Suctioning an Endotracheal Tube: Closed System

Goal: The patient exhibits improved breath sounds and a clear, patent airway.

1. Bring necessary equipment to the bedside stand or overbed table.

2. Perform hand hygiene and put on PPE, if indicated.

3. Identify the patient.

4. Close curtains around bed and close the door to the room, if possible.

5. Determine the need for suctioning. Verify the suction order in the patient’s chart. Assess for pain or the potential to cause pain. Administer pain medication, as prescribed, before suctioning.

6. Explain what you are going to do and the reason for doing it to the patient, even if the patient does not appear to be alert. Reassure the patient you will interrupt the procedure if he or she indicates respiratory difficulty.

7. Adjust bed to comfortable working position, usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009). Lower side rail closest to you. If patient is conscious, place him or her in a semi-Fowler’s position. If patient is unconscious, place him or her in the lateral position, facing you. Move the overbed table close to your work area and raise to waist height.

8. Turn suction to appropriate pressure. For a wall unit for an adult: 100–120 mm Hg (Roman, 2005); neonates: 60–80 mm Hg; infants: 80–100 mm Hg; children: 80–100 mm Hg; adolescents: 80–120 mm Hg (Ireton, 2007). For a portable unit for an adult: 10–15 cm Hg; neonates: 6–8 cm Hg; infants 8–10 cm Hg; children 8–10 cm Hg; adolescents: 8–10 cm Hg.

9. Open the package of the closed suction device using aseptic technique. Make sure that the device remains sterile.

10. Put on sterile gloves.

11. Using nondominant hand, disconnect ventilator from endotracheal tube. Place ventilator tubing in a convenient location so that the inside of the tubing remains sterile or continue to hold the tubing in your nondominant hand.

12. Using dominant hand and keeping device sterile, connect the closed suctioning device so that the suctioning catheter is in line with the endotracheal tube.

13. Keeping the inside of the ventilator tubing sterile, attach ventilator tubing to port perpendicular to the endotracheal tube. Attach suction tubing to suction catheter.

14. Pop top off sterile normal saline dosette. Open plug to port by suction catheter and insert saline dosette or syringe.

15. Hyperventilate the patient by using the sigh button on the ventilator before suctioning. Turn safety cap on suction button of catheter so that button is depressed easily.

16. Grasp suction catheter through protective sheath, about 6 inches (15 cm) from the endotracheal tube. Gently insert the catheter into the endotracheal tube. Release the catheter while holding on to the protective sheath. Move hand farther back on catheter. Grasp catheter through sheath and repeat movement, advancing the catheter to the predetermined length. Do not occlude Y-port when inserting the catheter.

17. Apply intermittent suction by depressing the suction button with thumb of nondominant hand. Gently rotate the catheter with thumb and index finger of dominant hand as catheter is being withdrawn. Do not suction for more than 10 to 15 seconds at a time. Hyperoxygenate or hyperventilate with sigh button on ventilator, as ordered.

18. Once catheter is withdrawn back into sheath, depress the suction button while gently squeezing the normal saline dosette until the catheter is clean. Allow at least a 30- second to 1-minute interval if additional suctioning is needed. No more than three suction passes should be made per suctioning episode.

19. When procedure is completed, ensure that the catheter is withdrawn into the sheath, and turn the safety button. Remove normal saline dosette and apply cap to port.

20. Suction the oral cavity with a separate single-use, disposable catheter and perform oral hygiene. Remove gloves. Turn off suction.

21. Assist patient to a comfortable position. Raise the bed rail and place the bed in the lowest position.

22. Reassess patient’s respiratory status, including respiratory rate, effort, oxygen saturation, and lung sounds.

23. Remove additional PPE, if used. Perform hand hygiene.