Skill 72

Suctioning

Closed (In-Line)

Endotracheal tubes (ETs) and tracheostomy tubes (TTs) are artificial airways inserted to relieve airway obstruction, provide a route for mechanical ventilation, permit easy access for secretion removal, and protect the airway from gross aspiration in patients with impaired cough or gag reflexes. An ET tube is inserted through the nares (nasal ET tube) or the mouth (oral ET tube) past the epiglottis and vocal cords into the trachea. The length of time that an ET tube remains in place is somewhat controversial; however, in most cases a tracheostomy tube (TT) is inserted if a patient still requires an artificial airway after 2 to 4 weeks (AARC, 2010).

A TT can be temporary or permanent, depending on the patient’s condition. It is inserted directly into the trachea through a small incision made in the patient’s neck. Some agencies use a closed-suction catheter system or in-line suction catheter device to minimize infections, especially in critically ill or immunosuppressed patients (Pedersen et al., 2009). Use of a closed-system catheter (in-line) allows quicker lower airway suctioning without applying sterile gloves or a mask and does not interrupt ventilation and oxygenation in critically ill patients. With a closed-system method, the patient’s artificial airway is not disconnected from the mechanical ventilator (Jongerden et al., 2011).

Delegation Considerations

The skill of airway suction with a closed (in-line) suction catheter cannot be delegated to nursing assistive personnel (NAP). In special situations, such as suctioning a permanent tracheostomy, this procedure may be delegated to NAP. The nurse is responsible for cardiopulmonary assessment and evaluation of the patient. The nurse directs the NAP about:

▪ Any individualized aspects of patient care that pertain to suctioning (e.g., position, duration of suction, pressure settings).

▪ Expected quality, quantity, and color of secretions and to inform the nurse immediately if there are changes.

▪ Patient’s anticipated response to suction and to immediately report to the nurse changes in vital signs, complaints of pain, shortness of breath, confusion, or increased restlessness.

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