Suctioning - Endotracheal suctioning in the neonate
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- Increase in oxygen requirement
- Increase in CO2
- Apnoea and/or bradycardia
- Decreased air entry / increased work of breathing
- Audible crepitations
- Visible secretions
- Irritable agitated baby
- Radiological changes: consolidation, collapse
- Decreased minute volumes
Complications of Endotracheal (ET) suctioning
- Increased cerebral blood flow and intracranial pressure
- Mucosal trauma and injury
- Destruction of mucociliary transport
- Decrease in lung compliance
Frequency of suctioning
- Suctioning is not a routine practice, the need to suction should be assessed on an individual basis.
- Ventilated babies with Respiratory Distress Syndrome have minimal secretions. In the first 72hrs, the need for suctioning should be minimal
- Wait at least 8 hrs after surfactant administration
- Functioning wall suction tubing connected (check at shift commencement). Check suction pressure prior to suction by occluding the suction tubing. Use a maximum pressure of 100 mmHg (~13kPa)
- Check that Neopuff is set to baby's ventilator settings with a PIP equalling prescribed PIP (check at shift commencement)
- Non-Sterile Gloves
- Suction catheter (the smaller the better):
ETT Size (mm) Suction Catheter Size 2.5 5-6 Fr 3.0 - 3.5 6-7 Fr 4.0 - 4.5 8 Fr
This is a two person procedure at all
This first person performs suction, the second assists and supports the baby during the procedure
- Auscultate lung fields.
- Measure length required (just beyond tip of ET tube)
- Check that the PIP (Babylog 8000)/ Pmax (VN500) is set at no more than 4 cmH2O above the given working inspiratory pressure (PIP)
- Babylog 8000: consider to turn off VG prior to commencing
VN500: Do NOT change ventilator settings and do NOT turn off VG
- Silence ventilator alarms, remove flow sensor and reconnect circuit to ETT.
- Insert catheter through one way valve to pre-measured length
and provide suction on removal. To avoid hypoxia, suctioning should
not exceed 6 seconds.
Reinsert the flow sensor as soon as possible after each pass with suction catheter and remove again if a further pass is required during the same session of suctioning, especially if in VG mode or on the VN500.
This method of suctioning provides a hybrid between open and closed suction.
- 7 If the baby desaturates or it is anticipated that the baby
will be unstable, escalate respiratory support as follows:
Increase the PEEP by 1-2 cmH2O, up to a maximum PEEP of 8 cmH2O
Give a manual inflation, which will give an inflation at your set PIP (Babylog 8000) / Pmax (VN500). Be careful to not hold manual inflation, as the ventilator will support the inflation for up to 5 sec!
Turn back the PEEP and FiO2 to prescribed settings as soon as the baby has recovered from the suction
- Gently suction oropharynx using a separate larger catheter.
- Record colour, type, amount of secretions, baby's tolerance of the procedure and ventilator setting required during suctioning on observation chart.
Note: Saline (NaCl 0.9%) instillation is only used if secretions are deemed to be thick and tenacious on individual assessment.
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- Date last published: 25 November 2015
- Document type: Clinical Guideline
- Services responsible: Neonatology
- Owner: Newborn Services Clinical Practice Committee
- Editor: Sarah Bellhouse
- Review frequency: 2 years
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