MANUAL SUCTION USED IN HOSPITAL SERVICES

1. SUCTIONING OF THE PATIENT
DR.ANJALATCHI
M.SC(N)MD(AM)MBA(HA)

2. Introduction
• Suctioning is a procedure that removes excess
secretions from the mouth and throat
(oropharynx), from the nose and throat
(nasopharnyx), and from the windpipe
(trachea) using a mechanical aspiration device
(Suction machine).

3. Indications for Suctioning:
• The primary indication for suctioning the patient
at home is the patient’s inability to adequately
clear the airway by coughing.
• The need for clearing the airway is evidenced by:
• More frequent or congested-sounding cough
• Visible secretions
• Audible gurgling noise while breathing
• Suspected aspirations of gastric or upper airway
secretions

4. Types of suctioning
• Correct suctioning depths
• Use the pre-measured
suction catheters (where
available) to make sure you
are suctioning at the correct
depth.The following pages
teach you how to do:
• nasal suctioning (suctioning
in the nose)
• oral suctioning
• nasopharyngeal and
oropharyngeal suctioning

5. What is the hospital wall/central
suction supply pressure?
• Suction levels for adults are 100-150 mmHg on wall suction and 10-15 mmHg on
portable suction units. Always refer to hospital policy for suction levels.
• For adult normal pressure not exceed 80-120 mm of hg
• For pediatric normal pressure not exceed 80-100 mm of hg

6. Type of medical gas used in hospital

7. Key points To be monitor daily
• Before you begin suctioning, you should be comfortable setting up
the suction machine, know the equipment you need and which
size catheter to use.
• Check your suctioning equipment every day to make sure it is
working properly and everything is clean.
• Different suctioning catheters may be used for different types of
suctioning, so it is important to know which one you need.

8. What is the normal suctioning
pressure?
• Suction pressure should be kept at less than 200 mmHg in
adults.
• It should be set at 80 mmHg to 120 mmHg in neonates.
• The catheter size used for suction should be less than 50%
of the internal diameter of the endotracheal tube.
• A common conversion is that a 1 mm diameter is equal to
a 3 French.0

9. What should the suction machine
pressure be set at?
• 15 mm/Hg
• The portable suction pressure should not be
set higher than 15 mm/Hg. Check pressure by
turning the machine on and covering the open
end of the suction line with one hand. Look at
the pressure dial. It should rise but not go any
higher than the 15 marker on the dial.

10. How long should suctioning last?
• The normal duration of suction is 5-10 seconds.
• The maximum sucti8on time should only be 15
seconds. After suctioning, re-oxygenate the patient.

11. Type of suction machine

13. Setting up the suction machine
• Connect the suction tubing to the canister.
• Check the suction pressure by turning on the unit and
covering the end of the tubing with your finger. Look at
the number on the gauge, and make sure it is the
number set by your health-care provider. This should
be checked each time before you suction.
– Pressure setting for neonates (newborn): 60-80 mmHg
– Pressure setting for infants: 80-100 mmHg
– Pressure setting for children/teens: 100-120 mmHg
• Attach the correct suction catheter, Yankauer or tip to
the tubing.
• Proceed with suctioning.

15. What to look for when checking
equipment
• Check your equipment every day to make sure that
the:
– suction pressure is set
– filter is clean
– tubing is clean
– canister is clean
– machine is plugged in or battery is charged
• Ensure you have the correct size suction catheters.
• Your child’s health-care professional will help you
determine the best size catheter for your child. Please
make note of the catheter size and the required
pressure setting on the suction machine.

16. Operating the Suction Machine:
• 1. Plug the suction machine into a grounded outlet.
• 2. Check that the tubing from the machine to the collection jar is on and snug.
• 3. Check that the lid to the collection jar is closed tightly.
• 4. Attach the extension tubing to the collection jar.
• 5. Turn the machine on and kink the extension tubing to block the flow of air.
• a. If the pressure gauge did not move when kinking the tubing,
• recheck all of your connections. Look for leaks in the system.
• The lid may not be closed tightly;
• a tub may not be on properly or the tube in punctured.
• 6. Look at the pressure gauge. Using the control dial, set the gauge pressure
between 15” and 20” of Hg. (for an adult)
• a. An infant or a child will use less pressure. Consult with your doctor or call our
therapist.
• 7. After the pressure is set, connect the oral suction device (Yankauer Suction Tip)
or suction catheter to the suction extension tubing.

