptic technique.

CONDITION
Suction a simulated patient that is having copious secretions and difficulty breathing. The patient has an endotracheal tube and is being
ventilated with a bag-valve device. Necessary equipment will be adjacent to the manikin or brought to the field setting.

EQUIPMENT
Simulated adult and pediatric airway management manikin, endotracheal tube, oxygen tank with connecting tubing, suction device with
connecting tubing, or hand-powered suction device with adaptor, sterile flexible suction catheter, sterile normal saline irrigation solution,
sterile container, sterile and unsterile gloves, goggles, masks, gown, waste receptacle, and timing device.

PERFORMANCE CRITERIA
y
y
y

Items designated by a diamond () must be performed successfully to demonstrate skill competency.

Items identified by double asterisks (**) indicate actions that are required if indicated.
Items identified by () should be practiced.
Ventilations must be at least at the minimum rate required.
Must maintain aseptic technique.

PREPARATION
Skill Component

Key Concepts

Take body substance isolation precautions

Mandatory personal protective equipment gloves

Assess patient for the need to suction tracheal secretions

y Indications for suctioning: noisy respirations, coughing up

secretions, respiratory distress or patient request.

Ensure suction device is working

y Hand-powered suction devices may be used as long as they have an

adaptor for a flexible catheter.

** Set appropriate suction setting:

y Excessive negative pressures may cause significant hypoxia,

damage to tracheal mucosa or lung collapse.

y Adult - between 80-120 mmHg

y Pediatric and the elderly - between 50-100mmHg
Open suction kit or individual supplies

y Establish and maintain a sterile field. Use the inside of the wrapper
to establish field.
y Catheter size should not exceed 2 the inner diameter of the airway.

Fill sterile container with irrigation solution

y Sterile saline is used to flush suction catheter as needed.

y Depending on kit, container may be under gloves and catheter; this
should be removed without contaminating gloves and catheter. Not
a problem to put on sterile gloves if an assistant is present.

PROCEDURE
Skill Component

Key Concepts

Pre-oxygenate patient - if indicated

y Pre-oxygenation is required to offset volume and oxygen loss during

suctioning.

Remove oxygen source

y Oxygen should be maintained until ready to suction.

Apply sterile gloves

y Sterile gloves are pulled over existing clean gloves.

Connect sterile catheter to suction tubing/device

y The suction catheter should only be handled using sterile glove.

** Keep one (dominant) hand sterile

Airway Emergency Suctioning ETTube 2002, 2010

y Keep catheter in sterile package until ready to use.

y Catheter size should be 2 the inner diameter of the trach tube to
allow for ease of insertion and air to enter during suctioning.
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Skill Component

Key Concepts
y Lubricating the tip of the catheter with irrigation solution prevents the
catheter from adhering to the sides of the endotracheal tube or
tracheal mucosa.

Suction small amount of irrigation solution to:

y Ensure suction device is working
y Lubricate tip of catheter
Insert catheter into endotracheal tube without applying
suction

y The patient is not being oxygenated at this time and applying suction
would deplete any oxygen reserve that is present.

Advance catheter gently until resistance is met

y Deep suctioning is at the level of the carina which is determined by

the catheter meeting resistance during insertion.
y The patient may cough when the tip of catheter touches the carina or
develop bronchospasms.
y Catheter insertion should be accomplished as rapidly as possible
since the patient is not oxygenated during this step.

Withdraw catheter slightly before applying suction

y Withdraw catheter slightly before applying suction prevents damage

to the mucosa of the carina.

Suction while withdrawing using a rotating motion

y Rotating the catheter prevents the direct suctioning of the tracheal

mucosa and suctions secretions from side of the tube.

** Maximum suction time of 5-15 seconds from

insertion to withdrawal of catheter:

y Roll the catheter between thumb and forefinger for rotating motion.

y Adults maximum 10-15 seconds

y Suctioning longer than recommended time will result in hypoxia.

Maximum suction time depends on patients age and tolerance:

y Peds maximum 5-10 seconds

y Roll the catheter between thumb and forefinger for rotating motion.
y Patients response by coughing or grimacing may indicate the
catheter is too deep and irritating the tracheal mucosa or carina.
y Ventilation rates for pediatric patients vary due to a wide age range.

