UNIVERSITY OF NORTH CAROLINA HOSPITALS

Nursing Procedure Manual

TITLE: Suctioning: Infant and Small Children – Endotracheal, Tracheostomy,

Nasotracheal

PURPOSE: To outline the procedure for suctioning.

LEVEL: RN, LPN, and Respiratory Therapy.

SUPPORTIVE
DATA: Tracheal suctioning should be performed only when assessment reveals a
need. Evaluation should include breath sounds, secretion color, skin
color, vital signs, and security of ET tube to ascertain airway patency in
the intubated or tracheotomized patient.

EQUIPMENT: Item: Location:

• Sterile gloves and suction catheter package
• Normal saline for tracheal instillation
• Clean gloves
• Suction gauge and trap bottle attached Patient Equipment
to suction
• Manual ventilation bag attached to oxygen Patient Equipment/
source with appropriate size face mask Respiratory Therapy
• Neopuff NCCC

CONTENT:

STEPS: KEY POINTS:

1. Wash your hands.

2. Adjust oxygen setting for manual
ventilation bag to 100%.
2. Infants and patients receiving mechanical
ventilation with FiO2 less than .50, should
have oxygen source to manual ventilation
bag adjusted to the same FiO2 deliverance
via mechanical ventilation.

3. Turn wall suction to 60-80 mm Hg for an

infant or 90-100 mm Hg for a child.

4. Choose appropriate sized catheter using the

following formula: (2x ET tube) + 2.

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UNC HOSPITALS, Nursing Procedure Manual
STEPS:
5. Maintain sterile technique, and open
suction catheter kit. Place sterile gloves on
hands.
6. Hold the catheter by the sterile wrapping
with the dominant hand. Attach the
catheter to the tubing from the wall suction
trap bottle. Leave the outer wrapping on
the catheter until ready for use.
7. Remove the ventilator tubing from the ET
tube with the non-dominant hand.
8. Attach the manual ventilation bag to the
endotracheal tube and hyperventilate the
patient to adequate O2 saturation per MD
order.
9. Instill normal saline 0.5-2.0 ml into the ET
tube only if the patient has thick secretions.
10. Determine depth to pass catheter.
11. Insert the appropriate sized catheter gently
with gloved hand.
12. Do not suction while inserting catheter.
STEPS:
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Suctioning: Infant and Small Children - 2
Endotracheal, Tracheostomy, Nasotracheal
KEY POINTS:
5. Two gloves are used to meet universal
precautions.
7. Since pediatric endotracheal tubes are
uncuffed and easily dislodge, it is
recommended that this be performed by
two people.
8. Neopuff® is used in NCCC.
9. Saline helps loosen thick secretions, and
makes suctioning easier. Saline may
decrease surfactant levels and increase
incidence of bronchospasm.
10. Match the calibration on the suction
catheter to the calibration on the ET tube
size. Insert 0.5 cm beyond this distance.
11. Appropriate catheter size allows for some
gas exchange around the catheter and ET
tube thereby decreasing severe
hypoxemia for the patient.
12. If copious secretions are noted in ET
tube, it is advisable to suction
intermittently upon insertion of the
suction catheter. This prevents pushing
the copious secretions out the end of the
ET tube and into the airway.
KEY POINTS:
UNC HOSPITALS, Nursing Procedure Manual Suctioning: Infant and Small Children - 3
Endotracheal, Tracheostomy, Nasotracheal

13. Apply suction by intermittently covering 13. Never suction for longer than 5 seconds.
the catheter port with the dominant hand
while withdrawing the catheter using a
gentle rotating motion.
14. Hyperventilate the patient between every
pass of the suction catheter.
Hyperventilate until O2 saturation (as
determined by pulse oximeter) returns to
pre-suction level for 30 seconds after last
passage of the catheter.

15. Re-attach the ventilator tubing to the

endotracheal tube.

16. Discard catheter and gloves.

17. Flush the wall suction trap bottle tubing

with water.

18. Re-evaluate breath sounds, skin color,

activity level, vital signs, and ET tube
placement.

19. Wash hands.

Suctioning Tracheostomy Tubes:

1. Follow the same procedure as endotracheal 1. Very stable patients not requiring oxygen
suctioning taking care to introduce the therapy who can deep breath on
catheter just beyond the distance of the command, may not require
tracheostomy tube, about 0.5 cm., to reduce hyperventilation.
the incidence of the tracheobronchitis.

2. Apply suction only on withdrawal.

Nasotracheal Suctioning:

1. Suction patients nasotracheally using 1. Laryngospasm is associated with

appropriate catheter size if patient status
warrants, i.e. if patient is in respiratory
distress with audible upper airway
congestion. Perform according to the adult
procedure.
nasotracheal suctioning in infants.
It is rarely performed in the first 72 hours
after extubation.

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UNC HOSPITALS, Nursing Procedure Manual Suctioning: Infant and Small Children - 4
Endotracheal, Tracheostomy, Nasotracheal

DOCUMENTATION: Record completion of suction procedure, color and character of

secretions, breath sounds afterwards, and patient response.

APPROVAL: February, 1996 By: Nursing Procedure Committee

REVISED: June, 1998

November, 2001

REVISED: November, 2001 suctioning.infant.small.children.endotracheal.trachestomy.nasotracheal.11.01