17. Equipment and Supplies Needed:
1. Electric or battery powered aspirator with pressure gauge and collection
jar with overflow protection
2. Suction catheters (sized appropriately)
3. Tap water that has been boiled and stored in a closed, clean container.
Water needs to be used within 24 hours of boiling to flush the catheter.
o Water from the tap that is not boiled will increase the risk of
contamination and infection.
4. Clean or sterile disposable gloves
5. A manual resuscitator bag (for hyperinflation of the lungs if medically
indicated)
6. An oxygen source (when pre-oxygenation is medically indicated)
7. Sterile normal saline (for instillation when medically indicated)
8. Oral suction device (Yankauer Tonsil Tip)
9. Sterile distilled water, and/or recently boiled water and cleaning solution
(alcohol or hydrogen peroxide)

18. What other equipment do I need for
suctioning?
Additional equipment and supplies
Sterile or distilled water
Clean container for flushing solution
Clean disposable gloves (to avoid
direct contact with secretions from
your child; sterile gloves are not
needed)
Water-based lubricant for
nasopharyngeal suctioning
Hand sanitizer
Good light source
Towel or small blanket for positioning
if needed
Oximeter and probes (if applicable)
Oxygen, if needed
Plastic bag for soiled supplies

19. Types of suctioning catheters
• Different catheters may be used
for nasal, oral, nasopharyngeal
and oropharyngeal suctioning:
• Tip catheters are used for nasal
and oral suctioning.
• Little Suckers are used for nasal
and oral suctioning.
• Yankauer catheter is used for
oral suctioning.
• A longer suction catheter can be
used for nasal, nasopharyngeal
and oropharyngeal suctioning,
as seen in the image below.

20. Preparing the Patient for Suctioning:
• Whenever possible, the patient should be
encouraged to clear the airway by directed cough
or other airway clearance techniques.
• The patient’s response to suctioning during their
stay in the acute care or long-term care facility
should be made a part of the discharge summary
and
• The health care professional establishing the
patient in the home should request this
information.

21. How to perform nasopharyngeal and
oropharyngeal suctioning
• Key points
• Nasopharyngeal and oropharyngeal suctioning is performed to
remove mucus or saliva from the back of the throat when a child
cannot cough or swallow.
• Make sure you know how to use the suction machine and
equipment before you begin suctioning on your child.
• Talk to your child's health-care provider if you are unsure about any
of the following steps.
• Nasopharyngeal (through the nose) and oropharyngeal (through
the mouth) suctioning are done to clear secretions (mucus) from
the throat if a child is unable to cough them up or swallow them. A
hard-plastic tip with a handle called a Yankauer is usually used to
suction secretions in the mouth.

22. Step of procedure
• Gather your equipment and supplies.
• If your child uses an oximeter, make sure it is
on and providing an accurate reading.
Have oxygen available, if prescribed by your
child’s health-care team.
• Make sure the suction machine is at the
correct setting.

23. Suction tubes in different size

24. • Wash your hands well.
• Fill a clean container with sterile water or saline.
• Make sure your child is in a comfortable position (lying or sitting).
• Attach the suction tubing to the correct size suction catheter. Keep the catheter in the packaging
until just before use. Do not touch the end of the catheter that will go into your child’s nose or
mouth. This illustration shows how to correctly measure the length you will need.
• Suction a small amount of water based lubricant or sterile water/saline through the suction
catheter to lubricate (wet) it and make it easier to insert.
• For nasopharyngeal, insert the suction catheter into your child’s nostril and to the back of the
throat (nasopharynx) to the length instructed by your health-care team. Be careful not to force the
catheter and rotate position as needed to guide the catheter gently. If you meet resistance, try the
other nostril. Keep your thumb off the suction control port.
• For oropharyngeal, insert the suction catheter into your child’s mouth and to the back of the throat
(nasopharynx) to the length instructed by your health-care team (see above illustration for
reference). Keep your thumb off the suction control port.
• Apply suction by holding your thumb over the suction control port. Slowly remove the catheter
while "twirling" it between your fingers to remove mucus. Limit suctioning to 5 to 10 seconds.
• Once the catheter is out, clean it by dipping it in the sterile water or saline and suctioning. Repeat
suctioning as needed, allowing at least 20 seconds between suctioning. Alternate nostrils each time
you repeat the suctioning. Once you are finished, discard the catheter and replace the tip
connector onto the suction tubing.
• After suctioning, assess your child’s respiratory status and oxygen needs.
• Turn off the suction unit. Empty and clean the suction drainage bottles and containers, if needed.
• Wash hands well. Prepare the suction equipment and supplies for the next use.

