Tracheo-bronchial suction

 

Suction is used to 'suck up' the 'gunk' (secretions) sitting on your bronchial tree for patients that can't clear their own airway for themselves.

You can suction via...

• Trachy (tracheostomy)
• Endotracheal tube
• Oral airway
• Nasal airway (e.g. Nasopharangeal)

Indications (when to think about using it!)

•  Reduced cough effort or inability to cough to clear airway

Contradications (when to NOT use it!)

•  Frank haemoptysis (expectoration of blood only)
• Severe bronchospasm
• Undrained pneumothorax
• Compromised CVS
• Raised ICP
• Fractured skull/facial bones

Hazards of Suctioning

• Mucosal trauma

Suction is an invasive procedure and causes irritation to the delicate lining of the airways (tracheal/bronchial epithelium). This adverse effect is minimised by using an appropriate size catheter (simple calucation to figure this out: double size of trachy and minus 2 e.g. size 8 trachy = 16 - 2 = size 14 catheter). Also make sure to use correct pressures e.g. around 25.

• Hypoxia

If ventilation is interupted (e.g. too big a tube, suctioning for too long etc) a reflex bronchospasm may occur. Pre and post Rx O2 can help reduce any hypoxia.

• Cardiac arrthymias/bradycardia

Suctioning can cause a vasovagal reflex (a GI tract reflex that controls contraction of gastrointestinal muscles in response to stretching of the tract by food, controlled by the stretch/osmo & chemoreceptors of the dorsal vagal complex). This can lead to arrthymias so check with medics first.

• Raised ICP

Suction raises ICP so if someone already has elevated levels (e.g. TBI, SAH etc) then be very cautious and seek medical opinion prior to attempting suction.