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Suctioning - Inline circuit

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Inline suction is used for all babies on HFOV. It can be considered for muscle relaxed babies or babies with copious secretions on conventional ventilation.

Frequency of suctioning

The frequency of suctioning should be individualised on the baby's respiratory status and clinical condition.

Complications of suctioning

Same as with endotracheal suctioning

Equipment required

Closed suction circuit, French size 6, size 7, or size 8 are attached to the end of the ET tube (removing the end piece and attaching the appropriate size adapter, which comes in the package).

Inline circuit

Nursing management

This is a two person procedure at all times

Conventional suctioning

  1. Auscultate lung fields.
  2. Using the chart below - select the correct Inline suction unit size and note the correct depth to insert the catheter to.
  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.
  6. Insert the catheter into the Y connection just enough to pass the ventilator connection.
  7. Instill saline (NaCl 0.9% 0.2 ml) ONLY if deemed necessary.
    Follow instillation with 0.3ml of air to flush NaCl down the ET tube.
  8. Introduce the catheter to required depth, ie the appropriate colour is seen in the window at the lavage port.
    Apply suction by depressing suction control valve and withdraw catheter to fully extended length.
    Repeat as necessary.
  9. If the baby desaturates or it is anticipated that the baby will be unstable, escalate respiratory support as follows:
    Turn the PEEP up 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
  10. On completion, to clear secretions from the catheter, depress suction before slowly instilling 2ml of NaCl.
    Follow with 2ml of air to completely clear system of NaCl. Remove syringe and close lavage port.
  11. Change Inline Suction system weekly and place sticker determining next change.
  12. Gently suction oropharynx using a separate larger catheter.
  13. 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.
NaCl 0.9% followed by 0.3ml of air to flush the NaCl down the ET tube is used with inline suctioning.

HFOV

  1. Check back of Level III chart for special orders, eg increases in MAP or O2.
  2. Using the chart below - select the correct Inline suction unit size and note the correct depth to insert the catheter to.
  3. Insert the catheter into the Y connection just enough to pass the oscillator connection.
  4. Instil saline (NaCl 0.9% 0.2 ml) if deemed necessary.
    Follow instillation with 0.3ml of air to flush NaCl down the ET tube.
  5. Temporarily turn oscillator off by pressing the "Stop/Start" button.
    Introduce the catheter to required depth, ie the appropriate colour is seen in the window at the lavage port.
    Apply suction by depressing suction control valve and withdraw catheter to fully extended length.
    Turn oscillator on by pressing the "Stop/Start" button.
    Repeat as necessary.
  6. On completion, to clear secretions from the catheter, depress suction before slowly instilling 2ml of NaCl.
    Follow with 2ml of air to completely clear system of NaCl. Remove syringe and close lavage port.
  7. Change Inline Suction system weekly and place sticker determining next change.

Note: Saline (NaCl 0.9%) instillation is only used if secretions are deemed to be thick and tenacious on individual assessment.
NaCl 0.9% followed by 0.3ml of air to flush the NaCl down the ET tube is used with inline suctioning.

Size and depth selection for inline suctioning

Et Tube Size Suction Catheter Size Distance/Colour to view
2.5 6 Fr (Green packet) 19cm  (between purple and red stripes)
3.0 7 Fr (Cream Packet)  21.5cm  (between blue stripes and yellow stripes)
3.5 8 Fr (Blue Packet) 23cm  (between black stripes and green stripes)
4.0 8 Fr 24.7cm

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Document Control

  • Date last published: 29 November 2018
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years