Ventilate patient at approximate rate of:

y Adult - 10-20/minute
y Peds - 12-20/minute

y Observe patient for hypoxemia: dysrhythmias, cyanosis, anxiety,

bronchospasms and changes in mental status.

Evaluate airway patency and heart rate - repeat

procedure if needed

y Allow patient to rest and regain adequate oxygen levels between

suctioning attempts.
Suction remaining water into canister, discard container
and change gloves

y Rinse solution is contaminated and should be treated the same as

secretions.

Discard contaminated catheter:

y Coil contaminated catheter around sterile (dominant)
hand and pull glove over catheter
y Pull glove from other hand over packaged catheter and
discard in approved waste receptacle

REASSESSMENT

(Ongoing Assessment)
Skill Component
Assess airway and breathing:
y Continuously or at least every 5 minutes
y Changes in airway sounds
y Changes in respiratory status

Key Concepts
y If vagal stimulation occurs, the patient may experience
bradycardia, especially pediatric patients.

Evaluate response to treatment:

Patients must be re-evaluated at least every 5 minutes if any

treatment was initiated or medication administered.

Evaluate results of reassessment and note any changes

in patients condition and vital signs
**Manage patient condition as indicated.

Comparing results assists in recognizing if the patient is

improving, responding to treatment or condition is deteriorating.

Airway Emergency Suctioning ETTube 2002, 2010

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PATIENT REPORT AND DOCUMENTATION

Skill Component
Verbalize/Document
y
y
y
y

Indication for suctioning

Oxygen liter flow
Patients tolerance of procedure
Problems encountered

Key Concepts
y Documentation must be on either the Los Angeles County EMS
Report form or departmental Patient Care Record form.

y Type of secretions:
- color
- consistency
- quantity
- odor
y Respiratory assessment and heart rate:
- respiratory rate
- effort/quality
- tidal volume
- lung sounds
Developed: 12/02

Revised: 1/05, 1/10

Airway Emergency Suctioning ETTube 2002, 2010

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AIRWAY EMERGENCY / AIRWAY MANAGEMENT

SUCTIONING - ENDOTRACHEAL TUBE
Supplemental Information
INDICATIONS: To maintain a patent airway in patients with an endotracheal tube

Rattling mucus sound from endotracheal tube (noisy respirations)

Bubbles of mucus in endotracheal tube
Coughing up secretions
Respiratory distress due to airway obstruction.

COMPLICATIONS:

Hypoxia
Bronchospasm
Cardiac dysrhythmias

Tracheal trauma
Infection/sepsis
Cardiac arrest

Hypotension

NOTES:

Aseptic technique must be maintained throughout suctioning procedure to prevent infection.

Over suctioning should be avoided to decrease potential for tracheal damage and increase in mucus production.

Catheter size should not exceed half (2) the inner diameter of the airway. Larger catheters may cause suction induced hypoxia, lung
collapse and damage to tracheal tissues.

Establish and maintain a sterile field. Use the inside of the wrapper to establish a field for equipment.

Keep suction settings between 80-120 mmHg and decrease to a lower setting for pediatric and elderly patients (50-100mmHg).
Excessive negative pressures may cause significant hypoxia and damage to tracheal mucosa. Too little suction will be ineffective.

Battery operated suction machine or hand powered suction devices may be used as long as they have an adaptor for a flexible catheter.

Pre-oxygenation may be required depending on patient=s condition. This offsets volume and oxygen loss during suctioning.
To hyper-oxygenate, increase oxygen liter flow for a brief period of time or ventilate the patient 3-4 times with a bag-valve device.

Rotating the catheter prevents the direct suctioning of the tracheal mucosa and suctions secretions from sides of the tube. Roll the
catheter between thumb and forefinger for rotating motion.

Suctioning longer than recommended time will result in hypoxia. Maximum suction time depends on patient=s age and tolerance and is
timed from the insertion to withdrawal of the catheter.
- Adults maximum 10-15 seconds
- Peds maximum of 5-10 seconds

Airway Emergency Suctioning ETTube 2002, 2010

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