This device has never appeared in the CICM Fellowship exam as a written paper question (at least not since the year 2000). However, it is ubiquitous enought to merit some attention. Certainly, the NSW Health policy authors think so; they have dedicated a 43 page document to the art and science of tracheal suctioning.
Complications of tracheal suctioning
- Tracheal ulceration
- Haemoptysis
- Hypoxia due to loss of PEEP
- Sympathetic overactivity
- Hypertension and increased intracranial pressure.
- Vasovagal reflex
- Laryngospasm (if suctioning from the nasopharyngeal airway)
Contraindications of tracheal suctioning
- unexplained haemoptysis
- severe coagulopathies
- severe bronchospasm
- laryngeal stridor (if suctioning via the nasopharynx)
- base-of-skull fracture (if suctioning via the nasopharynx)
- haemodynamic instability (cough may cause worsening of venous return)
Specific recommendations made by the NSW Health policymakers:
- Only suction when clinically indicated
- Try to suction at least every 4 hours
- Suction should only be applied for a maximum duration of 15 seconds
- Suction should only be applied as the catheter is being withdrawn
- The catheter itself should only occupy half of the internal diameter of the ETT, at maximum
- Post-suctioning hypoxia should be minimised by preemptively irrigating the respiratory tract with several breaths of 100% FiO2
- The old practice of "washing" the trachea with boluses of normal saline is actually harmful, and should not continue
- Closed suction systems are preferred, and should be changed every 48 hours (i.e. systems which do not allow the escape of endotracheal gas or secretions during suctioning)