Suction Catheters, Endotracheal Tubes, Tracheal Suctioning

What is a Suction Catheter?

A suction catheter is a medical device which is used to remove bodily secretions from the upper airway. It connects to a suction machine or a collection canister. Once one end of the catheter is attached to an aspirator or collection canister, the unattached end is placed directly into a tracheal tube or in the mouth to suck out the secretions. Suction catheters are available in several styles: closed systems, latex rubber, latex free, and a rigid yankauer.

What is a Closed Suction Catheter?

A closed, also called in-line, suction catheter is completely encased to help prevent infection that is commonly associated with suctioning. It involves a multi-use catheter that is inside a plastic sheath. A closed suction catheter is most often utilized for those who are being ventilated mechanically and have a tracheostomy or endotracheal tube in place. An advantage of this type of catheter is that is does not require disconnection of the ventilator or oxygen source from the airway when suctioning needs to be performed. This reduces the risks of oxygen desaturation and infection.

Once the patient is ready for the airway to be suctioned, make sure the suction device is unlocked, if required. Open the saline port and attach a syringe or vial of saline to the port to clear the catheter between suctioning, and when it is completed.

To perform, attach the suction catheter to the ventilation port and hold the device securely. Advance the catheter within the enclosed sleeve and continually push it in while pulling the plastic sleeve back. Keep advancing the catheter until resistance is met, or the patient coughs. Then, apply suction for 10 to 15 seconds by closing the suction control valve while pulling out the catheter slowly.

A closed catheter is normally not rotated like a single-use catheter because of the protective sheath. Withdraw the catheter completely to avoid obstructing the airflow. There should be a black mark on the catheter to indicate when full withdrawal is made. Check the patient to see if suctioning needs to be done again. If it is needed, repeat the process only once or twice more and wait at least 1 minute between suctioning for oxygenation and ventilation.

Once completed, withdraw the catheter all the way into the plastic sheath so the indicator line on the catheter is seen. Rinse the inside of the suction catheter by applying suction while pushing the syringe or squeezing the vial of normal saline. For an adequate rinse, use 5 to 10 cc of normal saline. Some catheters have a locking mechanism for suction control. Place it into the lock position when finished to prevent it from accidentally activating.

What is a Yankauer Suction Catheter?

A yankauer suction catheter is rigid, shatter resistant, and transparent to be used in the mouth. It is available with an optional vent to improve suction control. The catheter is made of one piece construction, sterile, and intended for single use.

To use, insert the yankauer tip gently into the mouth until it reaches the pouch of the cheek. Close the suction vent, if it has one, and gently sweep over the arch of the tongue to the opposite cheek. Apply suction through the yankauer for a short period of time, no longer than 10 seconds. Longer than this could result in grabbing the tissue and causing damage to the lining of the mouth. If necessary, repeat the process again. Once the process is done, suction clean, cold water through the system to clear it out. After flushing the tip and tubing, empty the collection bottle by disposing of its contents down a toilet, or however is required by the facility.

What is a Latex Rubber Catheter?

A latex rubber catheter is an x-ray opaque catheter which enables it to show up on x-rays to see its location when it is being used to clean the bronchi. It has a whistle tip, thumb valve, and one or two eyes. This type of catheter is sterile, and designed for single use.

A latex free suction catheter comes in a variety of styles and is used for those who are sensitive to latex.

Why is Suctioning Required?

As breathing transpires, the upper airway warms, cleans, and moistens the air. An endotracheal, or trach, tube bypasses these functions causing the air that moves through the tube to be cooler, dryer, and not as clean. The body responds to these changes by producing more mucus, but this can get in the way of proper breathing. Suctioning clears the mucus from the tracheostomy tube to ensure the airway is clear for breathing. If the secretions are left in the tracheal tube, they could become contaminated and a chest infection could develop. Conversely, suctioning too often could lead to more secretion buildup. Therefore, it is important to keep a good balance.

Determining when to suction is generally based on the need for easier breathing. It can be performed anytime throughout the day, such as in the morning, when breathing becomes hard, before meals, before going outdoors, before bedtime, or any time mucus is heard rattling in the tube or airway.

The secretions should be clear or white. If they begin to change color, such as to brown, yellow, or green, this may be an indication of infection. If the color change lasts for more than three days, or if it is hard to keep the trach tube clear, call the doctor. If blood appears in the secretions, making it look pink rather than red, initially increase the humidity and suction more gently. A cap, called an artificial nose (HME) that can be attached to the tracheal tube may help to maintain humidity. This cap contains a filter to keep particles from getting into the airway and helps maintain the patient’s own humidity. If immediate help is needed, place the affected individual in a bathroom with the door closed and shower on to increase the humidity. If bright red blood mucus is coughed up or suctioned, or if a fever develops, seek immediate medical attention.

Hulet Smith, OT
Rehabmart Co-Founder & CEO

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