Normally infants and children have the ability to keep their airways clear of mucus by either coughing, blowing their nose or sneezing. The presence of their gag reflex also prevents harm from secretions in the lower airways. The need to perform oropharyngeal or nasopharyngeal suctioning may arise in the presence of respiratory illness. The child’s respiratory system is immature and the altered physiology due to illness may lead to the retention of secretions. If these are not removed, the gaseous exchange may be affected. Suctioning is a traumatic procedure and should only be undertaken when clinically indicated and by experienced practitioners.

• Noisy breathing.
  
• Excessive secretions that may be visible or audible.
  
• Increased or decreased respirations.
  
• Increased heart rate.
  
• Decreased oxygen saturations.
  
• Prolonged expiratory breath sounds.
  
• Diminished air entry.
  
• Altered chest movements.

The correct catheter size should be identified and documented. Ideally it should have multiple eyes (two or three) as this will cause less damage than those with a single eye. Multiple eye suction catheters are not required to be rotated during the suctioning procedure. The catheter should always be less than 50% of the airway’s internal diameter.

The lowest suction pressure should be used to prevent mucosal trauma. Individual clinical need will also determine the amount of pressure to be used (see Table).