Iowa Neonatology Handbook: Procedures

Suctioning of Endotracheal Tubes

Iowa Neonatology Fellows
Peer Review Status: Internally Peer Reviewed

I. Indications.

A. To clear airways of secretions.

B. To keep artificial airway patent.

C. To obtain material for analysis of culture.

In-line suctioning preferred for indications other than obtaining material for culture.

II. Pre-assemble suction equipment. Recommended suction catheters are 5 or 6 French for 2.5 mm ET tube, 6 French for 3.0 ET tube and 8 French for 4.0 ET tube. The amount of suction applied to the catheter should be between 40-80 mmHg.

III. Suction between feedings or discontinue feedings for period of treatment.

IV. Auscultate chest prior to suctioning. Oxygenation prior to suctioning will be done with an FiO2 no greater than 0.10 above that being used to ventilate the infant. Monitor heart rate continuously. Suction should not be applied while the catheter is being inserted down the ET tube. The tip of the suction catheter will not be inserted beyond the end of the tube. When withdrawing the catheter, continuous suction is applies. The procedure should not take longer than 10 seconds. Following suctioning, ventilate the infant with an FiO2 no greater than 0.10 above that used prior to suctioning. The PaO2 should be raised to a level comparable to that prior to suctioning.

V. Do not add saline unless necessary. Saline may be used if the infant has thick tenacious secretions which cannot be extracted by using suctioning alone. Normal saline for secretions for Respiratory Therapy use is instilled into ET tube and 3-5 ventilated breaths performed prior to suctioning as above.

VI. Vibration and percussion (CPT) will not be performed routinely prior to suctioning. If the need for CPT is documented, it must be ordered by a physician describing the area to be treated and the frequency of treatments.

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