Policy Title: Suctioning
Policy Number: 3.42
Effective Date: May 1, 2017
Chapter: Respiratory Care Services
Section: Airway Care
To maintain a patent airway for patients with an ineffective cough or an artificial airway. This procedure
may be performed on patients with or without an artificial airway.
B. nasotracheal suctioning of patients with epiglottitis or croup
A. An RCP (respiratory care practitioner) will assess and suction patients requiring removal of retained
secretions when associated with any respiratory therapy procedures and in emergency situations.
B. Audible or visible secretions will be removed prior to and after completion of ventilator system checks
or any other respiratory therapy procedures.
C. If the patient is being seen specifically for suctioning and is not being seen for any other services, an
order must be written that designates RT to see the patient for suctioning.
D. All patients in American Family Children’s Hospital without an artificial airway require a provider’s
order. Nasal or oropharyngeal suctioning will only be done when secretions cannot be mobilized by other
E. Closed in-line suction system is the preferred method for patients who are mechanically ventilated.
F. Nasopharyngeal airway should be evaluated every 2 hours for patentcy and removed, cleaned and
reinserted in opposite nares every 24 hours.
A. Suction gauge, bottle and connecting tubing.
B. Sterile suction catheter kit or closed tracheal suction system.
C. Sterile water
D. Sterile normal saline-amount adequate for irrigation (5-10 ml for adults)
E. Oxygen flowmeter
F. Manual resuscitation bag with a mask
G. For patients who are being nasotracheally suctioned the below are also indicated
1. An oxygen mask or cannula
2. Water-based lubricant
3. Nasopharyngeal airway
A. Acknowledge the provider’s order.
B. Review the patient’s chart.
C. Obtain the appropriate equipment.
D. Introduce yourself to the patient &/or family. Explain the reason for the procedure.
E. Open System Suctioning for artificial airway.
1. Select the appropriate size and type of suction catheter. The size of the suction catheter may be
estimated by doubling the internal diameter of the artificial airway and adding 2 (e.g., size 6 =
6+6+2 = 14 French catheter).
2. Turn the suction gauge to the appropriate negative pressure level. Clamp the hose to assure that
the suction level will not be too high when suction is being applied.
a. Adults: 80-120 mmHg.
b. Children 0-5 years: 60-80 mmHg maximum
c. Children 5-10 years: 80-100 mmHg.
3. Pour sterile water into the water container.
4. Put on the sterile gloves included in the suction kit.
5. Pick up the catheter with the sterile hand.
6. Attach a sterile specimen cup to the suction catheter if samples are being sent to the lab.
7. Hyper oxygenate the patient for 30 seconds prior to suctioning.
8. Procedure for Suctioning.
a. Gently introduce the catheter without suction. Do not exceed the length of the artificial
airway. All pediatric patients with a tracheostomy tube have a suction catheter marked
with the maximum depth to suction. This catheter is displayed above the patient’s bed.
b. Apply suction continuously as the catheter is slowly withdrawn from the tube.
c. Suction should be applied for no more than 15 seconds in adult patients and 5-10
seconds in children.
d. Once the catheter is passed, the patient must be hyper oxygenated again for a minimum
of 15 seconds or until their oximetry has returned to baseline.
9. If necessary, aspirate the oropharynx or nares with the suction catheter once endotracheal
suctioning is complete.
F. Closed System Suctioning for Artificial Airway
1. Select the appropriate size in-line suction catheter.
2. Suction gauge should be set at the appropriate level of negative pressure.
3. Hyper oxygenate patient by increasing the FiO2 on the ventilator to 100% for >30 seconds.
4. Suction airway following step E.8.
5. Return patient to their previously ordered FiO2.
6. In-line suction catheters should be rinsed with normal saline until cleared of secretions.
7. Change in-line suction catheters.
a. Adults daily or when soiled.
b. Pediatrics every three days or when soiled.
