Suctioning: Endotracheal or Tracheostomy Tube

Procedure for suctioning Endotracheal tube or Tracheostomy Tube

Getting Ready

  1. Perform hand hygiene, and don personal protective equipment.
  2. Turn on suction apparatus and set vacuum regulator to 100 to 120 mm Hg. Follow manufacturer's directions for suction pressure levels when using closed-suction catheter systems.
  3. Secure one end of the connecting tube to the suction machine, and place the other end in a convenient location within reach.
  4. Monitor patient's cardiopulmonary status before, during, and after the suctioning period.
  5. Prepare to suction.

Closed-Suction Technique Only

Connect the suction tubing to the closed system suction port, according to manufacturer's guidelines.

Open-Suction Technique Only

  1. Open sterile catheter package on a clean surface, using the inside of the wrapping as a sterile field.
  2. Set up the sterile solution container or sterile field. Be careful not to touch the inside of the container. Fill with approximately 100 ml of sterile normal saline solution or water.
  3. Don sterile gloves.
  4. Pick up suction catheter, being careful to avoid touching nonsterile surfaces. With the nondominant hand, pick up the connecting tubing. Secure the suction catheter to the connecting tubing.
  5. Check equipment for proper functioning by suctioning a small amount of sterile saline solution from the container.
  6. Hyperoxygenate the patient for at least 30 seconds by one of the following three methods.
  • Press the suction hyperoxygenation button on the ventilator with the nondominant hand, or
  • Increase the baseline FIO2 level on the mechanical ventilator, or
  • Disconnect the ventilator or gas delivery tubing from the end of the endotracheal or tracheostomy tube, attach the manual resuscitation bag (MRB) to the tube with the nondominant hand, and administer 5 to 6 breaths over 30 seconds. Attach a positive end-expiratory pressure (PEEP) valve to the MRB for patients receiving greater than 5 cm H2O PEEP. Verify 100% oxygen delivery capabilities of MRB by checking manufacturer's guidelines or by direct measurement with an in-line oxygen analyzer when baseline ventilator oxygen delivery to the patient is greater than 60%.
  1. With the suction off, gently but quickly insert the catheter with the dominant hand into the artificial airway until resistance is met; then pull back 1 cm.
  2. Place the nondominant thumb over the control vent of the suction catheter and apply continuous or intermittent suction. Rotate the catheter between the dominant thumb and forefinger as you withdraw the catheter over 10 seconds or less into the sterile catheter sleeve (closed-suction technique) or out of the open airway (open-suction technique).
  3. Hyperoxygenate for 30 seconds
  4. One or two more passes of the suction catheter, as delineated, may be performed if secretions remain in the airway and the patient is tolerating the procedure. Hyperoxygenate for 30 seconds
  5. If the patient does not tolerate suctioning despite hyperoxygenation, try the following steps.
  • Ensure that 100% oxygen is being delivered. 
  • Maintain PEEP during suctioning. Check that the PEEP valve is attached properly to the MRB if using that method for hyperoxygenation.
  • Switch to another method of suctioning (e.g., closed-suctioning technique).
  • Allow longer recovery intervals between suction passes.
  • Hyperventilation may be used in situations in which the patient does not tolerate suctioning with hyperoxygenation alone, using either the MRB or the ventilator.
  1. Rinse the catheter and connecting tubing with sterile saline solution until clear.
  2. Once the lower airway has been adequately cleared of secretions, perform nasal or oral pharyngeal suctioning.
  3. Open-Suction Technique Only: On completion of upper airway suctioning, wrap the catheter around the dominant hand. Pull glove off inside out. Catheter will remain in glove. Pull off other glove in same fashion, and discard. Turn off suction device.
  4. Reposition patient.
  5. Perform hand hygiene.
  6. Discard remaining normal saline solution and solution container. If basin is nondisposable, place in soiled utility room. Suction collection tubing and canisters may remain in use for multiple suctioning episodes.
  7. Document in patient's record.