25. Oral Suctioning procedre
• Always review and follow your hospital policy regarding this specific skill.
Safety considerations:
• Avoid oral suctioning on patients with recent head and neck surgeries.
• Use clean technique for oral suctioning.
• Know which patients are at risk for aspiration and are unable to clear secretions because of an
impaired cough reflex. Keep supplies readily available at the bedside and ensure suction is
functioning in the event oral suctioning is required immediately.
• Know appropriate suctioning limits and the risks of applying excessive pressure or inadequate
pressure.
• Avoid mouth sutures, sensitive tissues, and any tubes located in the mouth or nares.
• Avoid stimulating the gag reflex.
• Always perform a pre- and post-respiratory assessment to monitor patient for improvement.
• Consider other possible causes of respiratory distress, such as pneumothorax, pulmonary edema,
or equipment malfunction.
• If an abnormal side effect occurs (e.g., increased difficulty in breathing, hypoxia, discomfort,
worsening vital signs, or bloody sputum), notify appropriate health care provider.

26. • STEPS
• 1. Assess patient need for suctioning (respiratory assessment for signs of
hypoxia), risk for aspiration, and inability to protect own airway or clear
secretions adequately, which may lead to upper airway obstruction.
• 2. Explain to patient how the procedure will help clear out secretions and
will only last a few seconds. If appropriate, encourage patient to cough.
• 3. Position patient in semi-Fowler’s position with head turned to the
side.This facilitates ease of suctioning. Unconscious patients should be in
the lateral position.
• 4. Perform hand hygiene, gather supplies, and apply non-sterile gloves.
Apply mask if a body fluid splash is likely to occur.
• 5. Fill basin with water.Water is used to clear connection tubing in
between suctions. Fill basin with enough water to clear the connection
tubing at least three times.
• Fill sterile container with sterile water
• 6. Attach one end of connection tubing to the suction machine and the
other end to the yankauer.This prepares equipment to function effectively.
• Suction container

27. • 7. Turn on suction to the required level. Test function by covering hole on the yankaeur with your thumb and
suctioning up a small amount of water.Suction levels for adults are 100-150 mmHg on wall suction and 10-15
mmHg on portable suction units. Always refer to hospital policy for suction levels.8. Remove patient’s oxygen
mask if present. Nasal prongs may be left in place. Place towel on patient’s chest.Always be prepared to replace
the oxygen if patient becomes short of breath or has decreased O2 saturation levels.
• The towel prevents patient from coming in contact with secretions.
• 9. Insert yankauer catheter and apply suction by covering the thumb hole. Run catheter along gum line to the
pharynx in a circular motion, keeping yankauer moving.
• Encourage patient to cough.
• Movement prevents the catheter from suctioning to the oral mucosa and causing trauma to the tissues.
• Insert yankauer and apply suction by covering the thumb holeCoughing helps move secretions from the lower
airways to the upper airways.
• Apply suction for a maximum of 10 to 15 seconds. Allow patient to rest in between suction for 30 seconds to 1
minute.
• 10. If required, replace oxygen on patient and clear out suction catheter by placing yankauer in the basin of
water.Replace oxygen to prevent or minimize hypoxia.
• Clear suction tubing with waterClearing out the catheter prevents the connection tubing from plugging.
• 11. Reassess and repeat oral suctioning if required.Compare pre- and post-suction assessments to determine if
intervention was effective.
• 12. Reassess respiratory status and O2 saturation for improvements. Call for help if any abnormal signs and
symptoms appear.This identifies positive response to suctioning procedure and provides objective measure of
effectiveness.
• 13. Ensure patient is in a comfortable position and call bell is within reach. Provide oral hygiene if required.This
promotes patient comfort.
• 14. Clean up supplies, remove gloves, and wash hands. Document procedure according to hospital policy.Cleanup
prevents the transmission of microorganisms. Documentation provides accurate details of response to suctioning
and clear communication among the health care team.

