The frequency with which suctioning is performed should be individualized based on the neonate’s needs. Auscultation, type and amount of secretions, FiO₂ requirement and resultant SaO₂ as well as tolerance are clinical signs used to assess the need for suctioning.

Prior to suctioning, the infant should be pre-oxygenated by increasing the FiO₂ 10-20% (or as needed by the individual patient) for at least one minute prior to suctioning. The increased FiO₂ should be continued during and after suctioning until the infant has returned to baseline heart rate and saturation. This pre-oxygenation function is automatically performed by the Draeger ventilator using the O₂ Suction button.

A closed/inline suctioning technique (Ballard) is used at Vanderbilt so that babies do not need to be disconnected from the ventilator to be suctioned. An inline suction catheter should be placed on any intubated infant shortly after admission.

When suctioning, the catheter should only be passed the length of the endotracheal tube. This distance can be calculated by adding 4 cm to the length of the ETT at the point where the adapter contacts the tube. The catheter length for suctioning should be posted at the bedside and/or in the nursing plan of care.

One or two passes of the catheter are usually sufficient. No irrigant is recommended for suctioning. Normal saline irrigant is used only to flush the catheter when using a closed/inline suction technique. Irrigation of the endotracheal tube with saline is irritating to the infant’s airway mucosa and has been associated with an increased incidence of nosocomial pneumonia.

The infant’s heart rate and oxygen saturation should be monitored during suctioning to assess tolerance. Auscultation can be used to assess efficacy. After suctioning, manual breaths may be needed to re-recruit FRC. The amount, color, and consistency of the secretions as well as the infant’s tolerance of suctioning should be documented in the nursing notes.

Reference:

Hodge D. Endotracheal suctioning and the infant: a nursing care protocol to decrease complications. Neonatal Network 1991; 9: 7-15.

Discussed at the Nursery Policy & Procedure Meeting 2/17/99.