In this section
Note: This guideline is currently under review.
Definition of terms
Family Centred Care
Intermittent oesophageal pouch suction is used in the management of neonates and infants with unrepaired oesophageal atresia. A suction catheter is placed into the oesophageal pouch intermittently to remove saliva.
Adequate drainage of the upper oesophageal pouch is essential to prevent saliva spilling over into the trachea resulting in aspiration or aspiration pneumonia.
To outline the principles of intermittent oesophageal pouch suction for infants with unrepaired oesophageal atresia in Newborn Intensive Care (NICU) at The Royal Children’s Hospital.
Intermittent oesophageal pouch suction is indicated for all infants with unrepaired OA to prevent aspiration. Saliva accumulates in the blind upper oesophageal pouch and if not adequately cleared with suction will overflow into the infant’s trachea with resultant aspiration or aspiration pneumonia.
As the neonate continues to produce saliva, it is essential to clear the upper oesophageal pouch every 5-30 minutes (or more frequently if necessary) to prevent aspiration. This continues until surgical repair of the oesophagus is performed.
Infants with long-gap OA may be suitable for the use of a Replogle tube connected to continuous low pressure suction. (Refer to the guideline on Replogle Tube Management)
Assessment of suitability of neonate for intermittent suction:
For all infants, on all occasions, the length of the oesophageal pouch should be measured with a size 10Fg suction catheter by the Surgical Registrar, NICU AUM, Oesophageal Atresia Nurse, Clinical Nurse Specialist, NICU Educator or Clinical Support Nurse, This is done by gently passing the suction catheter into the oesophagus, via the oro-pharynx, until resistance is felt. The suction catheter is then withdrawn 1cm and suction applied at less than 120mmHg to remove saliva from the upper oesophageal pouch. The measurement of the oesophageal pouch length and the length for oesophageal pouch suction is recorded in the EMR Suction Orders, Progress Notes and Observation Chart. A tape measure with the suction distance marked is also attached to the infant’s cot and labeled as ‘oesophageal pouch suction’.
The infant requires:
The infant requires continuous:
Ongoing nursing assessment for any sign of respiratory distress/compromise indicating the need for immediate and more frequent suction including:
If any of the above signs are present, the infant should receive immediate oesophageal pouch suction and more frequent suction should be undertaken.Signs of respiratory distress/compromise should be reported to the neonatal registrar and documented on Observation Flow Sheet, and interventions performed as appropriate.
a) Connect suction regulator to suction outlet on wall. Connect short suction tubing from suction regulator to canister and long tubing to suction catheter.
b) The length of the oesophageal pouch and suction length should be confirmed by the Surgical Registrar, NICU AUM, Oesophageal Atresia Nurse, Clinical Nurse Specialist, NICU Educator or Clinical Support Nurse if initial oesophageal pouch suction is undertaken by the bedside nurse or NICU Registrar.
c) Subsequent suction of the pouch is to the same length, which is 1cm above the distal end of the oesophageal pouch, to prevent trauma to the blind end of the oesophageal pouch.
d) A size 8Fg suction catheter (size 7Fg in premature neonates) is used to intermittently suction the oesophageal pouch. Intermittent suction is performed approximately 5-30 minutely or more frequently if necessary.
e) This suction technique is continued for the duration of the preoperative period. Less frequent suction may be required if the neonate is asleep or quiet. Use timer to set appropriate time interval between suction.
Time between suctioning should not exceed 30 minutes due to the risk of aspiration of saliva.
f) The timing of suction should be set to prevent desaturations, bradycardias, increased work of breathing and audible secretions in the oesophageal pouch from occurring. Therefore intermittent suctioning may need to be as frequently as every 2-5 minutes.
g) The frequency of suction should be documented in the EMR in the Progress Notes and Observation Chart.
h) Change the suction catheter at least once per shift or more frequently if required.
i) Change the suction canister and tubing weekly or as required. Record date of change on the suction canister.
j) Ensure spare suction catheters size 7Fg, 8Fg and 10Fg are at the bedside at all times.
Long-gap OA: These babies are nursed in the NICU for a number of weeks to months, prior to repair. The oesophageal pouch should be remeasured by the Oesophageal Atresia Nurse, NICU AUM, Clinical Nurse Specialist, NICU Educator or Clinical Support Nurse monthly (or sooner if required), to assess growth of the upper oesophageal pouch and to recalculate required length of pouch suction. This new suction length will then be displayed on the infant’s cot and recorded in the EMR on the Suction Orders and Nursing Communication Order.
Please note: For those infants with long-gap OA, a decision may be made to use a Replogle tube to provide continuous low pressure suction to the oesophageal pouch. (Refer to the guideline on Replogle Tube Management. (Infants with a Replogle tube in-situ may still require intermittent oesophageal pouch suctioning)
It is the responsibility of the clinician caring for the infant with intermittent oesophageal pouch suction to ensure that the parents understand the rationale for the intervention, as well as potential complications.
Intermittent oesophageal pouch suction for the neonate/infant with unrepaired oesophageal atresia (including long-gap) Evidence Table
Please remember to read the disclaimer.
development of this nursing guideline was coordinated by Alisa Hawley, Care Manager & Oesophageal Atresia Nurse, NICU,
and approved by the Nursing Clinical Effectiveness Committee. Updated September 2016.