28. Observe the patient after the
suctioning procedure
 Are the visible secretions gone?
 Has the gurgling wet breath sounds stopped or at least greatly
diminished?
 Does the patient appear more comfortable and less distressed?
 Observe the skin color.
 (Including the presence or absences of cyanosis).
 Get into the habit of monitoring their pulse rate before and after you
suction.
 Take their blood pressure and Oximetry if you have the equipment.
 Look at the color of the sputum.
 Are there any changes in the color?
 Keep your doctor’s office informed of the color changes.
 Is there an odor to the sputum?
 Again, keep the doctor’s office informed.

29. Recording and reporting
• Keep material and supplies for the next use.
• Suction catheter size:
Depth of suction catheter insertion for
nasopharyngeal or oropharyngeal
suctioning:
• Suction machine pressure setting (mmHg):
• Date /time/sign of health workers done the
procedure
• Finding of suction procedure

30. If the patient need home suctioning
means must give training :
• Caregiver Training: The caregivers or family
members that will be taking care of the patient
should be taught the proper suction techniques
by qualified hospital personnel. The caregivers or
family members should be trained to understand:
• When it is necessary to suction • What type of
suctioning is needed (oral vs. nasal tracheal) They
should be trained as to when it’s necessary to
pre-oxygenate, preform normal saline
instillations, use of the resuscitator bag to hyper
inflate the lungs and then to deep suction.

31. Cleaning:
• The suction canister should be emptied daily and washed, along
with the connecting tubing, in hot water and mild dishwashing
detergent.
• Rinse with clean, hot tap water. It is recommended that these items
be disinfected daily with a solution of one part white vinegar and 3
parts water.
• Allow the items to soak for 30 minutes and then rinse with clean,
hot tap water.
• All caregivers should practice reasonable infection control
procedure in the home setting.
• Patients should be protected form visitors and caregivers with
active viral and bacterial infections.
• Or the opposite is true if the patient has yet to be diagnosed with
the organism they are carrying which could be spread to others by
droplet infection.

32. Cleaning procedure
• Take 1:20 (1 ml of soap and 20ml of water , 5ml in
100ml of water )ratio for detergent soap mix with
water (I.e, one litre of water and 50 ml of
detergent soap to be mix and stir it well ).
• Take two mitten cloth one for dry and one for
soap solution soaked cleaning purpose.
• Clean from inner to outer part of equipments and
disinfect it , keep it dry area with cover
• Ready to use next time .

33. Storage
• How do you store a suction unit?
• Remember that these devices should be plugged
in and charging when not in use, so it is
important to keep them in a location with access
to an outlet. Battery-powered suction machines,
such as those designed for use in a disaster,
should have a supply of alkaline batteries stored
with the unit.
• Put the cover the suction machine transparent to
visible outside.

34. Disinfection and sterilization
• How do you care for a suction machine?
• Cleaning: The suction canister should be emptied daily and
washed, along with the connecting tubing, in hot water and mild
dishwashing detergent. Rinse with clean, hot tap water. It is
recommended that these items be disinfected daily with a solution
of one part white vinegar and 3 parts water.
• How do you sterilize a suction machine?
• Use a mild detergent or a mixture of bleach and water (1 part
bleach/10 parts water) and rinse thoroughly. Follow the instruction
manual when disinfecting the mechanics of the unit. Never
submerge the suction unit. Use disinfectant wipes to clean all outer
surfaces, including control knobs, screens and handles

35. Suction bottles
• How do you clean suction bottles?
• How do I clean the canister?
• Gather your equipment and supplies:
• Remove the short tubing from the lid. ...
• Wash all parts in the container of warm, soapy
water.
• Rinse all parts with tap water.
• Place all parts in the container of vinegar and
water and soak for 30 minutes.
• Rinse all parts with tap water again.

36. Maintenance and repair