Suctioning on the NCLEX
Wall pressures, pass duration, hyperoxygenation, and sterile vs clean technique.
Suctioning removes secretions and oxygen at the same time. Every rule exists to limit the second part.
The numbers
Wall suction 80 to 120 mmHg for adults; do not exceed 120 for routine tracheal suctioning. Lower ranges for children and infants per policy. Suction applied no more than 10 seconds per pass. Limit to 2 to 3 passes, with 30 to 60 seconds of recovery and reoxygenation between. Catheter size: no more than half the internal diameter of the artificial airway.
Technique
Hyperoxygenate with 100% oxygen for 30 to 60 seconds before and after each pass (ventilator button, or deep breaths with the existing device). Insert the catheter gently without suction; forcing it or suctioning on the way in strips mucosa. Apply suction only while withdrawing, rotating the catheter. Stop immediately for bradycardia or dysrhythmia: vagal stimulation is real and shows up on the monitor before the patient tells you.
Sterile vs clean
Sterile: endotracheal and tracheostomy suctioning, and nasotracheal suctioning, because you are entering a sterile airway. Sterile catheter, sterile glove on the dominant hand. Clean: oropharyngeal suctioning with a Yankauer and home tracheostomy care per provider guidance. The mouth is not sterile. In-line (closed) suction systems on ventilated patients keep the circuit closed and do not require gloving a fresh sterile catheter each pass.
When to suction
On assessment, not on a schedule: coarse crackles or rhonchi, visible or audible secretions, sustained coughing, rising peak airway pressures on a ventilator, falling SpO2, or restlessness in a patient who cannot clear the airway. Routine scheduled suctioning traumatizes the airway and provokes hypoxia for nothing.
Frequently asked
Patient drops to 40 beats per minute mid-pass?
Vagal response. Withdraw the catheter, stop suctioning, give oxygen, and monitor. Reassess before any further pass.
Suction on insertion or withdrawal?
Withdrawal only, while rotating. Suction on insertion damages mucosa and steals oxygen.
Is oral Yankauer suction sterile?
No, clean technique. Sterile technique is for tracheal routes.
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