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Suctioning - Endotracheal suctioning in the neonate

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Indications

  • 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

  • Hypoxia
  • Bradycardias/arrhythmias
  • Increased cerebral blood flow and intracranial pressure
  • Mucosal trauma and injury
  • Destruction of mucociliary transport
  • Pneumothorax/perforation
  • Infection
  • Atelectasis
  • 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

Equipment

  • 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

Nursing management

This is a two person procedure at all times
This first person performs suction, the second assists and supports the baby during the procedure

  1. Auscultate lung fields.
  2. Measure length required (just beyond tip of ET tube)
  3. Check that the PIP (Babylog 8000)/ Pmax (VN500) is set at no more than 4 cmH2O above the given working inspiratory pressure (PIP)
  4. Babylog 8000: consider to turn off VG prior to commencing suction.
    VN500: Do NOT change ventilator settings and do NOT turn off VG
  5. Silence ventilator alarms, remove flow sensor and reconnect circuit to ETT.
  6. 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. 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
    Increase FiO2
    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
  8. Gently suction oropharynx using a separate larger catheter.
  9. 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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Document Control

  • 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