Endotracheal intubation prevents the cough reflex and interferes with normal muco-ciliary function, therefore increasing airway secretion production and decreasing the ability to clear secretions. Endotracheal tube (ETT) suction is necessary to clear secretions and to maintain airway patency, and to therefore optimise oxygenation and ventilation in a ventilated patient. ETT suction is a common procedure carried out on intubated infants. The goal of ETT suction should be to maximise the amount of secretions removed with minimal adverse effects associated with the procedure. The aim of the guideline is to outline the principles of management for infants requiring ETT suction for clinicians on the Neonatal Unit at the Royal Children's Hospital.
ETT suction should be attended based on a clinical assessment of the infant. It does not need to be attended "routinely" as the inspired gas is warmed and humidified (therefore preventing secretions from drying and occluding the airway).
Auscultate with stethoscope before and after ETT suction in order to evaluate necessity and effectiveness of the procedure.
Monitor the infant closely before, during and after the procedure to assess baseline, acute physiological changes and recovery. Parameters to observe:
Effectiveness of ETT suction should be assessed after the procedure by observing:
Suction should only be to the tip of the ETT, and should never exceed more than 1cm beyond the tip of the ETT, to prevent mucosal irritation and injury. Measurement of length to suction is to be predetermined at shift commencement. Length is determined by using the centimetre markings on the ETT; and by adding the length of additional space of the ETT adapter (usually 1-1.5 cm). If patient on HFOV or HFJV, allow for different lengths of adaptors.
The length for suctioning should be documented on a measuring card that is clearly visible on the cot.
The following procedures can be used but should not be performed routinely:
Complications of ETT suction:
Complications of oropharyngeal and nasopharyngeal suction:
Document clearly on the MR100:
It is the responsibility of the clinician caring for the infant requiring ETT suction to ensure that the parents understand the rationale for the procedure, as well as potential complications.
Evidence table for Endotracheal Tube Suction of Ventilated Neonates
Please remember to read the disclaimer.
The development of this clinical guideline was coordinated by Sharlene Pattie, Clinical Nurse Educator, McKinnon Nursing Education. Approved by the Clinical Effectiveness Committee. Authorised by Bernadette Twomey, Executive Director Nursing Services. First published May 2009, current as of December 2012.
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