G. Nasotracheal suctioning.
1. Obtain and insert the appropriate size nasal pharyngeal airway.
H. Appropriate size suction catheter (allow for individual variation).
1. Newborn to 6 months: 6-8 F
2. 6 months to 3 years: 8-10 F
3. 3 years to 10 years: 10 F
4. 10 years to 16 years: 12 F
5. Adult: 12-14 F
I. Position the patient in semi-fowler’s or near-sitting (head of bed all the way up)
J. Estimate the appropriate NPA length by measuring the distance from the patient’s earlobe to the tip
of the nose.
K. Lubricate the NPA with water soluble agent to ease insertion.
L. Tilt the patient’s head slightly backward. This may be best accomplished by standing at the head
of the bed. Once lubricated, position the NPA perpendicular to the frontal plane of the face and
slowly advance it through the inferior meatus of either right or left nasal cavity. Never force suction
catheter. It should move into oropharyngeal cavity with minimal resistance. A gentle, rotating motion
can be used when advancing catheter through the naris. If an obstruction is felt, attempt passage
through the other naris.
M. Once the NPA is inserted, the RCP should attempt to quickly visualize and confirm its correct
position, using a tongue depressor if necessary.
N. When suctioning the patient, care should be taken to secure the NPA so that it doesn’t advance
into the nasopharynx during the suctioning procedure. This may require assistance from a second
O. Tell patient to breathe slowly and deeply as catheter is advanced. Continue to advance until
patient coughs or takes a deep breath. The catheter will be directly above the glottis at this point.
P. Instruct the patient to cough (if not spontaneous), and quickly advance catheter into the larynx.
1. When catheter enters larynx or touches carina (about ¾ length of catheter), patient should
2. Maneuvers to facilitate catheter entrance into trachea.
a. reposition patient’s head
b. pull mandible forward slightly to lift tongue.
c. pull tongue forward with 4x4
d. ask patient to cough
Q. Apply suction and withdraw catheter.
R. After catheter withdraw and when suctioning is completed, ask patient to take 5-6 deep breaths, or
provide at a minimum 5-6 deep breaths with prescribed oxygen device (nasal prongs,
Oxymask, or resuscitation bag). Deep breathing can reduce the potential for suction-induced hypoxia
S. Repeat suctioning procedure until patient’s upper airway is clear and/or breathing is improved.
1. Lubricate the catheter with water-soluble lubricant.
2. Insert the catheter through the nasal pharyngeal airway and guide it into the airway.
Instruct the patient to take slow deep breaths. When the patient begins their inhale, advance
the catheter to the level of the vocal cords. This usually stimulates a cough, at which point
suction is applied and the catheter is withdrawn.
3. Hyper oxygenate the patient again by having them take 10-12 deep breaths or until their
oximetry has returned to baseline.
4. Repeat steps 3-4 until the nasal trumpet is visible free of secretions and the initial indications
for suctioning are relieved.
5. If necessary, aspirate the oropharynx with the suction catheter once nasotracheal suctioning is
6. The nasopharyngeal airway (NPA) should be left inserted only when necessary to facilitate
suctioning (i.e. adult patients receiving suctioning every four hours). This should be evaluated
every 2 hours.
7. The NPA that is left inserted should be removed, cleaned, and reinserted in the opposite nares
every 24 hours.
A. RCS P&P #3.41 “Insertion, Use and Care of Nasal Pharyngeal Airway”
B. Nursing Policy 7.17, “Tracheal Suctioning of the Patient without an Artificial Airway”
Approved by Director and Medical Director of Respiratory Care.
C. AARC Clinical Practice Guidelines “Endotracheal Suction of Mechanically Ventilated Patients
with Artificial Airways 2010”, RC, June 2010 vol. 55 no6 758-764.
D. AARC Clinical Practice Guideline “Nasotracheal suctioning 2004 Revision and Update”, RC,
September 2004, vol. 49 no9.